Ostalo
THE IMPORTANCE OF ANTENATAL IMMUNOPROPHYLAXIS FOR PREVENTION OF HEMOLYTIC DISEASE OF THE FETUS AND NEWBORN
MIRTA STARČEVIĆ
; Klinika za pedijatriju, Klinička bolnica „Sestre milosrdnice“, Zagreb, Hrvatska
MARINA MATAIJA
; Klinika za pedijatriju, Klinička bolnica „Sestre milosrdnice“, Zagreb, Hrvatska
DRAGICA SOVIĆ
; Zavod za transfuziju, Klinička bolnica „Sestre milosrdnice“, Zagreb, Hrvatska
JAVORKA DODIG
; Zavod za transfuziju, Klinička bolnica „Sestre milosrdnice“, Zagreb, Hrvatska
RATKO MATIJEVIĆ
; Klinika za ginekologiju i porodništvo, Opća bolnica “Sveti Duh“, Zagreb, Hrvatska
MONIKA KUKURUZOVIĆ
; Klinika za pedijatriju, Klinička bolnica „Sestre milosrdnice“, Zagreb, Hrvatska
Sažetak
Hemolytic disease of the fetus and newborn (HDFN) is a consequence of maternal alloimmunization against fetal red blood cell antigens. Alloimmunization against D antigen from Rhesus (Rh) blood group system is particularly important because of its strong immunogenicity. During the last few decades, the introduction of RhD prophylaxis by postpartum administration of anti-D immunoglobulin to RhD negative women, now improved with antenatal prophylaxis, has led to a dramatic decrease in perinatal mortality and morbidity from HDFN. However, severe cases have not disappeared, mostly due to prophylaxis failure. In our case, inappropriate prenatal care during the first pregnancy in an RhD negative mother resulted in primary immunization. In the next pregnancy with an RhD positive child, the mother’s secondary immune response was extremely strong and led to early development of severe fetal anemia. The fetus survived thanks to the treatment with intrauterine transfusions (IUT), but they caused suppression of erythropoiesis, which lasted for months after birth. The long lasting, late anemia was treated with repeated postnatal red cell transfusions and recombinant human erythropoietin (rHuEPO). Despite the severity of HDFN in our case, the short-term outcome is good. The boy has normal growth until now, but due to the possibility of an adverse long-term neurodevelopmental outcome, this case requires continuous follow up. It also reminds of the fact that RhD alloimmunization remains an actual problem in daily routine. Antenatal prophylaxis is a crucial step in quality care of those who are at a risk of HDFN.
Ključne riječi
RhD alloimmunization; hemolytic disease of the fetus and newborn; antenatal prophylaxis
Hrčak ID:
86133
URI
Datum izdavanja:
1.3.2011.
Posjeta: 3.863 *