The process of blood transfusion in children. Intrauterine blood transfusion to the fetus: how is the procedure performed and why is it dangerous for the child? Indicators for blood transfusion in children

The period of fetal development in premature babies was shorter, so they do have special health problems. But all children are different. It is impossible to predict what the first months or years of a baby's life will be like.

Many children born prematurely grow up strong and healthy. According to statistics, babies born almost at term (that is, between 37 and 40 weeks) are less likely to have health problems than those who were born earlier.

Premature babies require special care from their parents, affection, patience, love and care. They are more susceptible to infectious diseases, especially pustular diseases of the skin, eyes and navel.

If a baby is born prematurely, parents usually have a difficult time. But awareness of the health of premature babies helps to cope, as well as qualified personnel - doctors and nurses who have experience in monitoring such children.

What lung problems can a premature baby have?

Premature babies often have trouble breathing because the lungs take longer to develop. Therefore, once labor has begun, the expectant mother is often given steroids, drugs that help protect the baby's lungs (Bliss 2007) .

After delivery, premature babies are often given a course of another drug called a surfactant. This natural substance is produced by the lungs and makes breathing easier. But many premature babies are deficient. In such cases, it is inserted through a tube into the child's windpipe and from there into the lungs (Bliss 2007) .

Here are some common lung problems faced by premature babies:

Respiratory failure syndrome. This is a rather serious condition in which the lungs do not receive enough oxygen. Surfactants help prevent respiratory failure syndrome in many cases, but sometimes children still need to be connected to a breathing machine for a while (NIH 2011a) .
Apnea. This is a condition in which the child's breathing is irregular. Detected using the monitor. Treated with drugs such as caffeine or temporary connection to a breathing apparatus (Kopelman 2009) .
chronic lung disease or bronchopulmonary dysplasia. Occurs in children born much prematurely - or in cases where their lungs become stiff and inactive due to prolonged artificial ventilation. In this state, the child will not be discharged from the hospital, but simply transferred to another ward. In addition, the baby in this case will need to be especially carefully protected from respiratory infections (Bliss 2007) .

Do premature babies have heart problems?

A common heart problem in premature babies is patent ductus arteriosus (heart disease). When a baby is in the uterus, its circulatory system allows oxygen-rich blood to flow around the lungs. After birth, the corresponding circulatory pathways are closed, because the lungs take over the function of breathing and oxygenation.

With heart disease, the ductus arteriosus, which should have closed, remains open, which adversely affects blood circulation between the heart and lungs (Beerman 2009, Hamrick 2010, NHLBI 2009a).

If the arterial duct is almost closed, that is, only a small hole remains, this does not create big problems. With a large non-closure, the child quickly gets tired, eats poorly and slowly gains weight. From excessive load, the heart is stretched, breathing problems appear, lung function is disturbed (Beerman 2009, Hamrick 2010, NHLBI 2009b, 2009c).

Sometimes a small hole is left so that it can close itself. In the meantime, this natural process is going on, the child may be prescribed anti-inflammatory drugs - for example, indomethacin or ibuprofen. In some cases, surgery is required to close the ductus arteriosus (Beerman 2009, Hamrick 2010) .

Can a baby's brain be damaged due to premature birth?

Premature babies have very thin and fragile blood vessels in the brain. One of the risks that such babies are exposed to is cerebral hemorrhage, also called intraventricular hemorrhage. It usually occurs in the first days or weeks after birth, with very early births at greatest risk (McCrea 2008) .

If the area of bleeding is small, there are usually no consequences. But a more extensive hemorrhage can cause brain damage (NIH 2011a) .

Doctors routinely do ultrasounds of premature babies to check for signs of cerebral hemorrhage. There is no reliable way to stop a hemorrhage if it has already begun. In some cases, blood transfusion or ventilation helps (NIH 2011b) .

Massive hemorrhage can cause problems such as cerebral palsy, epilepsy, or future learning difficulties (McCrea 2008) . In the event of a hemorrhage, the child will have to be observed by neonatologists for a long time, who will be able to identify any problems that have arisen as a result of the hemorrhage in time and help the child.

Do premature babies have eye problems?

At the bottom of the pupil there is a thin tissue called the retina. It works much like film in a non-digital camera, capturing an image for the brain.

If the baby is born much too early, the blood vessels in the retina may not develop correctly (Fleck 2008) . This causes bleeding and scar tissue that can cause visual impairment (RNIB 2011) .

This condition is called retinopathy of prematurity. The shorter the period at which the child was born, the higher the likelihood that he will develop this disease (RNIB 2011) .

The exact cause of retinopathy is unknown, although it is thought that exposure to concentrated oxygen may cause it. Therefore, neonatologists carefully control the amount of oxygen that premature babies receive (Fleck 2008, RNIB 2011) .

In addition, children at risk are examined by an ophthalmologist (RCPCH 2008) . Moderate retinopathy of prematurity usually does not affect future vision. But if problems do occur, the damaged eye tissue is treated with cryotherapy (cold treatment) or laser (RCPCH 2008, RNIB 2011) .

Is there a risk of bowel problems in premature babies?

Premature babies sometimes have a very serious bowel disease called necrotizing enterocolitis. The condition is characterized by the fact that the tissues of the intestine die off. The exact cause is unknown, but a bacterial infection may play a role (NIH 2011b, AlFaleh 2011) .

Among the symptoms of necrotizing enterocolitis are swollen abdomen, diarrhea, vomiting, unwillingness to eat (NIH 2011b) .

If a child is diagnosed with necrotizing enterocolitis, the usual diet is replaced with a nutrient drip. This unloads the digestive system of the child. In addition, surgery may be performed to remove damaged parts of the bowel (GOSH 2008) .

Breastfed babies are less likely to develop necrotizing enterocolitis (Boyd 2007, Renfrew 2009) . In addition, probiotics (bacteria that promote bowel function) have been seen to help prevent this disease. However, some experts believe that this issue has not been studied enough (AlFaleh 2011) .

Do premature babies need a blood transfusion?

Children rarely need a blood transfusion. Premature babies are often anemic, but the transfusion method is used only in severe cases.

Anemia occurs when there is a lack of red blood cells that carry oxygen throughout the body. This condition is caused by a variety of reasons. Some premature babies simply don't form enough red blood cells or die too quickly. In addition, preterm infants are too frequently bled for testing (Potter 2011) .

Doctors still argue at what stage of anemia a blood transfusion should be performed due to conflicting data on the benefits of this manipulation (Bell 2008) .

If jaundice is severe, premature babies may also need a blood transfusion.

Do premature babies suffer from jaundice?

Neonatal jaundice is common in both full-term and premature babies. It is caused by a byproduct of the breakdown of red blood cells called bilirubin. This substance is formed in the liver and must be excreted in the feces.

Jaundice occurs when the liver cannot keep up with the amount of bilirubin produced. Very high levels of bilirubin can harm a child's brain (NICE 2010a, NICE 2010b) .

An obvious sign of jaundice is a yellow tint to the skin and sometimes the whites of the eyes in a child. But to confirm the diagnosis, doctors will need to do a blood test and determine the level of bilirubin.

Jaundice can be cured by placing the child under special rays that help break down bilirubin. This is called phototherapy (NICE 2010a, 2010b) .

If the blood bilirubin level is dangerously high, the child may need a total blood transfusion (NICE 2010a, 2010b) .

This method of treatment is now the most common in medicine, because it contributes to a quick solution to the problem. Replacement in children is distinguished both early - on the second day after birth, and later - after the third day of a newborn's life. Indications for it is a severe form of icteric disease.

Replacement blood transfusion is done to children, if the indirect one is 308-340 µmol / l - it is also carried out depending on the body weight of the newborn. A transfusion is carried out, first of all, in order to remove toxic substances from the baby's body, such as bilirubin, antibodies, and which adversely affect the health of the child. Of course, such an operation does not guarantee a 100% recovery. But it all depends on what disease is treated in this way, and how timely the treatment is.

Indications

Replacement blood transfusion in children is carried out only after appropriate examinations and diagnosis. This operation should be prescribed only by the attending physician.

According to doctors, the main indications for replacement transfusion are:

An increased content of indirect bilirubin in the blood taken for analysis from a newborn.
A rapid increase in the amount of bilirubin in the blood of a newborn in the first few hours of life.
Manifestations of signs of jaundice or in the first days of a child's life, or immediately after childbirth.

But the main indicator is the growth of bilirubin in the blood of a newborn in the first days of his life, when he is still in the hospital. It also focuses on the rate at which it accumulates in the blood so that the necessary treatment can be carried out as soon as possible.

Holding

Blood is transfused in the amount of 80% of the mass of blood that circulates throughout the body of the newborn. The volume of transfused blood should be about 150-180 ml/kg. Naturally, only prepared blood is used, which is no more than three days old.

Before an exchange transfusion, the necessary tests are carried out, both for the amount of bilirubin, and for the donor and patient. It should be noted here that even if the mother’s blood is suitable for the baby, then she is not recommended to be a donor until two months after the birth, because her body has not yet recovered. The procedure is performed either through the subclavian vein or through the umbilical cord.

Replacement transfusion of blood begins first with the removal of blood, and then the introduction of a new one - this is the so-called "pendulum method". If a child has a low level of hemoglobin, then the transfusion begins with its correction, i.e. with transfusion of erythrocytes only. When the level of hemoglobin in the blood reaches the norm, it is possible to transfuse and, either mixing it with the red blood cell mass, or using two syringes for this.

The total time of blood transfusion is no more than two hours. And as it is transfused into the blood of a newborn, a solution of calcium chloride is introduced to prevent further illness and death. With the help of this procedure, indirect bilirubin is removed from the circulatory system of the newborn and a further improvement in his condition gradually occurs.

Performing a blood transfusion procedure

Indications

Of course, first of all, replacement blood transfusion in children is carried out because of. This may be due to hemolytic disease of the newborn. What are the signs of this pathological condition? Most often, it is caused by incompatibility between mother and fetus. For example, if the mother's Rh factor is negative, but the child's is positive, then antibodies are formed in the mother. They pass through the umbilical cord or placenta into the circulatory system of the fetus and cause the destruction of red blood cells.

After birth, a newborn may experience a pathological condition from which it can be removed by making the correct diagnosis and making a blood transfusion in time. In this case, the purpose of blood transfusion is the removal of red blood cells, which began to decay under the influence of maternal ones.

Of course, a complete blood exchange in this case is not carried out. There is an infusion of double the amount of blood and blood transfusion is performed by only 80-90%, but this is enough to save the baby.

Physiological jaundice

To date, the probability of disease in healthy full-term newborns with physiological jaundice is 60%.

The following factors contribute to this:

Replacement of hemoglobin in the fetal body involves the destruction of red blood cells in newborns.
There are such complications in childbirth that involve the entry into the blood of an infant of an unacceptable amount of indirect bilirubin.
The work of the liver is complicated.
In newborns, the liver does not always cope with the load.

Physiological jaundice resolves within two weeks after birth and usually does not cause any complications in the infant.

Blood transfusion with low hemoglobin is prescribed only in emergency cases, when its level falls beyond the critical phase, namely less than 60 g / l. Thanks to these measures, not only iron levels are rapidly increasing, but overall well-being is improving significantly. Despite the pronounced positive effect of the procedure, the consequences of blood transfusion with low hemoglobin are not always predictable.

How is a blood transfusion performed to restore hemoglobin

The process of blood transfusion with reduced hemoglobin readings in medical terminology is called hemotransfusion. It is carried out only in a hospital and under the watchful supervision of medical personnel. Blood is transfused to increase the iron content from a healthy donor to a recipient. The procedure is possible only if the blood type and Rh factor match.

The sequence of mandatory actions for blood transfusion:

The doctor finds out if there are good reasons for transfusion, and if there are any contraindications. Taking anamnesis in this case is mandatory, it is necessary to find out from the patient: whether the transfusion of the hemotransfusion medium was previously performed to increase hemoglobin, there were no allergic reactions or side effects, the presence of chronic diseases and other individual characteristics of the body that must be taken into account.
After conducting laboratory studies of the patient's personal blood parameters, such as group and Rh factor. Additional confirmation of the initial data will be required already on the spot, that is, in the hospital. To do this, a re-analysis is carried out in a medical institution, and the indicator is compared with the laboratory one - the data must completely match.
Select the most appropriate donor red blood cell mass for blood transfusion with low hemoglobin. In the event of even the slightest mismatch even in one indicator, blood transfusion in order to increase hemoglobin is not allowed. The doctor must make sure that the packaging is airtight, and the passport contains all the information regarding the number and date of the harvest, the name of the donor, his group and Rh, the name of the manufacturer's organization, the expiration date and the doctor's signature. The duration of storage of the donor blood transfusion composition varies from 20 to 30 days. But even with full compliance with all indicators during visual inspection, the specialist should not detect any extraneous clots or films in it. After a thorough quality check, a re-analysis is carried out to confirm the group and Rhesus.
Compatibility is checked using the AB0 system, while donor blood is combined with the recipient's blood on a special glass.
To check compatibility according to the Rh factor, two parts of the patient's serum mass of blood, one part of the donor's blood mass, a part of polyglucin, 5 milliliters of saline are added to a special test tube, and the reaction is observed during rotation.
After studying the compatibility data, a biological test is carried out by injecting 25 milliliters of donor blood into the recipient. It is administered three times with an interval between injections of three minutes. At this time, the patient is closely monitored, if the heart rate and pulse are normal, the face is without signs of redness and the general state of health is stable, then the plasma is allowed for transfusion.
Blood is not used in its original form, its various components are transfused, depending on the purpose. With low hemoglobin, an erythrocyte mass is transfused. This component of the blood flow is introduced by drip at a rate of 40–60 drops per minute. The patient must constantly be under the supervision of a doctor who monitors his general well-being, pulse, pressure, temperature, condition of the skin, with subsequent entry of information into the medical record.
At the end of the process, the patient needs rest for two hours. For another day, he is under the supervision of a doctor, then he takes blood and urine tests.
After completion of the transfusion, approximately 15 milliliters of the recipient's blood serum and the donor's red blood cells are left. They are stored in the refrigerator for about 2 days, if it becomes necessary to do an analysis, in case of complications.

Blood transfusion for anemia is not allowed for everyone, with the exception of people with a rare blood group. Restoration of hemoglobin in them can be carried out only with the use of iron-containing preparations and a special diet that includes foods rich in iron.

Possible consequences of a blood transfusion for raising hemoglobin

Before putting a dropper on the recipient, a series of tests for compatibility are carried out in order to avoid sticking (agglutination) of erythrocytes, which can be fatal. Despite the observance of preliminary safety measures when performing a blood transfusion with reduced hemoglobin, it is not always possible to avoid unforeseen consequences.

Types of complications during blood transfusion in order to increase hemoglobin:

Reactive:
- increase in body temperature;
- syndrome of massive blood transfusions, may be associated with a larger than necessary amount of blood injected;
- hemolytic shock, can develop with antigenic incompatibility of the blood, in such a situation, the breakdown of erythrocyte membranes occurs, which leads to poisoning of the body with metabolic products;
- citrate shock, can only occur if canned blood is used during transfusion, due to the use of citrate salt as a preservative;
- post-transfusion shock, is caused by the consequences of transfusion of "bad" blood in an overheated state, contaminated with toxins, with an admixture of decayed blood cells;
- anaphylactic shock, may occur with an allergy to the administered blood transfusion medium.

Mechanical:

acutely formed expansion of the heart, due to the rapid introduction of blood transfusion media;
thrombosis, thickening of the blood, leading to blockage of blood vessels;
embolism resulting from the penetration of air into the blood transfusion system.

infectious

A hemocontact infection is possible when an emergency blood transfusion is necessary with a sharp decrease in hemoglobin and there is no time to maintain it. Without fail, the blood transfusion medium is carefully monitored for the presence of microorganisms. To do this, it is kept for six months and re-examined.

Symptoms of low hemoglobin

It is easy to determine the level of iron in the blood, for this you only need to take a blood test at the district clinic or diagnostic laboratory. The reason for passing the analysis may be an examination associated with a visit to the doctor or the presence of obvious signs indicating anemia. According to the results of the study, it will become clear what measures to restore iron in the body to prefer - iron-containing nutrition and drugs or blood transfusion to raise hemoglobin.

The most common symptoms of anemia include:

Strong heartbeat and difficulty breathing.
Fainting and dizziness.
Pain in the head, sensation of ringing in the ears.
Feeling of weakness and pain in the muscular system.
Change in taste and smell.
Change in the structure of the nails.
Thinning, dry hair.
Paleness and dryness of the mucous membranes and skin.
Protracted lethargic, apathetic state, fatigue, depression.
Reduced blood pressure, deviations in the work of the VGT system, cold lower extremities.

If the quantitative value of iron has not decreased much, then a person may not be aware of it. Or he begins to worry about the incessant feeling of fatigue, even after a full sleep, although anemia is often accompanied by insomnia.

Such sensations are caused by oxygen starvation of the body due to a lack of iron-containing protein in the blood in red blood cells or a decrease in their number or volume. After all, as you know, it is on the red blood cells that one of the most important missions is assigned to supply all organs, systems and tissues of the body with oxygen and the subsequent removal of carbon dioxide. Therefore, with a strong deviation from the norm of the hemoglobin index, it may be necessary to resort to a blood transfusion to increase it.

Blood transfusion with insufficient hemoglobin in childhood

If you or your loved ones have one or more symptoms of reduced hemoglobin, you should contact the clinic to conduct a study of the composition of the blood flow.

Particular attention should be paid to maintaining iron in the blood in children at the proper level.

The child is unlikely to be able to clearly explain what is happening to him. Namely, in childhood, a violation of oxygen metabolism is the most dangerous, because it can lead to physical or mental retardation.

Not infrequently, the need for transfusion to raise hemoglobin or eliminate the effects of anemia appears in newborns and, especially in premature babies. It should be borne in mind that prematurity always entails an insufficient hemoglobin index, but in the absence of a severe form of anemia, the iron level is completely restored on its own by the first year of life. In the case of a vital need for blood transfusion with low hemoglobin, a careful selection of donor blood will be required, since it is forbidden to use maternal blood in such a situation.

A blood transfusion for a newborn due to hemoglobin may be required with hemolytic anemia - this is when the blood of the mother and child is incompatible.

Hematologic anemia has a number of serious consequences:

Inability to bear a fetus.
The birth of a baby with edema.
The appearance of severe jaundice.

With the timely detection of a severe form of anemia in the fetus during pregnancy, an intrauterine transfusion of erythrocyte mass is done to him. The procedure, in addition to following the standard measures for the selection of donor blood, testing for susceptibility and compatibility, takes place using ultrasound.

A normal level of hemoglobin is necessary for the implementation of all human life processes, the full formation of the body, and maintaining health. The indicator of iron in the bloodstream is one of the main ones for a healthy state of health. To maintain it in the norm, you only need to fully eat and devote as much time as possible to walks in the fresh air.

In contact with

Indications for it is a severe form of icteric disease.

Replacement blood transfusion is done to children, if indirect bilirubin in the blood is µmol / l - it is also carried out depending on the body weight of the newborn. Transfusion is carried out, first of all, in order to remove toxic substances from the baby's body, such as bilirubin, antibodies and an increase in red blood cells, which adversely affect the health of the child. Of course, such an operation does not guarantee a 100% recovery. But it all depends on what disease is treated in this way, and how timely the treatment is.

Indications

Replacement blood transfusion in children is carried out only after appropriate examinations and diagnosis. This operation should be prescribed only by the attending physician.

According to doctors, the main indications for replacement transfusion are:

An increased content of indirect bilirubin in the blood taken for analysis from the vessels of the umbilical cord of a newborn.
A rapid increase in the amount of bilirubin in the blood of a newborn in the first few hours of life.
Manifestations of signs of jaundice or in the first days of a child's life, or immediately after childbirth.
Low hemoglobin level.

Increase in bilirubin in a newborn

Holding

Blood is transfused in the amount of 80% of the mass of blood that circulates throughout the body of the newborn. The volume of transfused blood should be about ml/kg. Naturally, only prepared blood is used, which is no more than three days old.

Before an exchange transfusion, the necessary tests are carried out, both for the amount of bilirubin and for the compatibility of the blood of the donor and the patient. It should be noted here that even if the mother’s blood is suitable for the baby, then she is not recommended to be a donor until two months after the birth, because her body has not yet recovered. The procedure is performed either through the subclavian vein or through the umbilical cord.

Replacement transfusion of blood begins first with the removal of blood, and then the introduction of a new one - this is the so-called "pendulum method". If a child has a low level of hemoglobin, then the transfusion begins with its correction, i.e. with transfusion of erythrocytes only. When the level of hemoglobin in the blood reaches the norm, then it is possible to transfuse the blood plasma either by mixing it with the erythrocyte mass, or using two syringes for this.

Performing a blood transfusion procedure

Indications

Of course, first of all, replacement blood transfusion in children is carried out due to increased bilirubin in the blood. This may be due to hemolytic disease of the newborn. What are the signs of this pathological condition? Most often, it is caused by the incompatibility of the Rh factor in the blood of the mother and fetus. For example, if the mother's Rh factor is negative, but the child's is positive, then antibodies are formed in the mother. They pass through the umbilical cord or placenta into the circulatory system of the fetus and cause the destruction of red blood cells.

After birth, a newborn may experience a pathological condition from which it can be removed by making the correct diagnosis and making a blood transfusion in time. In this case, the purpose of a blood transfusion is to remove red blood cells that have begun to decay under the influence of maternal antibodies in the blood.

Physiological jaundice

To date, the probability of disease in healthy full-term newborns with physiological jaundice is 60%.

The following factors contribute to this:

Replacement of hemoglobin in the fetal body involves the destruction of red blood cells in newborns.
There are such complications in childbirth that involve the entry into the blood of an infant of an unacceptable amount of indirect bilirubin.
The work of the liver is complicated.
In newborns, the liver does not always cope with the load.

Physiological jaundice resolves within two weeks after birth and usually does not cause any complications in the infant.

Exchange transfusion in newborns

Replacement transfusion is prescribed for newborns with severe forms of icteric diseases. This method of treatment is quite common today, as it contributes to the most rapid solution to the problem. First of all, we are talking about the removal of toxic products from the body. It can be indirect bilirubin, a large number of red blood cells, as well as many other antibodies that adversely affect the health of newborns.

It is impossible to say with certainty that the disease can be cured immediately by exchange transfusion alone. In this case, it all depends on the form of the disease and its progression.

Indications for transfusion

Blood transfusion in children should be carried out only after doctor's prescriptions. For this, there are appropriate diagnoses, which should be guided by. For example, one of the most important indicators is the fact that the manifestation of the disease is noticeably earlier and its rapid increase. In children, this may be early jaundice, an enlarged liver or spleen, as well as the appearance of a large number of young red blood cells in the blood.

The main criterion for starting an exchange transfusion is still the bilirubin index. If at birth in the cord blood it becomes more than 50 µmol / l, then this is already the first sign of a possible further transfusion. Also in this case, it is necessary to accurately focus on the rate of its accumulation, since in some cases therapy is prescribed in an accelerated form. A dangerous indicator of the rate of accumulation of indirect bilirubin is more than 4.5 µmol / l in the first hours of a newborn's life.

How is an exchange transfusion performed?

This procedure is carried out in a blood volume of not more ml / kg. This is approximately 80% of the total amount of all circulating blood in a newborn. For this, exclusively prepared blood is used, which has been aged for at least three days - this is fresh blood. All indicators of donation in this case are as important as in other procedures. Therefore, in any case, a donor must be selected.

Even if the mother is suitable as a donor, her blood is not allowed to be taken within two months after giving birth. This primarily suggests that the mother's body must already recover from blood loss and be strong for further lactation.

When transfused, only erythrocytes can be replaced separately from plasma. In this case, the umbilical vein of the newborn is used, subject to all the rules of transfusion. First, you need to remove ml of blood from the child through the catheter, and then introduce a replacement in the right amount. Also in this transfusion procedure it is very important to monitor the speed, because it should not exceed more than 2-3 ml / minute.

As a rule, the total duration of a blood transfusion takes about two hours. During this time, every 100 ml, an additional calcium chloride solution is injected into the vein. Such replacement transfusion in children allows timely prevention of death or the spread of further disease. As a result of this, indirect bilirubin is excreted from the child's body and a gradual recovery occurs. It is a large amount of toxic indirect bilirubin that can be a lethal dose for newborns.

Why do you have to do a transfusion?

The first reason for exchange transfusion, as mentioned earlier, is an increased amount of indirect bilirubin. Because of this, children have a yellow body color. This indicates the destruction of red blood cells. A large amount of bilirubin significantly and quickly spreads through the blood of a newborn and gradually affects the liver, intestines, and the skin accordingly acquires a yellowish color. Thus, already within two hours after the birth of children, it is possible to determine the first symptoms of an increased content of bilirubin.

The likelihood of physiological jaundice in newborns

Unfortunately, almost 60% of full-term babies develop physiological jaundice on days 3-4. To date, the reasons for this have not yet been identified, but it is safe to list the main indicators that characterize this disease:

in newborns, the destruction of erythrocytes is observed, which is due to the replacement of fetal hemoglobin;
as the next symptom for transfusion, some complications during childbirth may serve, which gave impetus to a strong release of indirect bilirubin;
there is a complication of the liver, since this is the only organ that will be responsible for removing it from the body at the moment;
since the baby’s liver has not yet matured for such active work, it can gradually reduce its productivity, which in turn will make it difficult for the body of such young children to work.

As a rule, the peak of such physiological jaundice in newborns falls on the 7-9th day, and after two weeks it may disappear on its own. At this time, the main thing is to keep the condition of the blood under control and conduct appropriate tests. If there were no serious violations at birth, then perhaps such a procedure can be avoided. All children are different, just like adults, so do not immediately get upset and panic.

Replacement blood transfusion for a newborn with GBN

Exchange transfusion.

Gilerbilirubinemia, always find out the cause!
Anemia in fetal dropsy (erythroblastosis).
Polycythemia (hematocrit > 70%).
Disseminated intravascular coagulation (DIC): only as a last resort (Ultima Ratio), mostly without success.
Controversial: with sepsis or severe viral infection.

Diagnostic measures before each replacement transfusion

Mother: blood group, indirect Coombs test.

Child: blood group, direct Coombs test, OAK with leukocyte formula, hematocrit and reticulocytes: bilirubin. KOS and gas composition: screening for metabolic diseases. In case of malformations (chromosomal diseases) and, above all, metabolic diseases, consider taking a blood sample before the procedure.

If the disease is not based on the usual fetomaternal incompatibility, look for other reasons:

Infectious. (TORCH, especially CMV), sepsis. Lues, listeriosis.
Hemolytic anemia: fermentopathy (glucose-6-phosphate dehydrogenase, pyruvate kinase, etc.), membranopathies (congenital spherocytosis, elliptocytosis), hemoglobinopathies (α-thalassemia: Hydrops); anemia caused by parvovirus B19, CMV.
Galactosemia: screening for metabolic diseases.
Incompatibility for rare blood types (Kell, Anti-C).
Hemorrhages in the skin and body cavities (for example, severe cephalohematoma).

Practical recommendations for exchange transfusion in the newborn

Red blood cell concentrate (EC):

With incompatibility in the ABO system (0 (1), Rh (-)) and AV plasma.
With Rh-incompatibility, the blood type is like that of a child, but Rh-negative. Caution: maternal antibodies. Conduct a preliminary test for compatibility of EC and maternal blood (in the department / blood transfusion station).
RBC alkalization: Hasek or blind for every 100 ml of EC 0.8 ml of TRIS 3 M.
EC irradiation (10 min). Caution: Irradiated red blood cells are only good for a limited time.
Warm up to body temperature.

Quantity: 2-3 BCC (BCC = 80 ml / kg) (with hyperbilirubinemia); mix with plasma (usually 2:1) to match the child's hematocrit. In this way, 90-95% of the baby's blood will be exchanged.

Blood sampling can be carried out through an umbilical arterial catheter, transfusion through an umbilical venous catheter. Even if vascular catheterization is performed only for a short period, it is necessary to fix the catheters well and, if possible, take an x-ray (careful, portal vein thrombosis!).

Caution: draw blood from the umbilical artery in small portions to avoid impaired perfusion of the intestine (otherwise, the risk of developing NEC).

Perform exchange transfusion through peripheral access (artery and vein).

A constant exchange without fluctuations in blood pressure is possible.
Safer in terms of the development of portal vein thrombosis.

Attention, only in exceptional cases, harvest from small arteries (for example, a. radialis). In case of their use draw blood by passive current, without active aspiration (danger of disturbance of perfusion). Before each puncture of the peripheral artery, check the perfusion of the limb with collateral branches (Allen's test).

Exchange volume: 2-3 ml/kg per serving.

Attention, collect the first ml of the child's blood (5-10 ml of EDTA blood).

2 ml of 10% calcium solution is injected after every 100 ml of exchange (debatable).

Monitoring: heart rate, blood pressure and respiratory rate (to keep a record). With fluctuations in blood pressure, you can reduce the planned volume of exchange.

Laboratory control: before, during and after the exchange: electrolytes (Na, K, Ca), KOS and gas composition, bilirubin, total protein, blood glucose and OAK (Ht, platelets, leukocytes).

Perform exchange transfusion slowly, at least 2-3 hours, as the exchange between intra- and extracellular bilirubin takes time.
Control of bilirubin every 3-6 hours (may need a new exchange transfusion).

Exchange transfusion in DIC. the presence of circulating antibodies:

The exchange should be done quickly - in one hour.

Caution: danger of fluctuations in blood pressure and the development of pulmonary edema.

Anemia about 1/3 of the volume should be replaced quickly (transfusion, up to Ht> 35%), the remaining volume slowly, over 2 hours.

Hemolytic disease of the fetus and newborn

Changes in the body of the fetus with hemolytic disease

Hyperbilirubinemia does not have a significant effect on the condition of the fetus, since the mother's liver takes on the function of neutralizing the resulting bilirubin. Hyperbilirubinemia is dangerous for the newborn.

According to autopsies of fetuses who died from hemolytic disease, a characteristic dropsy with abdominal distention and severe subcutaneous edema is observed. Severe anemia is always noted with a predominance of immature forms of erythrocytes. At autopsy, ascites, excessively enlarged liver and spleen are found; their lower poles may reach the iliac crest. In both organs, pronounced extramedullary erythropoiesis, a large number of erythroblasts are noted. All this leads to a violation of normal anatomy. The cavities of the heart are usually dilated, the muscular wall is hypertrophied. Along the coronary vessels, foci of erythropoiesis can be found. Hydrothorax is often detected. In the lungs, plethora and a large number of erythroblasts are found. The kidneys may have marked erythropoiesis, but they are usually of normal size. The bone marrow shows polycythemia. The placenta also has a characteristic appearance: pronounced edema, an increase in size. Its mass often reaches 50% of the mass of the fetus. The placenta and membranes are more or less yellow due to bile pigments secreted by the fetal kidneys. In the villi of the chorion - edema, stromal hyperplasia, an increase in the number of capillaries.

Despite the well-known pattern of pathological changes, the chronology of the process is not entirely clear. At first it was believed that dropsy was a consequence of heart failure that developed against the background of severe anemia and hypervolemia of the fetus, but now it has become known that liveborn children with dropsy have neither significant ventricular failure nor hypervolemia. A newer view is that fetal ascites is the result of hypertension in the portal and umbilical veins due to enlargement and anatomical changes in the liver. Due to erythropoiesis, hypoproteinemia develops in the liver tissue as a result of liver failure and the inability of the edematous placenta to ensure the normal transfer of amino acids and peptides. This, in turn, leads to an increase in ascites and subsequent generalized edema. With the development of the cordocentesis technique, it became possible to understand the pathophysiology of dropsy. Indeed, hypoproteinemia and hypoalbuminemia are often found in affected fetuses, and in fetuses with dropsy this is an obligatory finding. These data prove that hypoproteinemia plays a major role in the genesis of fetal dropsy. It was revealed that dropsy does not develop until the level of hemoglobin in the fetus decreases to less than 40 g/l. The average level of hematocrit in dropsy is 10.2%.

The breakdown of red blood cells, damage to the function of the kidneys, liver and brain of the fetus occur as a result of exposure to incomplete antibodies passing to the fetus from the mother. When exposed to incomplete antibodies, capillary thrombosis and ischemic tissue necrosis develop. In the fetal liver, protein synthesis decreases, hypo- and dysproteinemia occurs, as a result, plasma oncotic pressure decreases, vascular permeability increases, swelling and anasarca increase. When erythrocytes are destroyed, thromboplastic factors are released, DIC develops, microcirculation is disturbed, and deep metabolic disorders in the fetus occur.

Hemolytic disease often develops in a newborn due to the massive influx of maternal antibodies into his bloodstream during birth, before the umbilical cord is cut.

In the first hours after birth, toxic indirect bilirubin accumulates in the tissues of the child. In the cells of the nervous system, the processes of cellular respiration (bilirubin encephalopathy) are disrupted, resulting in the death of a child or persistent neurological disorders (deafness, blindness) that persist for life.

Diagnosis of hemolytic disease of the newborn

Immediately after the birth of a child, he is determined:

hemoglobin (normal - 38.4 g / l);

the number of erythrocytes (normal - 6.0 10 | 2 / l);

To determine the blocking (complete) antibodies, an indirect Coombs test is performed, which makes it possible to identify the newborn's erythrocytes associated with antibodies; an hourly increase in bilirubin, an increase in its content over 5.13 μmol / l in 1 hour indicates an increase in the severity of jaundice.

Hemolytic disease of the newborn is characterized by a rapid increase in anemia, jaundice, the content of indirect toxic bilirubin and its rapid hourly increase. The newborn has lethargy, hyporeflexia, decreased tone, decreased sucking reflex, and apnea.

The essence of hemolytic disease of the fetus is hemolysis of red blood cells, anemia, bilirubin intoxication. Due to the breakdown of erythrocytes under the influence of anti-rhesus antibodies of the mother, there is an increase in toxic indirect bilirubin. The liver loses the ability to convert indirect bilirubin into direct bilirubin, which dissolves in water and is excreted from the body by the kidneys. Hypoxia develops, severe intoxication.

Forms of hemolytic disease of the newborn

There are three forms of hemolytic disease:
Hemolytic anemia associated with jaundice.

Hemolytic anemia with jaundice and dropsy.

Let us briefly consider these clinical forms, which reflect the severity of the disease.

Hemolytic anemia is the mildest form of the disease. The newborn has a reduced hemoglobin level and the number of red blood cells. The skin is pale, there is a slight increase in the liver and spleen. The content of hemoglobin and bilirubin may be at the lower limit of the norm or slightly lower.

The anemic form of hemolytic disease is the result of exposure to a small amount of Rh antibodies on a full-term or almost full-term fetus (37-40 weeks).

Isoimmunization of the fetus occurs more often in childbirth. Anemia is the leading sign of mild injury.

Hemolytic anemia in combination with jaundice is a more frequent and severe form of the disease. The main symptoms are: hyper- or normochromic anemia, jaundice and hepatosplenomegaly. In these cases, there is icteric staining of amniotic fluid, skin, primordial lubrication, umbilical cord, placenta and fetal membranes. The content of indirect bilirubin is more than µmol/l. The condition of the newborn gradually worsens, convulsive twitches, nystagmus, and hypertonicity appear.

With a rapid increase in the hourly increase in bilirubin by 5-10 times, "nuclear jaundice" develops, indicating damage to the central nervous system, when blindness, deafness, and mental disability can occur. The hemoglobin content is below 38 g/l.

The icteric form occurs if antibodies act on a mature fetus for a short time. Decompensation of protective and adaptive mechanisms does not occur, the fetus is born viable.

After birth, jaundice and intoxication with indirect bilirubin develop rapidly. Often infectious complications (pneumonia, respiratory distress syndrome, omphalitis) join. After 7 days of life, the pathogenic effect of antibodies that have penetrated into the blood of the fetus stops.

Hemolytic anemia in combination with jaundice and dropsy is the most severe form of the disease. Newborns are usually either stillborn or die in the early neonatal period. Clinical symptoms of the disease are: anemia, jaundice and general edema (ascites, anasarca), severe splenomegaly. Often hemorrhagic syndrome develops.

The penetration of maternal antibodies through the placenta does not always occur, the severity of the fetal lesion does not always correspond to the titer (concentration) of Rh antibodies in the blood of a pregnant woman.

In some Rh-negative women, due to the pathology of pregnancy and placental insufficiency, Rh antibodies enter the fetus during pregnancy. In this case, fetopathy occurs: a congenital form of hemolytic disease of the newborn (edematous, icteric), the birth of macerated fetuses. In full-term fetuses, hemolytic disease of the newborn occurs ten times more often than in preterm ones. This indicates an increase in the transport of isoantibodies through the placenta before and during childbirth.

With the edematous form of hemolytic disease of the newborn, there are pronounced signs of immaturity even in full-term newborns. In the abdominal, pleural cavities, in the pericardial cavity contains a large amount of fluid, in the tissues of the liver, kidneys, spleen, various hemorrhages. The spleen is enlarged at once, the thymus gland is reduced by 50%, the liver is enlarged by 2 times, signs of hypoplasia are expressed in the lungs.

The immediate cause of death of newborns in the edematous form of hemolytic disease is severe dystrophic changes in vital organs, the impossibility of spontaneous breathing.

The edematous form of hemolytic disease of the newborn develops with repeated exposure during pregnancy to a moderate amount of Rh antibodies. The main sign of tissue reactions is the development of compensatory-adaptive processes, the variety and severity of which increase with the period of intrauterine life of the fetus (an increase in the size of the heart, liver, spleen, lymph nodes).

In this regard, despite the ongoing re-penetration of isoantibodies, the fetus survives, but it develops dystrophic processes in organs and tissues, and the development of the lungs and kidneys is impaired. Due to the high vascular permeability, edema appears, the weight of the fetus does not correspond to the gestational age and is increased by 1.5-2 times. A fetus born alive most often dies.

Fetal death with maceration during isoimmunological conflict occurs in sensitized women with a massive breakthrough of the placental barrier to antibodies during pregnancy. The immaturity of the organs and systems of the fetus causes the rapid development of dystrophic processes and necrotic changes, and the fetus dies. At a later date (34-36 weeks), the action of a very large amount of antibodies leads to the same outcome.

Treatment of fetal hemolytic disease

Currently, for the treatment of hemolytic disease of the fetus, intrauterine blood transfusions are performed under ultrasound control. Fetal blood transfusions can be performed from 18 weeks of gestation. Intrauterine blood transfusion creates preconditions for prolongation of pregnancy. There are intra-abdominal and intravascular methods of blood transfusion.

The technique of intra-abdominal transfusion consists in puncturing the abdominal wall of the mother, the wall of the uterus, the abdominal wall of the fetus and introducing into its abdominal cavity a single-group and Rh-negative erythrocyte mass, which is adsorbed by the lymphatic system and reaches the vascular system of the fetus.

Preference is given to intravascular blood transfusion to the fetus, the indications for which in case of Rh sensitization are severe anemia and a hematocrit of less than 30%.

In order to conduct intravascular hemotransfusion, cordocentesis is performed. The vein of the umbilical cord is punctured in the immediate vicinity of its entry into the placenta. The conductor is removed from the needle and blood is taken to determine the hematocrit of the fetus. The erythrocyte mass is slowly injected through the needle, after which a second blood sample is taken to determine the final fetal hematocrit and assess the adequacy of the therapy. To stop the movements of the fetus, as a result of which the needle can be pushed out of the vein of the umbilical cord, the fetus is injected with arduan (pipecuronium) intravenously or intramuscularly. Determination of the need and timing of subsequent blood transfusions to the fetus is based on the results of ultrasound, post-transfusion hemoglobin and hematocrit in the fetus.

The transfused components enter directly into the bloodstream of the fetus, which can save his life in case of a serious illness.

Intra-abdominal transfusion should be performed only if the gestational age is less than 22 weeks or intravascular transfusion is difficult. In the plasma taken during cordocentesis, the concentration of fetal hemoglobin, blood type and fetal karyotype are determined. Obviously, a fetus with Rh-negative blood will not develop hemolytic disease associated with incompatibility for Rh antigens.

Treatment of hemolytic disease of the newborn

To date, from the standpoint of evidence-based medicine, methods of treating hemolytic disease of the newborn are effective:

replacement blood transfusion;

intravenous administration of standard immunoglobulins.

Exchange transfusion. Exchange transfusion of blood to a newborn is based on the removal of Rh antibodies and bilirubin. An increase in the titer of antibodies in the mother during pregnancy to 1:16 and above should alert the neonatologist regarding hemolytic disease in the newborn. A particularly unfavorable fact is the decrease in antibody titer before childbirth, which indicates the risk of their movement to the fetus.

A severe form of hemolytic disease can be assumed in the presence of icteric staining of the skin, cheesy lubrication, placenta, amniotic fluid, swelling and enlargement of the fetal liver.

Risk factors for bilirubin encephalopathy include:

low body weight of the newborn (less than 1500 g);

hypoproteinemia (total protein content less than 50 g/l);

hypoglycemia (glucose content less than 2.2 mmol/l);

anemia (hemoglobin less than 140 g/l);

the appearance of jaundice in the first 12 hours of life; intrauterine infection of the fetus.

Indications for replacement blood transfusion:

the appearance of jaundice immediately after childbirth or in the first hours of life;

rapid hourly increase in bilirubin in the first hours of life 6.8 mmol / l);

low hemoglobin level (below 30 g/l). For exchange transfusion, one-group or 0(1) group Rh-negative red blood cells and plasma [single-group or AB(IV)] are used.

In case of conflict in the AB0 system, the erythrocyte mass should be 0 (1) of the group, suspended in the plasma of the AB (IV) group. In case of blood incompatibility due to rare factors, an individual selection of donors is carried out.

A ml of blood is removed from the newborn and the same amount of erythrocyte mass is injected. With repeated replacement transfusion, the dose is reduced by 2 times. Thus, the total volume of erythrocyte mass is 70 ml per 1 kg of the child's body weight.

Exchange transfusion is an effective way to remove toxic products of hemolysis from the body of a newborn, namely indirect bilirubin, antibodies, and incompletely oxidized products of interstitial metabolism. However, possible complications: heart failure, air embolism, infection, anemia, hemorrhagic syndrome, etc.

Phototherapy. In 1958 Cremer et al. found that light destroys indirect bilirubin. Therefore, a method of phototherapy was proposed - irradiation of the body of a newborn with a fluorescent lamp.

The yellow color of bilirubin is associated with the presence of a light absorption band in it in the blue region of the spectrum at a wavelength of 460 nm.

Phototherapy promotes the conversion of free bilirubin in the skin and capillaries into non-toxic metabolites (biliverdin), which are excreted in the urine and bile of the fetus. In this case, albumins lose their ability to bind bilirubin.

Light penetrates the skin of a newborn to a depth of 2 cm.

Indications for phototherapy are:

conjugative jaundice in full-term newborns with a level of indirect bilirubin in serum dokmol / l or more;

hemolytic disease of the newborn according to the Rh factor and group incompatibility;

condition after replacement blood transfusion in severe hemolytic disease;

prevention in newborns at risk for the development of hyperbilirubinemia (perinatal hypoxia, immature and premature newborns, impaired thermoregulation).

With phototherapy, the development of toxic effects in newborns is possible (erythema, dyspepsia, burns, hypohydration, "bronze baby syndrome"). At values of direct bilirubin in blood serum more than 85 µmol/l, phototherapy should be discontinued.

Therapy with intravenous immunoglobulins. Immunoglobulins (in high doses) block Fc receptors that are involved in the cytotoxic antigen-antibody reaction and thereby reduce hyperbilirubinemia.

Newborns are injected intravenously with ImBio-immunoglobulins at a dose of 800 mg/kg per day for 3 days in combination with phototherapy.

Thus, the complex therapy for hemolytic disease of the newborn, including exchange transfusion, phototherapy, and intravenous immunoglobulin, can reduce the frequency and severity of this pathology, as well as improve the health and prognosis of children's development.

It is believed that after the first pregnancy with an Rh-positive fetus, sensitization occurs in 10% of Rh-negative women. With each subsequent pregnancy, 10% are immunized with an Rh-positive fetus.

It is important to make an approximate calculation of the number of doses of immunoglobulin for obstetric institutions. Taking into account the literature data, it should be considered that out of 1000 giving birth, 170 will have Rh-negative blood. Of these, 100 women will have an Rh-positive child. Therefore, 100 doses of the drug are needed per 1000 births if it is administered to all women with Rh-negative blood who have given birth to children with Rh-positive blood.

With the strict implementation of the method of specific prevention of Rh sensitization, it is possible to practically solve the problem of Rh-conflict pregnancy.

Articles in this category:

Some nuances in the nutrition of children
Nutrition for preschoolers and schoolchildren
How is hemolytic disease of the newborn treated?
Jaundice in hemolytic disease of the newborn, why is it dangerous?
Hemolytic disease of the newborn

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Hemolytic disease in newborns by blood type and Rh factor: causes, consequences, treatment and prevention

Often in the first few days after birth, the baby's skin begins to rapidly turn yellow. This phenomenon is familiar to neonatologists, who immediately prescribe an examination of the baby and appropriate treatment.

However, not all young parents know how to properly respond to such a symptom and why it is dangerous for the child. Consider what the diagnosis of hemolytic disease means, what are the causes of jaundice and what should parents of a newborn do?

Hemolytic disease is a severe childhood illness

What is hemolytic disease and why is it dangerous?

Hemolytic disease is a rather serious condition of a newborn, in which a massive breakdown of red blood cells called hemolysis is noted in the baby's blood. Scientists explain this phenomenon by the difference in the composition of the blood of mother and child.

There are several varieties of this disease, but the most dangerous condition is caused by the incompatibility of the blood according to the Rh factor. This problem occurs in almost one hundred percent of cases in women who have a negative Rh. If the disease develops due to the difference in the blood groups of the mother and baby (according to the AB0 system), its course is less complicated.

More often, hemolytic disease of the newborn is manifested by a change in skin color - it acquires a yellow tint. However, this is only one of the symptoms of the development of the disease. The most dangerous manifestations can only be determined by the results of laboratory tests, ultrasound, dopplerography, reflex disorders.

A mild form of the disease can pass without consequences, however, it also requires the intervention of a specialist. If moderate to severe hemolytic jaundice in newborns is not treated, the baby may die. To date, there is a fully developed mechanism for the prevention and treatment of this dangerous condition, and therefore the scenario of the disease is favorable in most cases.

Causes of the disease in newborns

Why does pathology occur? Consider its main reasons. All people have a certain blood type. There are four of them - 0, A, B and AB (in domestic medicine, the designations I, II, III, IV are used). The group is assigned based on the composition of the blood in which antigens are present.

In addition to antigens, in the blood of most of the Caucasian population of the planet (about 85%) there are special erythrocyte proteins (D antigens) that determine the Rh factor. If this protein is not found in a patient, his blood belongs to the Rh-negative group.

The composition of the blood in a newborn may differ from the parent (according to genetic probability). If the mother and fetus have a different group or Rh factor, prerequisites for an immunological conflict arise.

What is this contradiction? The woman's body perceives the blood cells of the fetus as alien to him and begins to fight them, producing antibodies. These particles enter the baby's bloodstream through the placenta.

The described process can begin as early as the 8th week of pregnancy, when the Rh factor and blood type are formed in the fetus. However, more often the mass penetration of antigens through the placenta occurs at the time of delivery. As a result, the baby in the blood begins the process of disintegration of red blood cells - hemolysis.

Such a breakdown of red blood cells causes the accumulation in the tissues of the child's body of a bile pigment - bilirubin, which provokes damage to vital organs - the liver, spleen, and bone marrow. This component of bile is especially dangerous because it can penetrate the blood-brain barrier and disrupt the brain.

In addition, hemolysis significantly reduces the level of hemoglobin in the blood, and the baby develops anemia. Anemia is a rather dangerous condition for a newborn, as it contributes to oxygen starvation of tissues and organs.

The mismatch of blood according to the ABO system (that is, according to the group) usually does not lead to serious consequences. However, if during pregnancy a woman had ARVI, influenza or other infectious diseases, this increases the permeability of the placenta, which leads to the development of dangerous forms of the disease.

According to statistics, the disease often occurs in babies who do not match the Rh factor with maternal blood. However, some experts are sure that the immunological conflict in the ABO system is not a rare phenomenon, only its symptoms can be blurred and the diagnosis is often not made.

Classification and symptoms of hemolytic disease of the newborn

As we mentioned, hemolytic disease has several varieties. More precisely, there are four of them.

Icteric form of hemolytic disease

Let's take a closer look at these types:

The icteric form of hemolytic disease is especially common in newborns. This is a moderate severity type of the disease. It is characterized by the appearance of initial symptoms only on the next day after birth. The child is born with normal skin color and no visible pathologies. Then the skin of the baby acquires a yellowish tint, which gradually becomes brighter. The child may have depressed reflexes, enlarged liver, spleen.
Nuclear jaundice or bilirubin encephalopathy is a dangerous intoxication of the brain. The disease occurs with delayed therapy of the icteric type of the disease. Nuclear jaundice occurs in two stages. The initial phase is characterized by a relaxed posture of the baby, weak reactions to stimuli. The skin becomes bluish, convulsions occur, the baby's eyes are wide open. The next stage is spastic. The child is screaming, his muscles are tense, his breathing is ragged. This disease can lead to cerebral palsy, deafness, speech disorders.
The anemic form is the most harmless. In this condition, the child has reduced hemoglobin in the blood, the baby is lethargic, weakened, and sucks poorly at the breast. This type of disease occurs in every 10 sick newborn and has a favorable scenario.
The edematous variety is the most dangerous case of the disease. A child is born with characteristic edema in all cavities of the body - the heart sac, the pleural region, and the abdominal cavity. The skin has a yellow tint, with pronounced pallor. The liver and spleen are enlarged, blood tests show profound anemia. These symptoms can lead to heart failure and death while still in the womb or immediately after birth.

Diagnostic methods

Diagnosis of the disease is carried out at the stage of intrauterine development of the fetus and after birth. Consider the methods of natal and postnatal diagnosis.

If the mother's blood is Rh negative, even during pregnancy, the doctor collects data to draw up a picture of possible pathologies. A lot of information is taken into account: incompatibility of the blood of parents, abortions, miscarriages, previous births of the mother.

At least three times during pregnancy, a woman has a titer of anti-Rhesus antibodies. Alarming symptoms - spasmodic values, their stable growth, as well as a decrease in levels shortly before childbirth - may indicate the penetration of antibodies through the placenta.

If there is a risk of immune conflict, the doctor prescribes a study of amniotic fluid (bilirubin, protein, iron, glucose levels, etc. are determined). The results of ultrasound and Dopplerography are certainly taken into account - thickening of the placenta, polyhydramnios, blood flow velocity in the cerebral artery, etc.

If a pregnant woman has Rh negative blood, most likely doctors will insist on an analysis of amniotic fluid

Postnatal diagnosis is made on the basis of an examination of the infant after birth. This is the presence of jaundice, control of bilirubin in dynamics, erythroblastosis, hemoglobin levels in the blood, etc. All indications are considered as a whole. The immunological conflict in the ABO system, despite a favorable prognosis, also requires the attention of a doctor.

Differential diagnosis is carried out with conditions such as hereditary hemolytic jaundice, sepsis, hemorrhages, which can cause anemia. Cytamegalovirus infections and toxoplasmosis are also screened out.

Jaundice in newborns can be purely physiological in nature. Its occurrence is due to insufficient maturity of liver enzymes and the replacement of hemoglobin cells. As soon as the enzymes begin to be produced in the right amount, the baby's skin color takes on a normal shade. The described condition does not require treatment.

Features of treatment

Treatment of icteric and other types of hemolytic disease is based on the severity of its course. It is important to quickly rid the body of toxins - the decay products of red blood cells. Bilirubin lowering therapy is also required to stop the hemolysis process.

Hemolytic disease requires blood transfusion, hemosorption, or plasmapheresis

In difficult cases, blood transfusion is indicated, which is done to the fetus in utero or after birth. Other ways to eliminate symptoms are hemosorption (passing blood through special filters) and plasmapheresis (removal of plasma containing toxins from a limited volume of blood). However, exchange transfusion and other interventions have clear indications:

if indirect bilirubin in the cord blood exceeds 60 µmol / l or grows at a rate of more than 10 similar units per hour;
the hemoglobin level in the baby is critical - less than 100 g / l;
jaundice appeared immediately after birth or in the first 12 hours.

It should be remembered that blood transfusions often carry complications, most of which are associated with a violation of the technique of the procedure. Only fresh blood, stored for no more than 2 days, and a low transfusion rate are used. In addition, it is important that the red cell mass is close to body temperature in order to avoid cardiac arrest.

Babies with milder symptoms are treated conservatively. As a rule, this is:

in / in the introduction of glucose, protein;
the use of liver enzyme activators;
the appointment of absorbents that help bind and remove toxins from the body;
the use of vitamins and drugs that stimulate the liver and accelerate metabolic processes in the baby's body.

All children with signs of yellowing of the skin are prescribed phototherapy. This procedure involves exposing the skin to crumbs of fluorescent light (white or blue). Such activities remove indirect bilirubin from the body, transforming it into water-soluble substances.

Also, phototherapy is carried out in order to prevent the occurrence of hyperbilirubinemia, if there was fetal hypoxia, and violations of thermoregulation. Often the procedure is prescribed for premature babies.

You can start lactation with hemolytic disease only after the permission of the attending physician. As a rule, attachment to the breast is carried out only three weeks after birth. During this period, antibodies are completely removed from the mother's milk, but for now the baby is fed with a mixture or donor milk.

With HDN, it is not possible to apply the baby to the breast immediately, as a rule, lactation can begin at 3-4 weeks after birth

Vaccinations, which are customary to do in the hospital, with jaundice can be postponed. In particular, BCG is done a little later.

Consequences of hemolytic disease for a child

The consequences of hemolytic disease of the newborn may be absent altogether, and may be quite significant. It all depends on the form of the disease, as well as on the timeliness and adequacy of therapy. When diagnosing a mild form of hemolytic disease, by the end of the second week, all indicators of the child's health return to normal. Subsequently, the baby will grow and develop well according to his age.

If the level of bilirubin exceeded the critical values of 340 μmol / l, negative consequences are possible in the future. The short-term include the development of a nuclear form of the disease, when the baby's brain suffers from toxins. This form can lead to various mental disorders, the development of cerebral palsy, hearing loss.

The development of the nuclear form can be judged by the rigidity of the muscles at the back of the head, the protrusion of the fontanel, muscle twitching, and signs of suffocation. There are also other symptoms of this condition that neonatologists are aware of.

Babies who have had a severe form of HDN are registered with a neurologist, ophthalmologist and pediatrician

High levels of bilirubin may affect later. According to statistics, every third child with similar symptoms is diagnosed with neuropsychiatric disorders. In this regard, babies with a severe form of hemolytic disease after stabilization of the condition are registered with a neurologist, ophthalmologist and pediatrician.

Some of the children require a long period of rehabilitation, while others need only a couple of months for the final recovery. However, the observation of specialists is shown by both.

Preventive actions

Preventive measures include special monitoring of the condition of a pregnant woman who is at risk.

The following events are being held:

History taking - previous pregnancy blood transfusions, miscarriages, stillborn babies, abortions. This information will help assess the likely level of antigens in the patient's blood. The most vulnerable of them are those who have already given birth or with a history of abortions, since in these cases the body is already ready to “resist” and the likelihood of an immune conflict is high.
In critical cases, the doctor recommends an injection of anti-Rhesus immunoglobulin to suppress the production of antibodies. Such an injection will prevent problems with a new pregnancy.
Systematic monitoring of the blood of a pregnant woman for the presence of Rh antibodies. If their concentration increases, the patient is referred for preventive treatment.
Often the doctor prescribes the stimulation of labor after the 36th week of pregnancy. Premature birth is caused due to the high risk of hemolytic disease of the newborn, since it is in the last month of bearing a child that the permeability of the placenta increases and the exchange of blood cells between mother and child is activated.

My child and I had a mismatch in blood type and it manifested itself as mild jaundice. But the mother-in-law said that she was registered in the antenatal clinic, since she has a negative Rh. But it's okay - she gave birth to my husband and his sister without problems.

This is not the first time I hear about such problems and how they are solved. I wonder how it was before, when medicine was not yet so modern? Did the fetus just die? Or is this a problem of our time, and this has not happened before?

Attention! All information on the site is provided for informational purposes only and is for informational purposes only. For all questions of diagnosis and treatment of diseases, it is necessary to consult a doctor for an internal consultation.

Blood transfusions for children are performed for the same purposes as for adults. Often, not whole blood is transfused, but some of its components (serum or plasma, erythrocyte mass, etc.). Blood transfusion is widely used in surgical operations, as well as in acute blood loss, anemia of various etiologies, blood diseases, hemorrhagic diathesis, malnutrition, septic conditions, hypoproteinemia, etc. Blood plasma transfusion is indicated for toxicosis, coma, jaundice, and malabsorption syndrome.
Replacement transfusion is the main method of therapy for hemolytic disease of the newborn (see). In its severe forms, an exchange transfusion is indicated immediately after the birth of a child with the replacement of 70-75% of the total blood of the newborn.
The doses of blood transfused to children, the intervals and the number of transfusions vary widely. There are large doses, medium and small.
Relatively large doses are used with a substitution purpose at the rate of 10-15 ml per 1 kg of body weight of a child under 2 years old (for older children 100-300 ml, in rare cases up to 500 ml); average doses are determined at the rate of 5-8 ml per 1 kg of body weight (for older children 50-100 ml per infusion), small doses are used for stimulation - at the rate of 3-5 ml per 1 kg of body weight (for older children 25-30 ml for infusion).
Children are transfused with blood specially prepared in small containers. It is forbidden to transfuse blood from one ampoule to several children. In neonates, direct maternal blood transfusion is most desirable if compatible. Blood transfusion is performed by jet and drip methods.
Usually, blood transfusions for children are performed using venipuncture or venesection. For transfusion in a young child, not only the cubital vein, but also the temporal, jugular, and especially the subclavian can be used. In case of impossibility of intravenous blood transfusion, it can be transfused intraosseously (heel bone, iliac crest). The umbilical vein is used for replacement transfusion.
The doctor is obliged to substantiate and document in the medical history the need for blood transfusion, to determine the dose.
Before a blood transfusion, the blood group of the donor and recipient is checked, as well as the compatibility of the blood of the recipient and the donor. In order to prevent post-transfusion reactions and complications, calcium gluconate solution with novocaine is administered intravenously to children before blood transfusion, blood is transfused mainly by the drip method.
Along with blood transfusion, it is recommended to introduce blood substitutes to children, in particular protein hydrolysates (see).

Source - http://www.medical-enc.ru/15/perelivanie_krovi_child.shtml