Cases of which hemolytic disease on the fetus and newborn (HDFN) present with late anemia in newborns should be treated in a consistent, evidence-based manner, according to a study recently published in Best Practice & Research Clinical Obstetrics & Gynaecology.
Fetal anemia is a common symptom of HDFN due to maternal antibodies that attack and destroy fetal red blood cells. However, in some cases, anemia is only detected after birth. These diagnoses of anemia are therefore considered “late”.
In cases of “late” anemia in HDFN, it may be valuable to distinguish between newborns who have anemia due to hemolysis (the destruction of red blood cells) as compared to hypoproduction (the reduced production of red blood cells). Regardless of the primary driver of anemia, newborns who have been diagnosed with HDFN are very likely to have some degree of anemia, even if they received treatment before birth in the womb.
Studies suggest that the use of erythropoiesis-stimulating agents may prevent the emergence of “late” anemia in HDFN. Erythropoiesis is otherwise known as the production of red blood cells. These therapies can help reduce the risk of “late” anemia in newborns diagnosed with HDFN.
Read more about HDFN testing and diagnosis
In the interest of streamlining transfusion practices, the creation of transfusion stewardship committees should be considered to provide education and promote transfusion best practices. This is especially valuable for newborns in intensive care as it can reduce the rate of errors and complications.
The withholding of breast milk in newborns with HDFN is not recommended as the benefits of breast milk outweigh any potential disadvantages. To ensure that newborns affected by HDFN receive appropriate care, a complete blood count should be taken at birth, preferably from the umbilical cord. Furthermore, surveillance for “late” anemia should continue for up to six weeks after delivery.
“Controlled clinical trials will be needed to bring forth the best evidence,” the authors of the study wrote. “These trials should be accomplished with the goals of improving outcomes, reducing costs, preserving resources and diminishing the stress of the involved families.”
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