Hemolytic disease of the newborn - Eritroblastoza newborn

The three forms of manifestation in the offspring eritroblastozei are placental anasarca, jaundice of the newborn seriously, hemolytic anemia, pure.
 1. Placental anasarca.
It is a morbid condition of the fetus (intrauterine so) as a consequence of severe anemia.Anemia triggers compensatory reactions: reticulocytosis, eritroblastoza, reactivation hematopoezei extramedullary liver, spleen and lungs, increasing blood flow velocity.In advanced stages, anemia leads to failure pluriviscerala (Cardica anoxic failure, liver failure with hypoalbuminemia and impaired clotting factors, vascular-capillary alterations, renal failure). It is a syndrome that oedematous-looking baby and placenta ascites (placental anasarca) and is accompanied by polyhydramnios.
Newborn with placental anasarca edema has deformed monster facial features and the care and trunk and limbs, the abdomen is large, flaccid due hepatosplenomegaliei huge (up to the previous iliacee spines) and ascites, on very pale tagumentele petechiae observed and bruising. If the infant is born alive shows signs of respiratory distress, heart and kidney failure (oligoanurile, nitrogen retention).
Laboratory examinations will highlight:a) immune conflict (because there are multiple causes of placental anasarca) Rh incompatibility between mother and child: the mother Rh negative, Rh positive child, positive direct Coombs test in children, antibodies in serum free dozabili mother and child;b) hemolytic anemia: Hb <8g/100, eritroblastoza peripheral;c) metabolic acidosis, hypoglycemia;d) lower blood coagulation factors and platelets (clotting imtravasculara disseminated).
 2. Severe jaundice of newborn
 Jaundice appears early in the first hours of life, sometimes immediately after cutting the umbilical cord. Jaundice is seen initially at the front and quickly descends to the thorax, the remaining trunk and limbs. Growth rate of bilirubin is> 0.5 mg/100 per hour.Jaundice is accompanied by polar cutaneomucoasa, hepato-splenomegaly, possibly swelling.
Natural evolution is to kernicterus (on day 3, 4th) as a result of the filing of bilirubin in the brain gray nuclei.
Clinical manifestations of kernicterus are:a) jaundice skin deep, orange, total bilirubin exceeds 20 mg/100;b) neurological signs: drowsiness to lethargy, this fund appears crisis irritability: opistotonus, extension contracture in the upper limbs, crying loudly, on the "sunset".
Evolution kernicterus is to death in the first week of life or survival at the cost of permanent sequelae: deafness, and no purchaser hipotomie motor (not your head, not sit, does not work), lack of motor coordination, choreo-atetozic syndrome, impaired intellect (imbecility).
Total bilirubin threshold for kernicterus is based on pregnancy age: 18-20 mg/100 the term infant, 15 to 18 mg/100 g in weight from 2500 to 1500, 10 to 15 mg/100 weight of 1500 -1000 g, 10 mg/100 weight <1000 g.Jaundice is accompanied by signs of hemolytic anemia Blood.
 3. Hemolytic anemia "pure"
 Infant does not have jaundice or jaundice is mild and short a few days. Anemia can have different degrees.
It is estimated that of infants living come from the alloimunizare risk pregnancies, 40% do not require treatment, 14% are stillborn and the remaining 46% may have different forms of anemia (jaundice) hemolytic.