Hemolytic Disorders and Congenital Anomalies

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Lowdermilk: Maternity & Women’s Health Care, 10th Edition

Chapter 36: Hemolytic Disorders and Congenital Anomalies

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This section discusses key points about hemolytic disorders. ·Hyperbilirubinemia is a condition in which the total serum bilirubin level is increased. It is characterized by jaundice, a yellow discoloration of the skin, mucous membranes, and sclerae. Jaundice primarily results from accumulation of unconjugated bilirubin, which is a product of hemoglobin breakdown. ·Although physiologic jaundice is common and usually benign, pathologic jaundice is serious and can lead to acute bilirubin encephalopathy, which is associated with acute and chronic neurologic damage. ·Pathologic hyperbilirubinemia can result from various causes. The most common causes are hemolytic diseases of the newborn, which usually occur when the blood groups of the mother and neonate are different. ABO and Rh factor incompatibilities are the most likely hemolytic diseases. ·Rh incompatibility occurs when an Rh-negative mother has an Rh-positive fetus who inherits the Rh-positive gene from the father. oSevere Rh incompatibility results in marked fetal hemolytic anemia. The fetus compensates by producing excessive immature erythrocytes, which causes erythroblastosis fetalis. oErythroblastosis fetalis leads to anemia, cardiac decompensation, cardiomegaly, hepatosplenomegaly, and generalized edema. Fetal or neonatal death can result. ·ABO incompatibility is more common than Rh incompatibility, but usually results in milder anemia. ABO incompatibility occurs if the fetal blood type is A, B, or AB, and the maternal blood type is O. ·The nurse should determine women’s blood type and Rh factor prenatally and should take steps to prevent sensitization in Rh-negative women. ·In Rh-negative and Coombs’ test–negative women, injection of Rho(D) immunoglobulin confers passive immunity and minimizes the risk of isoimmunization. ·Neonatal exchange...
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