Hemolytic Disease of the Newborn: A study of 50 cases

Background: Hemolytic disease of the Newborn (HDN) is characterized by the presence of IgG antibodies in maternal circulation, which causes hemolysis in the fetus by crossing the placenta and sensitizing red cells for destruction by macrophages in the fetal spleen with consequent hyperbilirubinemia. Aim: The present study was carried out to evaluate the importance of various etiologies of Hemolytic Disease of Newborn in our hospital, to study the effect of sex, birth weight, gravidity of the mother and blood group in the outcome of disease and also to study the efficacy of Direct Antiglobulin test on predicting the outcome of alloimmune HDN. Methods: Infants with indirect hyperbilirubinemia were taken as subjects and were compared with a control group of healthy infants. Patients were divided into two groups. Patients with indirect bilirubin less than 12 mg/dl and having mild disease were classified into Group A and patients having indirect bilirubin more than 12 mg/dl were labeled as Group B. Result: Out of the 50 patients studied, 23 belonged to group A and remaining 27 to group B. Group C (control group) comprised of 50 healthy infants. ABO incompatibility was the leading cause of hemolysis (in 48%) followed by Rh incompatibility (in 22%), septicemia in 26% and G6PD deficiency in 4%. Conclusions: In our study, we concluded that alloimmune hemolytic anemia due to ABO incompatibility is the most common cause of HDN. Gender of the baby and gravidity of the mother does not affect the outcome of disease process. However HDN due to Rh antibodies is uncommon in primigravida. Direct Antiglobulin test of baby has a strong predictive value determining the outcome of alloimmune hemolytic disease of newborn but it does not predict the severity of disease.