Hemolitic disease of newborns
Contents:
Description:
Hemolitic disease of newborns - the hemolitic jaundice of newborns caused by an immunological havoc between mother and a fruit because of incompatibility on erythrocyte antigens.
Symptoms of the Hemolitic disease of newborns:
Distinguish three forms of hemolitic anemia: edematous, icteric, anemic. The edematous heaviest is also characterized by the general hypostasis at the birth, accumulation of liquid in cavities (a pleural, cordial bag, belly), sharp pallor with yellowness, increase in a liver, spleen. In blood tests sharp anemia, a significant amount normo-and erythroblasts. The combination of sharp anemia and a hypoproteinemia promotes development of heart failure which leads to death (vnutriutrobno or right after the birth). Icteric form - the most frequent clinical form; it is shown for the 1-2nd day of life of the child. Jaundice is noted, the liver and a spleen increase, pastosity of fabrics is observed. Children are sluggish, adynamic, badly suck. Reflexes are lowered. Anemia (level of hemoglobin lower than 160 g/l), a pseudo-leukocytosis, a reticulocytosis, eritro-and нормобластоз is expressed. A bright ghost is the increased maintenance of an indirect bilirubin in blood (100-265-342 µmol/l and more). Urine dark, kcal of usual coloring. Further the increased contents and direct bilirubin can be observed. Bilirubinovy intoxication is characterized by slackness, vomiting, vomiting, pathological yawning, decrease in a muscle tone. Then there are classical symptoms of a kernicterus: a muscle hyper tone, a stiff neck, an opisthotonos, sharp "brain" shout, a hyperesthesia, protrusion of a big fontanel, twitching of muscles, spasms, a positive symptom setting the sun, a nystagmus, an apnoea and a full apnoea. In 2-3 weeks the condition of the patient improves, however in the subsequent signs children's це rebralny paralysis come to light (an athetosis, a choreoathetosis, paralyzes, paresis, a delay of psychophysical development, deafness, a dysarthtia, etc.) The anemic form - the most high-quality, meets in 10-15% of cases and is shown by pallor, small appetite, slackness, increase in a liver and spleen, anemia, a reticulocytosis, normoblastozy, moderate increase in bilirubin.
Reasons of the Hemolitic disease of newborns:
The disease is caused by incompatibility of a fruit and mother on D-rezus-or AVO-antigens, incompatibility on others a Rhesus factor takes place less often - (With, E, with, d, e) or M - M - to Kell-, Duffy-, Kidd-antigens. Pathogeny. Any of the specified antigens (D-Rh-Hr antigen is more often), getting into blood of Rh-negative mother, causes education in her organism of specific antibodies. The last through a placenta come to fruit blood where destroy the corresponding antigensoderzhashchy erythrocytes.
Treatment of the Hemolitic disease of newborns:
Treatment can be both conservative, and operational (according to indications). Conservative treatment: in/in injections of 5% of solution of glucose; ATP, Erevitum, phenobarbital on 10 mg/(kg-days), an agar-agar on 0,1 g Z times a day, 12,5% solution of xylitol or magnesium sulfate on 1 teaspoon 3 times a day, phototherapy (lamps of blue or blue color, a session of 3 bucketed h 2 h, all in days the radiation time makes 12-16ch).
Operational treatment: the absolute indication to zamenny hemotransfusion is the hyperbilirubinemia higher than 342 µmol/l, with rate of increase of bilirubin it is higher than 6 µmol / (l Ђ h) and at level of it in umbilical blood higher than 60 µmol/l. In most cases zamenny hemotransfusion is carried out on Daymond's way through a funic vein by means of a polyethylene or metal catheter. For these purposes use svezhekonservirovanny odnogruppny blood (better Rh-negative). Calculation-120 - 170 ml of blood on 1 kg of body weight.
The current and the forecast of a disease depend on a form. At the level of bilirubin of 257-342 µmol/l and more even if the kernicterus did not develop, almost at 1/3 children deviations in the psychological status take place. If zamenny hemotransfusion is carried out, then within 1-2 months it is observed normokhromny hypo - or normoregeneratorny anemia.
For prevention of all pregnant women inspect on a Rhesus factor accessory. At a Rh-negative blood at the pregnant woman each 1-1,5 months define a caption of anti-Rh antibodies. At increase of a caption introduction anti-is shown D - globulin. Preservation of the first pregnancy and a break of 4-5 years before the subsequent is recommended. The children who had a hemolitic disease of newborns are on the dispensary account with monthly survey of the neuropathologist, orthopedist, oculist. It is challenged from inoculations by duration till 1 year.
