A recent case report published in Polish Gynecology described an infant with hemolytic disease of the fetus and newborn (HDFN) whose anemia had several potential causes.
The report presents a 32-year-old patient who presented at 25 weeks of gestation with signs of severe fetal anemia and hydrops fetalis. A doppler ultrasound further supported the diagnosis of anemia, and an umbilical cord blood test confirmed severe anemia.
What is hydrops fetalis?
Hydrops fetalis is a symptom of an underlying medical condition that affects an unborn baby and can occur with HDFN. In this condition, large amounts of fluid accumulate in the baby’s tissues or organs. If it remains untreated, this abundance of fluid can place stress on the fetal heart and other vital organs.
The doctors administered five intrauterine transfusions (IUTs) over the course of the pregnancy. At 34 weeks of gestation, the fetus began showing signs of asphyxia, indicating a lack of oxygen. They performed a cesarean section and admitted the baby to the neonatal intensive care unit for further treatment and monitoring.
Read more about HDFN causes and risk factors
During his time in the hospital, the neonate received several blood transfusions, which significantly improved his overall condition. However, because each transfusion only induced a short-term response, the authors suspected numerous factors might have been at play.
The patient was found to have HDFN with both RhD and RhC immunization, as well as anti-human leukocyte antigen antibodies. He also tested positive for immune thrombocytopenic purpura (ITP), an autoimmune disease in which the body destroys its own platelets. Additionally, he was diagnosed with immunological neutropenia, a condition where the immune system attacks the body’s white blood cells.
The family underwent further testing due to the possibility of fetal and neonatal immune thrombocytopenia (FNAIT), which was ruled out.
Along with the blood transfusions, the infant received intravenous immunoglobulin (IVIG) and transfusions of albumin, a key protein found in the blood. He also received medication to improve his white blood cell count, antibiotics and steroids.
“Ongoing education of medical practitioners and pregnant patients are recommended to raise awareness of prenatal diagnostic and treatment methods of fetal anemia,” the authors concluded.
Sign up here to get the latest news, perspectives, and information about HDFN sent directly to your inbox. Registration is free and only takes a minute.
