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A liver ultrasound would be useful in diagnosing biliary atresia, serious but rare cause of neonatal jaundice. However, biliary atresia usually develops around three weeks after birth. This history is more in keeping with an acute haemolytic cause for jaundice than a structural issue
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Liver ultrasound
QuestionChoice
This history suggests rhesus haemolytic disease of the newborn, as this is a woman in her second pregnancy, and the jaundice is apparent in the first 24 hours after birth. You would therefore expect a positive direct Coombs test. A direct Coombs test is used to test for autoimmune haemolytic anaemia where the immune system breaks down red blood cells, leading to anaemia. The direct Coombs test is used to detect antibodies or complement proteins attached to the surface of red blood cells
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Direct Coombs test
QuestionChoice
An indirect Coombs test looks at antibodies floating freely in the blood and, therefore, can be used in prenatal testing for pregnant women or in testing prior to blood transfusion. A positive indirect Coombs would not diagnose the cause for haemolysis in this case
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Indirect Coombs test
QuestionChoice
Breastfeeding is a common cause for prolonged jaundice in newborns; however, it would not develop in the first few hours of life. Visible jaundice in the first 24 hours of life is always abnormal
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Withdrawal of breastfeeding
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Whilst liver function tests would help confirm whether this was true jaundice, they would not help diagnose the underlying cause
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Liver function tests
QuestionComment
I'm confused - are we testing the mum or the baby?
Indirect Coombs test would be positive in the baby due to the alloimmune destruction wouldn't it? 
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The baby 
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Fronk
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Myotonia Chronic
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good question

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Dorsal RNA
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# Summary

Haemolytic Disease of the Newborn (HDN) is an immunological disorder that occurs when a rhesus negative mother becomes sensitised to her baby's rhesus positive blood cells in utero. Key signs and symptoms include hydrops foetalis, yellow amniotic fluid, neonatal jaundice, kernicterus, foetal anaemia, hepatomegaly or splenomegaly, and severe oedema if hydrops foetalis was present in utero. It is vital to identify and manage HDN to prevent complications including neurodevelopmental issues and foetal death. Key investigations include Direct Antiglobulin Test (DAT), Ultrasound, and LFTs. Management strategies include intrauterine transfusions, early delivery, and postnatal management with phototherapy or exchange transfusion.


# Definition



Haemolytic Disease of the Newborn (HDN) is an immunological condition that arises when a rhesus negative mother becomes sensitised to the rhesus positive blood cells of her baby while in utero.


# Epidemiology



HDN is relatively rare, but it can have serious consequences if not properly managed. It is most common in pregnancies where there is blood group incompatibility between the mother and the foetus. 


# Aetiology



HDN occurs due to immune response following rhesus or ABO blood group incompatibility between the mother and foetus. The sensitisation events are responsible for enabling foetal blood to cross the placenta into the maternal circulation. These events include antepartum haemorrhage, placental abruption, abdominal trauma, external cephalic version, invasive uterine procedures such as amniocentesis and chorionic villus sampling, rhesus positive blood transfusion to a rhesus negative woman, intrauterine death, miscarriage or termination, ectopic pregnancy, and delivery.


# Signs and Symptoms


The features of haemolytic disease of the newborn include:

- Hydrops foetalis appearing as foetal oedema in at least two compartments, seen on antenatal ultrasound
- Yellow coloured amniotic fluid due to excess bilirubin
- Neonatal jaundice and kernicterus
- Foetal anaemia causing skin pallor
- Hepatomegaly or splenomegaly
- Severe oedema if hydrops foetalis was present in utero


# Differential Diagnosis


It is important to differentiate HDN from other conditions that can present with similar symptoms, including:

- Spherocytosis: Characterised by haemolytic anaemia, jaundice, and splenomegaly
- G6PD deficiency: Causes episodic haemolysis, jaundice and pallor
- Thalassemia: Presents with anaemia, hepatosplenomegaly, and jaundice

# Investigations


Investigations for HDN include:

- Direct Antiglobulin Test (DAT)
- Ultrasound to detect foetal oedema
- Liver function tests (LFTs) to check for complications

# Management


Management of HDN includes:

- Intrauterine transfusions if severe anaemia is detected in the foetus
- Early delivery if the condition is severe
- Postnatal management with phototherapy or exchange transfusion to manage high bilirubin levels
- Immunoglobulin administration to the newborn to prevent further haemolysis
- Regular follow-up to assess for any developmental issues
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Haemolytic disease of the newborn
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Obstetrics
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Haemolytic disease of the newborn
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Quesmed Tutorial: Haemolytic Anaemia
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Haemolytic disease of the newborn
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Haemolytic disease of the newborn
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Rhesus haemolytic disease of the newborn typically presents with jaundice within 24 hours of birth and is confirmed by a positive direct Coombs test.
A 28-year-old female gives birth to her second child at full term following an uneventful pregnancy. You check on the baby three hours after delivery, and you notice that the neonate is jaundiced. Observations are otherwise normal.

What test would confirm your diagnosis?
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