By Momina Shehzadi
In this article we will learn about Erythroblastosis Fetalis ,Causes, Symptoms & Prevention.This topic is very important for BS zoology students.
Introduction
In our previous post, we studied in detail about ABO and Rh blood group system. After reading that post, many BS Zoology students asked me a very important question: What will happen if an Rh-negative woman marries an Rh-positive man? Will their baby be healthy? The answer to this question is directly connected to a very serious clinical condition known as Erythroblastosis Fetalis. It is also called Hemolytic Disease of the Newborn or HDN. This topic is extremely important for BS Zoology 5th semester, FSc Biology, and all MLT and Nursing exams. In this article, I will explain its causes, symptoms, and prevention with a simple diagram.
What is Erythroblastosis Fetalis? Definition with Word Meaning
Erythroblastosis Fetalis is a blood disorder in which the red blood cells of the fetus are destroyed by antibodies coming from the mother.
Let's understand the word: Erythro means Red, Blasto means immature, osis means condition, and Fetalis means fetus. So it means presence of immature red blood cells (erythroblasts) in fetal blood. Why immature? Because when mother's antibodies destroy baby's mature RBCs, baby's bone marrow starts releasing immature RBCs early to compensate for anemia.
This condition occurs ONLY in one case: Mother is Rh-negative (dd) and Fetus is Rh-positive (Dd or DD).
Detailed Causes - Concept of Rh Incompatibility
To understand this disease, you must understand Rh incompatibility. It happens in two steps.
Step 1: First Pregnancy - Why First Baby is Always Safe?
When an Rh-negative mother (dd) is pregnant with her first Rh-positive baby, the pregnancy is completely normal for 9 months. The reason is that mother's blood and baby's blood never mix because of the placental barrier. The problem starts only at the time of birth. During delivery, due to small cuts in placenta, about 2-5 ml of baby's Rh-positive blood enters mother's circulation. Mother's immune system is very intelligent. It sees the Rh antigen (D antigen) on baby's RBCs as a foreign particle. So it starts an immune response and produces Anti-Rh antibodies (IgM type initially). This process is called sensitization. But by this time, the first baby has already been delivered safely. So first baby never suffers.
Step 2: Second Pregnancy - Why Second Baby is Affected?
This is the dangerous stage. Now mother is sensitized, meaning she already has memory cells. If her second fetus is again Rh-positive, mother's Anti-Rh IgG antibodies are very small in size. They can easily cross the placenta and enter fetal blood circulation. Once inside fetal blood, they attach to fetal Rh-positive RBCs and destroy them by hemolysis. The fetal liver tries to make more RBCs, but fails, leading to severe anemia.
Comparison for Exam: First vs Second Pregnancy
1. First Pregnancy:
- Mother's Antibodies: No antibodies initially, sensitization happens after delivery
- Effect on Baby: Baby is completely SAFE and healthy
- Type of Antibody: Mother makes IgM which cannot cross placenta
- Result: Normal delivery
2. Second Pregnancy:
- Mother's Antibodies: Antibodies already present from first pregnancy
- Effect on Baby: Baby is AFFECTED badly
- Type of Antibody: Mother makes IgG which CAN cross placenta
- Result: Destruction of fetal RBCs, anemia, jaundice
Symptoms of Erythroblastosis Fetalis in Baby
1. Severe Anemia:
Because RBCs are continuously destroyed.
2. Jaundice:
After birth, baby becomes yellow within 24 hours due to high bilirubin.
3. Hepatosplenomegaly:
Liver and spleen become enlarged because they start making blood outside bone marrow.
4. Hydrops Fetalis:
In very severe cases, fluid accumulates in baby's body and baby may die inside womb.
Prevention and Treatment - The Miracle of Rhogam Injection
This disease was a big problem 50 years ago, but now it is almost finished due to one injection.
What is Rhogam Injection?
It is called Rho(D) Immune Globulin. It contains ready-made antibodies against Rh antigen.
When to give?
It must be given to Rh-negative mother within 72 hours after first delivery, abortion, miscarriage, or ectopic pregnancy. Also a dose is given at 28 weeks of pregnancy as a routine.
How does it work?
The injected antibodies quickly find and destroy any fetal Rh-positive cells present in mother's blood. So mother's own immune system does not get a chance to make its own permanent memory cells. She remains unsensitized for next pregnancy.
Important MCQs for Exam:
1. Erythroblastosis fetalis occurs when mother is __? Ans: Rh-negative
2. Which antibody crosses placenta in this disease? Ans: IgG
3. Rhogam injection should be given within __? Ans: 72 hours
Conclusion
So dear students, Erythroblastosis fetalis is not a genetic disease. It is an excellent example of mother-fetal immune incompatibility. With proper knowledge of blood groups before marriage and timely use of Rhogam injection, we can save the lives of thousands of newborns. I hope your concept is now 100% clear.
If you have not read our previous post, first read about ABO and Rh Blood Group System in detail.
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