Untold Stories of the E.R.: Extra Dose is a series that airs Extended Enhanced Episodes with extra information and unseen footage from the show "Untold Stories of the E.R." that also airs on TLC.
Runtime: 60 minutes
Untold Stories of the E.R.: Extra Dose - Hemolytic disease of the newborn - Netflix
Hemolytic disease of the newborn, also known as hemolytic disease of the fetus and newborn, HDN, HDFN, or erythroblastosis fetalis, is an alloimmune condition that develops in a peripartum fetus, when the IgG molecules (one of the five main types of antibodies) produced by the mother pass through the placenta. Among these antibodies are some which attack antigens on the red blood cells in the fetal circulation, breaking down and destroying the cells (hemolysis). The fetus can develop reticulocytosis and anemia. This fetal disease ranges from mild to very severe, and fetal death from heart failure (hydrops fetalis) can occur. When the disease is moderate or severe, many erythroblasts (immature red blood cells) are present in the fetal blood, and so these forms of the disease can be called erythroblastosis fetalis (or erythroblastosis foetalis). HDFN represents a breach of immune privilege for the fetus or some other form of impairment of the immune tolerance of pregnancy. Various types of HDFN are classified by which alloantigen provokes the response. In order of incidence, the types include ABO, anti-RhD, anti-RhE, anti-Rhc, anti-Rhe, anti-RhC, multiantigen combinations, and anti-Kell.
Untold Stories of the E.R.: Extra Dose - Antibody Specific Information - Netflix
Anti-D is the only preventable form of HDN. Since the 1968 introduction of Rho-D immunoglobulin, (Rhogam), which prevents the production of maternal Rho-D antibodies, the incidence of anti-D HDN has decreased dramatically. Anti-C and anti-c can both show a negative DAT but still have a severely affected infant. An indirect Coombs must also be run. Anti-M also recommends antigen testing to rule out the presence of HDN as the direct coombs can come back negative in a severely affected infant. Anti-Kell can cause severe anemia regardless of titer. Anti-Kell suppresses the bone marrow, by inhibiting the erythroid progenitor cells. Kidd antigens are also present on the endothelial cells of the kidneys One study done by Moran et al., found that titers are not reliable for anti-E. Their most severe case of hemolytic disease of the newborn occurred with titers 1:2. Moran states that it would be unwise routinely to dismiss anti-E as being of little clinical consequence.
Untold Stories of the E.R.: Extra Dose - References - Netflix