Rhesus disease: postnatal management and outcome

Abstract

The incidence of rhesus haemolytic disease has been markedly reduced. Affected infants who have had intrauterine transfusions suffer a late hyporegenerative anaemia. Postnatal haemolysis and hence treatment for hyperbilirubinaemia is less commonly needed. Optimal phototherapy reduces the need for postnatal exchange transfusions, but data on the efficacy of inhibitors of bilirubin production such as haem oxygenase inhibitors or immunoglobulin are less secure. Even hydropic infants have less than 20% mortality and bilirubin encephalopathy is uncommon. There is, however, very limited information on the long-term outcome of infants with rhesus haemolytic disease. Multicentre collaboration is required to test strategies to improve the management of affected individuals further and to provide meaningful data on their prognosis.

Fetal Intrauterine Transfusion Therapy: Neonatal Outcomes

“…The cause of late anemia has previously been explained by the presence of ongoing hemolysis [19], suppression of erythropoiesis [9,20], late anemia of hemolytic disease [21], and possibly the presence of anti-D antibodies in the bone marrow that destroy erythroid precursors [9]. In accord with the results of a previous study [22], hypo generative late anemia in our cohort was significantly correlated with the need for more than 2 IUTs.…”

Severe iron overload and hyporegenerative anemia in a case with rhesus hemolytic disease: therapeutic approach to rare complications

“…Intrauterine transfusions (IUTs) have markedly decreased the risk of hydrops fetalis and stillbirth of infants with RHD, but it can be a rare cause of complications like hyporegenerative anemia and symp- tomatic iron overload [1]. Hyporegenerative anemia is characterized by depressed erythropoiesis with reduction in circulating reticulocyte count and low or undetectable numbers of erythrocytes containing fetal hemoglobin.…”

“…It is seen between 2 to 6 weeks after birth and the pathogenesis is still unclear. The possible explanations of anemia are intramedullary destruction of normoblasts with Rh antibodies and low erythropoietin levels due to suppression of the bone marrow by IUT [1,6,9]. These patients require erythrocyte transfusions in the postnatal period, and the use of rHuEPO may reduce the need for postnatal transfusions [10][11][12][13].…”

“…Intrauterine transfusions (IUTs) are performed as part of the management of neonates who have developed fetal anemia due to RHD. Along with technological improvements, IUT can be easily applied to babies with RHD and mortality and morbidity ratios may decrease distinctly [1,2]. Although there are many detailed reports in the literature about anemia and hyperbilirubinemia development in RHD, the data about complications such as iron overload secondary to IUT and hyporegenerative anemia are limited; the postnatal management of severely affected infants is still challenging.…”

“…The incidence of rhesus hemolytic disease (RHD) has significantly declined all over the world with the use of prophylactic anti-D immunoglobulin [1]. However, in developing countries like Turkey, RHD remains a major cause of severe mortality and morbidity since prophylactic anti-D immunoglobulin may not be administered appropriately or because RHD may develop despite anti-D.…”