Once HDN is diagnosed, treatment may be needed. Treatment for HDN can be divided to before delivery and after delivery for Rh HDN and ABO HDN.
Rh HDN
- If HDN is detected during pregnancy (before delivery) that is Rh HDN cases,
it will be treated using intrauterine transfusion (IUT). Intrauterine transfusion is done if the fetus if affected severely, transfusions will be done every 1 to 4 weeks until the fetus is mature enough to be delivered safely. Amniocentesis may be done to determine the maturity of the fetus's lungs before delivery is scheduled. It is given to the fetus to prevent hydrops fetalis and fetal death. This method can be done as early as 17 weeks, although preferable to wait until 20 weeks. After multiple IUTs, most of the baby’s blood will be D negative donor blood, therefore, the Direct Antiglobulin test will be negative, but the Indirect Antiglobulin Test will be positive. After IUTs, the cord bilirubin is not an accurate indicator of rate of hemolysis or of the likelihood of the need for post-natal exchange transfusion.
- IUTs procedure will be firstly done by sedating the mother, and an ultrasound image is obtained to determine the position of the fetus and placenta. After the mother's abdomen is cleaned with an antiseptic solution, she is given a local anesthetic injection to numb the abdominal area where the transfusion needle will be inserted. Medication may be given to the fetus to temporarily stop fetal movement. Ultrasound is used to guide the needle through the mother's abdomen into the fetus's abdomen or an umbilical cord vein. A compatible blood type (usually type O, Rh-negative) is delivered into the fetus's abdominal cavity or into an umbilical cord blood vessel. The mother is usually given antibiotics to prevent infection. She may also be given tocolytic medication to prevent labor from beginning, though this is unusual. The risk of these procedures is now largely dependent on the prior condition of the fetus and the gestational age at which transfusion is commenced.
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| Intrauterine Transfusion |
ABO HDN
- Different from Rh HDN, ABO HDN is treated after delivery. Treatments after delivery are phototherapy and newborn transfusion. In mild HDN cases phototherapy is the treatment of choice. Phototherapy process slowly decomposes/converts bilirubin into a nontoxic isomer, photobilirubin, which is transported in the plasma to the liver. HDN is judged to be clinically significant (phototherapy treatment) if the peak bilirubin level reaches 12 mg/dL or more.
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| Phototherapy Treatment for mild jaundice. |
- In severe HDN, newborn transfusion is the treatment of choice. Physician will ask for newborn transfusion if the total serum bilirubin level is approaching 20 mg/dL and continues to rise despite intense in-hospital phototherapy.
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| Difference between normal baby and baby with severe jaundice. |
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| Newborn Transfusion |
