What Is Erythroblastosis Fetalis?: Red Blood Cells

What is erythroblastosis fetalis?
The adult human body is home to trillions of red blood cells, also known as
RBCs or erythrocytes. These blood cells carry oxygen, iron, and many
other nutrients to the appropriate places in the body. When a woman is
pregnant, it’s possible that her baby’s blood type will be incompatible with
her own. This can cause a condition known as erythroblastosis fetalis,
where the mother’s white blood cells (WBCs) attack the baby’s RBCs as they
would any foreign invaders. This condition is highly preventable and the
typical, severe form is now very rare in developed countries. Catching it
early can ensure a successful pregnancy for mother and child. If left
untreated, however, it can be life-threatening for the baby. Erythroblastosis
fetalis is now known as hemolytic disease of the newborn.
What are the symptoms of

erythroblastosis fetalis?
Babies who experience erythroblastosis fetalis symptoms may appear
swollen, pale, or jaundiced after birth. A doctor may find that the baby has a
larger-than-normal liver or spleen. Blood tests can also reveal that the baby
has anemia or a low RBC count. Babies can also experience a condition
known as hydrops fetalis, where fluid starts to accumulate in spaces where
fluid is normally not present. This includes spaces in the:
 abdomen
 heart
 lungs
This symptom can be harmful because the extra fluid places pressure on
the heart and affects its ability to pump.
What causes erythroblastosis

fetalis?
There are two main causes of erythroblastosis fetalis: Rh
incompatibility and ABO incompatibility. Both causes are associated with blood
type. There are four blood types:
 A
 B
 AB
 O
In addition, blood can be either Rh positive or Rh negative. For example, if
you’re type A and Rh positive, you have A antigens and Rh factor antigens
on the surface of your RBCs. Antigens are substances that trigger an
immune response in your body. If you have AB negative blood, then you
have both A and B antigens without the Rh factor antigen.
Rh incompatibility
Rh incompatibility occurs when a Rh-negative mother is impregnated by a
Rh-positive father. The result can be a Rh-positive baby. In such a case,
your baby’s Rh antigens will be perceived as foreign invaders, the way
viruses or bacteria are perceived. Your blood cells attack the baby’s as a
protective mechanism that can end up harming the child. If you’re pregnant
with your first baby, Rh incompatibility isn’t as much of a concern. However,
when the Rh-positive child is born, your body will create antibodies against
the Rh factor. These antibodies will attack the blood cells if you ever
become pregnant with another Rh-positive baby.
ABO incompatibility
Another type of blood type mismatch that can cause maternal antibodies
against her baby’s blood cells is ABO incompatibility. This occurs when the
mother’s blood type of A, B, or O isn’t compatible with the baby’s. This
condition is almost always less harmful or threatening to the baby than Rh
incompatibility. However, babies can carry rare antigens that can put them
at risk for erythroblastosis fetalis. These antigens include:
 Kell
 Duffy
 Kidd
 Lutheran
 Diego
 Xg
 P
 Ee
 Cc
 MNSs
How is erythroblastosis fetalis

diagnosed?
To diagnose erythroblastosis fetalis, a doctor will order a routine blood
test during your first prenatal visit. They’ll test for your blood type. The test will
also help them determine whether you have anti-Rh antibodies in your
blood from a previous pregnancy. The fetus’s blood type is rarely tested.
It’s difficult to test for a fetus’s blood type and doing so can increase the
risk for complications.
Frequency of testing
If initial testing shows your baby may be at risk for erythroblastosis fetalis,
your blood will be continually tested for antibodies throughout your
pregnancy — approximately every two to four weeks. If your antibody
levels start to rise, a doctor may recommend a test to detect fetal cerebral
artery blood flow, which isn’t invasive to the baby. Erythroblastosis fetalis is
suspected if the baby’s blood flow is affected.
Rh incompatibility
If you have Rh-negative blood, the father’s blood will be tested. If the
father’s blood type is Rh negative, no further testing is needed. However, if
the father’s blood type is Rh positive or their blood type isn’t known, your
blood may be tested again between 18 to 20 weeks of pregnancy, and
again at 26 to 27 weeks. You’ll also receive treatment to prevent
erythroblastosis fetalis.
ABO incompatibility
If your baby is jaundiced after birth, but Rh incompatibility isn’t a concern,
the baby may be experiencing problems due to ABO incompatibility. ABO
incompatibility occurs most frequently when a mother with an O blood type
gives birth to a baby who has an A, B, or AB blood type. Because O blood
types may produce both A and B antibodies, the mother’s blood can attack
the baby’s. However, these symptoms are generally much milder than a Rh
incompatibility. ABO incompatibility can be detected via a blood test known
as a Coombs test. This test, along with a test to determine the baby’s blood
type, is performed after the baby is born. It can indicate why the baby may
appear jaundiced or anemic. These tests are usually done for all babies
whose mothers have type O blood.
How is erythroblastosis fetalis

treated?
If a baby experiences erythroblastosis fetalis in the womb, they may be
given intrauterine blood transfusions to reduce anemia. When the baby’s
lungs and heart mature enough for delivery, a doctor may
recommend delivering the baby early. After a baby is born, further blood
transfusions may be necessary. Giving the baby fluids intravenously can
improve low blood pressure. The baby may also need temporary breathing
support from a ventilator or mechanical breathing machine.
What’s the long-term outlook for

erythroblastosis fetalis?
Babies born with erythroblastosis fetalis should be monitored for at least
three to four months for signs of anemia. They may require additional blood
transfusions. However, if proper prenatal care and postpartum care are
delivered, erythroblastosis fetalis should be prevented and the baby
shouldn’t experience long-term complications.
Can erythroblastosis fetalis be

prevented?
A preventive treatment known as RhoGAM, or Rh immunoglobulin, can
reduce a mother’s reaction to their baby’s Rh-positive blood cells. This is
administered as a shot at around the 28th week of pregnancy. The shot is
administered again at least 72 hours after birth if the baby is Rh positive.
This prevents adverse reactions for the mother if any of the baby’s placenta
remains in the womb.

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