Abstract

THE ROLE OF MATERNAL FOETAL BLOOD GROUP INCOMPATIBILITY IN ERYTHROBLASTOSIS FETALIS: A COMPREHENSIVE REVIEW

Dr. Rajaputana Lakshmi Manisha* and G. Vyshnavi

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Abstract

Red blood cells (RBCs) of the infant or foetus are destroyed as a result of maternal immunoglobulin G (IgG) antibodies in a disorder known as haemolytic disease of the foetus and new-born (HDFN), also known as alloimmune HDFN or erythroblastosis fetalis. When the mother's immune system reacts to foetal antigens, a process called isoimmunization takes place, leading to the formation of these antibodies. To be more precise, foetal erythrocytes that express RBC antigens that are absent from mother's blood cross the placenta and enter the maternal circulation. This immune reaction may result in haemolysis, the production of bilirubin, and anaemia as a result of the loss of foetal red blood cells. The severity of HDFN in the foetus is influenced by a number of variables. First and foremost, the mother's antibody production—both the quantity and quality—plays a critical role. Red cell breakdown and the problems that follow are more likely to occur when antibodies are present at higher amounts. The severity of the condition is also influenced by the foetus' gestational age. Because of the foetal immune system's immaturity and its diminished capacity to replace RBCs that have been killed, HDFN may be more severe at earlier gestational ages. The foetus' capacity to excrete bilirubin, a consequence of haemolysis, also plays a role in the sickness' overall severity. Hyperbilirubinemia and other possible problems, such as kernicterus, can result from impaired bilirubin clearance. Testing foetal blood and determining the status of the mother's antibodies are required for the diagnosis of HDFN. Pregnant women who are sensitised and at risk for HDFN can be identified through maternal antibody screening. The state of the foetal RBC antigen and the level of haemolysis can be determined by foetal blood tests, such as cordocentesis or percutaneous umbilical blood sampling. In order to manage the illness and make educated decisions about the course of treatment and when to deliver the baby, it is essential to monitor maternal antibody levels and the health of the foetus through ultrasound exams. The prevention or reduction of the disease's consequences is the main goal of HDFN management and treatment. This entails vigilant foetal surveillance, thorough monitoring of maternal antibody levels, and potential bilirubin reduction measures. Intrauterine transfusions to refill the foetal RBC supply, immunoglobulin therapy to prevent the effects of antibodies, and phototherapy to control hyperbilirubinemia at the new-born stage are all possible treatments. In extreme circumstances, foetal interventions or an early birth may be required. Optimising outcomes for new-borns with HDFN require prompt and coordinated care from a multidisciplinary team of obstetricians, neonatologists, haematologists, and transfusion medicine experts.

Keywords: Haemolytic disease of the foetus and new-born (HDFN), Alloimmune HDFN, Isoimmunization, Haemolysis, Replenishment of destroyed RBCs.