Haemorrhagic and Haemolytic Disease of the Newborn
Haemorrhagic Disease of the Newborn
• Haemorrhagic disease of a newborn is a bleeding disorder caused by deficiency of
vitamin K-dependent clotting factors, factors II, VII, IX and X
• The bleeding usually occurs 24 hours after delivery, but can be seen within hours of birth
• It is more common in preterm babies than in the babies born at term
• It occurs from injection sites and cord stump, but also from the nose and the
gastrointestinal tract.
Common Clinical Features
• Bleeding (spontaneous or at injection site)
• Pallor
• Signs of shock
• Prolonged bleeding time
• Prolonged prothrombin time.
Management
• Haemoglobin level, blood grouping and cross match
• Stop visible bleeding (e.g. umbilical stump) with direct pressure and bandaging
• I.M. Vitamin K1 1 to 2mg stat
• Blood transfusion with fresh blood.
Haemolytic Disease in Newborn •Haemolysis of foetal erythrocytes is a result of blood group differences between the
sensitized mother and foetus
• A mother is ‘sensitized’ when she and the foetus have blood group incompatibility,
causing production of maternal IgG antibodies directed against an antigen on foetal cells.
Causes • Rhesus blood incompatibility
o Antibodies are produced when the body is exposed to an antigen foreign to the makeup of the body
o Rhesus negative women do not develop natural IgM antibodies, and most Rh negative
women have no anti-Rh antibodies at the time of their first pregnancy
o If a mother is exposed to a foreign antigen and produces IgG (as opposed to IgM,
which does not cross the placenta), the IgG will target the antigen, if present in the
foetus, and may affect it in utero and persist after delivery
o In majority of Rh negative women, the D antigen of the foetus sensitizes the Rh
negative mother resulting in IgG antibody production during the first pregnancy
o The first ‘Rhesus mismatched’ pregnancy results in an antibody response in the
mother
o The first child is usually not affected or may develop only anaemia and
hyperbilirubinemia, the subsequent children are affected from mild form to severe
form
o Subsequent pregnancy result in an increasing severity of responses
Foetal anaemia, heart failure, elevated venous pressure, portal vein obstruction
and hypoalbuminemia result in foetal hydrops
• ABO blood incompatibility
o This develops only if the mother has IgG antibodies from the previous exposure to A
and B antigens
o It is most severe in pregnant women who are blood group O, carrying foetuses who
are not blood group O
o This IgG cross the placenta by active transport and affect the foetus or newborn.
Clinical Presentation • Jaundice
• Pallor
• Signs of infections like fever, vomiting or hypothermia
• Signs of hydrops foetalis like gross oedema, hepatomegaly, ascites and pleural effusion.
Management • If a child has signs of infection, give broad spectrum antibiotics (ampicillin 50mg/kg IM
stat), then refer to hospital
• Refer for exchange transfusion/phototherapy
• Prevent the development of anti-Rh IgG antibodies in rhesus negative mothers carrying
an Rh-positive foetus by giving anti-Rh-positive immunoglobulin (RhoGAM) 300mcg
between 28 and 32 weeks and within 72 hours after delivery
Key Points • Haemorrhagic disease of the newborn is a common neonatal disease cause by a
deficiency of vitamin K-dependent clotting factors.
• Management of haemorrhagic disease is by fresh blood transfusion and vitamin K
injection.
• Haemolytic disease of the newborn is a Rhesus incompatibility disease that leads to
haemolysis of foetal red blood cells. • Haemolytic disease presents with severe anaemia, jaundice and oedema and ascites
(hydrops foetalis) in severe cases.
• Haemolytic disease is managed by exchange blood transfusion and phototherapy.
References • Behrman, R.E., & Kliegman, R.M. (2002). Nelson Essentials of Paediatrics. (4th ed.)
Pennsylvania: Saunders Company.
• Beattie, J., & Carachi, R. (2005). Practical Paediatric Problems (International student
Edition) London: Hodder Arnold.
• Coovadia, H.M., et al. (2001). Paediatrics and Child Health: A Manual for Health
Professionals in the Third World. (4th ed.). Cape Town, South Africa: Oxford University
Press.
• Stanfield, P., & Bwibo, N. (2005). Child Health: A Manual for Medical and Health
Workers in Health Centres and Rural Hospitals. (3rd ed.) Nairobi: AMREF.
• Swash, M., & Glynn, M. (2007). Hutchinson’s Clinical Methods. (22nd ed.) USA:
Saunders.
• Swai, M., et al. (2009). KCMC Paediatric Management Schedule. (7th ed.) Moshi,
Tanzania: Kilimanjaro Christian Medical Centre.