Rhesus disease Treatment in UAE

Overview Of Rhesus disease

Rhesus disease, also known as hemolytic disease of the fetus and newborn (HDFN), is a condition that occurs when there is an incompatibility between the blood types of a pregnant woman and her fetus. Specifically, it arises when a Rh-negative mother carries a Rh-positive fetus, leading to the mother's immune system producing antibodies against the fetal red blood cells. These antibodies can cross the placenta and destroy the fetus's red blood cells, causing anemia, jaundice, and, in severe cases, hydrops fetalis (fluid accumulation in fetal tissues) or stillbirth. Rhesus disease is preventable through the administration of Rh immunoglobulin (RhIg) to Rh-negative mothers during pregnancy and after delivery.

Symptoms of Rhesus disease

The symptoms of Rhesus disease vary depending on the severity of the condition and may include:
Jaundice: Yellowing of the skin and eyes due to elevated bilirubin levels.
Anemia: Pale skin, lethargy, and rapid heart rate in the newborn.
Hydrops fetalis: Severe fluid accumulation in the fetus, leading to swelling and heart failure.
Enlarged liver or spleen: Due to increased red blood cell breakdown.
Kernicterus: A severe form of jaundice causing brain damage, characterized by high-pitched crying, poor feeding, and seizures.
Stillbirth: In untreated or severe cases. Early recognition of these symptoms is crucial for timely intervention.

Causes of Rhesus disease

Rhesus disease is caused by an immune response in a Rh-negative mother to the Rh-positive blood of her fetus. Key factors include:
Rh incompatibility: The mother is Rh-negative (lacks the RhD antigen), and the fetus is Rh-positive (inherits the RhD antigen from the father).
Sensitization: Occurs when fetal Rh-positive blood enters the mother's bloodstream, typically during delivery, miscarriage, or invasive prenatal procedures.
Antibody production: The mother's immune system produces anti-RhD antibodies, which can cross the placenta in subsequent pregnancies and attack fetal red blood cells.
Lack of RhIg prophylaxis: Failure to administer Rh immunoglobulin to prevent sensitization. Understanding these causes helps in implementing preventive measures.

Risk Factors of Rhesus disease

Several factors increase the risk of Rhesus disease, including:
Rh-negative mother with Rh-positive fetus: The primary risk factor.
Previous sensitization: From a prior pregnancy, miscarriage, or blood transfusion.
Invasive prenatal procedures: Such as amniocentesis or chorionic villus sampling.
Trauma during pregnancy: Leading to fetomaternal hemorrhage.
Lack of RhIg prophylaxis: In previous pregnancies or after sensitizing events.
Multiple pregnancies: Increased risk of fetomaternal hemorrhage. Identifying these risk factors helps in implementing preventive measures.

Prevention of Rhesus disease

Preventing Rhesus disease involves the administration of Rh immunoglobulin (RhIg) to Rh-negative mothers:
Antenatal RhIg: Given at 28 weeks of pregnancy to prevent sensitization.
Postnatal RhIg: Administered within 72 hours of delivery if the baby is Rh-positive.
After sensitizing events: Such as miscarriage, abortion, or invasive procedures.
Education and awareness: Promoting the importance of RhIg prophylaxis.
Routine screening: For Rh status and antibodies during prenatal care.
Monitoring high-risk pregnancies: For early detection and intervention. These measures are essential for reducing the incidence of Rhesus disease.

Prognosis of Rhesus disease

The prognosis for Rhesus disease depends on the severity of the condition and the timeliness of intervention. With early diagnosis and appropriate treatment, most affected newborns recover fully. However, severe cases, particularly those involving hydrops fetalis or kernicterus, can lead to long-term complications or death. Prevention through RhIg prophylaxis has significantly reduced the incidence and severity of Rhesus disease, leading to improved outcomes.

Complications of Rhesus disease

Rhesus disease can lead to several complications, especially if untreated or in severe cases:
Severe anemia: Requiring multiple transfusions.
Kernicterus: Leading to brain damage, cerebral palsy, or developmental delays.
Hydrops fetalis: Causing heart failure, respiratory distress, or stillbirth.
Chronic jaundice: Prolonged hyperbilirubinemia affecting liver function.
Neurological deficits: From untreated kernicterus.
Death: In severe or untreated cases. Early intervention and supportive care can mitigate these risks.

Related Diseases of Rhesus disease

Rhesus disease is often associated with other conditions, including:
ABO incompatibility: A milder form of hemolytic disease due to blood group differences.
Other blood group incompatibilities: Such as Kell or Duffy antigens.
Hemolytic anemia: From other causes, such as autoimmune disorders.
Neonatal jaundice: Due to other factors like G6PD deficiency or sepsis.
Hydrops fetalis: From non-immune causes like genetic disorders or infections.
Kernicterus: Resulting from severe hyperbilirubinemia of any cause. Understanding these related diseases is crucial for comprehensive care and management.

Treatment of Rhesus disease

The treatment of Rhesus disease depends on the severity of the condition and may include: 1. **Intrauterine transfusions**: To treat severe fetal anemia by transfusing Rh-negative blood into the fetus. 2. **Early delivery**: If the fetus is mature enough to survive outside the womb. 3. **Phototherapy**: To reduce bilirubin levels in the newborn and prevent kernicterus. 4. **Exchange transfusion**: To replace the newborn's blood with Rh-negative blood in severe cases of jaundice or anemia. 5. **RhIg administration**: To prevent sensitization in future pregnancies. 6. **Supportive care**: Including oxygen therapy and monitoring for complications. These treatments aim to manage symptoms and prevent long-term damage.