Evolving Strategies in the Diagnosis and Management of Hemolytic Disease of the Fetus and Newborn
Measurement of amniotic levels of bilirubin (ΔOD450), once the mainstay for surveillance of pregnancies at risk for HDFN, has been relegated to the annals of the history of Rh disease. Two decades have passed since the first reported use of a Doppler ultrasound measurement of the middle cerebral artery peak systolic velocity (MCA-PSV) of the fetus to detect moderate to severe anemia.8 Once a critical maternal titer has been reached in an alloimmunized pregnancy and the fetus is found to be at risk based on its antigen status, MCA Dopplers are performed every 1 to 2 weeks starting as early as 16 weeks’ gestation (see FIGURE). An increasing value that reaches a threshold of 1.5 multiples of the median for the corresponding gestational age warrants the need for cordocentesis and probable IUT.
Abbreviations: EGA, estimated gestational age; Hct, hematocrit; IUFD, intrauterine fetal demise; IUTs, intrauterine transfusions; IVIG, intravenous immunoglobulin; MCA, middle cerebral artery; MoM, multiples of median; Q, every; RhD, rhesus blood group D.
Kenneth J. Moise, Jr., MD
Department of Obstetrics, Gynecology and
McGovern School of Medicine – UT Health
The Fetal Center
Children’s Memorial Hermann Hospital
To receive CME credit, please read the articles and go to www.omniaeducation.com/HDFN to access the posttest and evaluation.
Hemolytic disease of the fetus and newborn (HDFN) is a rare condition with an estimated 3 to 80 cases per 100,000 persons annually in the United States. Nonetheless, the complexity and increased risk for adverse outcomes in such cases requires more targeted approaches to HDFN that minimize or negate the risks associated with intrauterine transfusion.
This article focuses on the pathophysiology underlying fetal/newborn allo- and autoimmune diseases, especially HDFN and the current/evolving diagnostic and treatment regimens for HDFN.
- Sean T. Barrett has nothing to disclose.
- Barry A. Fiedel, PhD has nothing to disclose.
- Amanda Hilferty has nothing to disclose.
- Kenneth J. Moise, Jr., MD receives royalties from Up-To-Date, Inc. and has contracted research with Momenta Pharmaceuticals Inc.
- Robert Schneider, MSW, has nothing to disclose.
- Lee Philip Shulman, MD, FACOG, FACMG, receives consulting fees from Biogix, Celula, Cooper Surgical, Natera, and Vermillion Aspira, is a speaker for Bayer, Lupin Pharmaceuticals, Inc., and Myriad.
After participating in this educational activity, participants should be better able to:
- Explain the pathophysiology underlying fetal/newborn allo- and autoimmune diseases, with a focus on HDFN.
- Identify current diagnostic and treatment regimens for HDFN.
- Explain the role of the neonatal Fc receptor pathway as a therapeutic means to address HDFN.
ACCREDITATION AND CREDIT DESIGNATION STATEMENTS:
Global Learning Collaborative is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Global Learning Collaborative designates this enduring material for a maximum of .25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This activity is supported by an independent educational grant from Momenta Pharmaceuticals.
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