Hemolytic Disease of the Newborn Hannah Cruickshank

Hemolytic Disease of the Newborn (HDN) specifically Rh incompatibility happens when an Rh negative mother carries an Rh-positive fetus. This is a problem because Rh negative individuals lack the Rh antigen, while Rh positive individuals have it. During pregnancy, the fetal red blood cells carrying the Rh antigen can cross into the maternal circulation, often during childbirth, or trauma. The Rh-negative mother’s immune system recognizes these Rh-positive RBCs as foreign, triggering an immune response that leads to the production of IgG antibodies against the Rh antigen. IgG antibodies are the only antibody that can cross the placenta membrane. This does not effect the first pregnancy as the antibodies are only made after the introduction of the antigen. If the mother becomes pregnant a second time with an Rh positive fetus, these antibodies can cross the placenta and enter the fetus’s bloodstream. Once in the fetal circulation, these antibodies bind to the Rh positive RBCs of the fetus, marking them for destruction. This destruction leads to anemia in the fetus. In response, the fetal body attempts to compensate by increasing RBC production in the liver and spleen, which can lead to organ enlargement and, if severe, can contribute to hydrops fetalis which can be a fatal condition with symptoms like severe fluid accumulation in fetal tissues. Symptoms of HDN due to Rh incompatibility in newborns can be mild to severe. Some of the symptoms include jaundice, anemia, hepatosplenomegaly and edema. Jaundice is a common symptom because of increased bilirubin. Diagnostics typically involves taking a blood tests from the mother to identify Rh factor and detect anti Rh antibodies. During pregnancy, an indirect Coombs test can be done to measure maternal antibody levels. After baby is born, a direct Coombs test on the newborn’s blood confirms the presence of antibodies attached to the RBCs, and bilirubin levels are measured to assess the severity of jaundice. Treatment is determined by the severity of the condition. For at-risk pregnancies, Rh immunoglobulin Rhogam injections are given to the mother to prevent HDN from happening in their second pregnancy during and after pregnancy to prevent antibody creation. Overall the pathophysiology of this was really easy to understand and flowed well.

Listening to the podcast Motherhood moments,  which spoke to Hemolytic Disease of the Newborn (HDN) due to Rh incompatibility, was a very detailed and was able to give a well rounded explanation of HDN. Dr. Montgomery explained each part of the disease progression in an easy to follow way making the pathophysiology process easy to follow. Pathophysiology can often be tricky as there are a lot of complicated concepts that can often be challenging to understand. They covered how Rh incompatibility happens, explaining how a mother’s immune system can produce antibodies against an Rh positive fetus, which ultimately can lead to hemolysis of the fetal red blood cells. The clear way the Doctor explained the disease from immune response to fetal anemia and the possible development of hydrops fetalis felt like I was being given all the information needed to understand this condition in depth. One aspect that particularly stood out was how well they connected the pathophysiology with the clinical outcomes, like jaundice, anemia, and in severe cases, hydrops fetalis. They moved from explaining the mechanism of hemolysis to how the breakdown of red blood cells causes these symptoms, which gave a full picture of how serious HDN can be. It felt thorough and informative without being overly complex or difficult to follow. I felt that the Doctor also kept an even tone and pace of delivering the message which made it easier to follow and understand and the Mother was able to share her story and ask questions to help podcast go in good depth. If I were to suggest one , I’d have liked a slightly more detailed explanation of the diagnostic testing involved. They mentioned the indirect Coombs test for the mother and the direct Coombs test for the newborn, but a bit more depth here would have enhanced my understanding of the other tests.

I really enjoyed the way your group structured this as a podcast. Presenting it in an interview format with a realistic scenario and a case study made this easy to follow and easy to understand. The use of a “real-life” story from a mother, with the explanations of the pathophysiology provided by the physician, helped me to better understand the rationale behind the events she experienced.  The podcast had a natural flow, as the case study and pathophysiology correlated, making it engaging and easy to follow. I appreciated how the physician provided clear explanations without an overwhelming amount of information with a lot of detail, which I feel like in a real scenario can happen and often overwhelm patients. This approach helped me grasp the pathophysiology of Hemolytic Disease of the Newborn (HDN) in a way that was easy to understand. I also noticed the use of language, the mother used basic, everyday language, which made it relatable, while the physician introduced medical terminology to explain the pathophysiology. Having both types of language made it educational and approachable, even for someone without a medical background. The case study format and interview style made it a valuable learning experience, as it not only explained HDN but also played it out in a case study situation. If I could add one thing, it would be a little more detailed explanation on the testing process for HDN. Overall, though, I felt it was extremely well done and would be a valuable resource for anyone looking to understand this condition better.

One change I would suggest for the podcast, since it’s an auditory format, without a visual, I think there would be benefit to spend a bit more time covering the different testing options mentioned. Since there’s a lot of information to take in, a bit more repetition around the testing processes could help reinforce learning. For example, having the mother ask the doctor for more detail on specific tests, or the doctor explaining more on which tests are most beneficial, might provide a better understanding of the diagnostics for HDN and help people listening have a better understanding. I feel for one who is apart of the general public may not know much about these tests and it would be beneficial as someone with no medical background to have a little more explanation. I understand that time constraints can make this challenging, but some extra time spent on explaining the differences between the tests could be very valuable to ones overall understanding. Having the timestamp sheet was really helpful, allowing me to review the information at my own pace after listening. I think the value in learning more about the tests would be beneficial to know why you would receive them. It would also be beneficial to understand how the tests are preformed and what stages they are preformed at during pregnancy or after baby is born. Overall, this podcast was extremely well done and there was a lot of valuable knowledge that really enhanced my understanding of this topic.

As an almost nurse who hasn’t work directly with mothers or babies since my second year clinical, understanding Hemolytic Disease of the Newborn (HDN) and Rh incompatibility doesn’t feel like it directly applies to me at this time, however it reminds of how it is still an important concept to understand the basics of blood typing and how important it is to always follow best practice when it comes to blood transfusions and ensuring the proper checks are done to ensure that the patient does not receive the incorrect blood as it can cause someone a lot of harm. The principles behind Rh incompatibility and how antibodies can target cells and cause hemolysis are relevant for a better understanding of some autoimmune diseases, transfusion reactions, or other conditions involving antibody-mediated cell destruction. I know as a nurse on the renal floor, there will be times where I will have to carry out blood transfusions, and I will always ensure I follow the protocols for the blood checks when transfusing blood. I think also getting to watch in a case study how first hand, it can be difficult for patients to understand what is happening in these traumatic situations and how important it is for us as medical professionals to take our time and explain what is going on, especially when it is involving their new baby. I feel like this podcast showed how to be methodical and sensitive while delivering the necessary information to help support the patient and provide them the comfort of having an easy to follow explanation. Finally, I think it is valuable knowledge for myself as someone who plans to have children, it will allow me to better understand the process of this disease and why there is potential to receive the Rhogam shot if I find out my blood is negative and I am carrying a positive fetus. Overall this podcast was done really well, and I really enjoyed listening to it. It really helped my overall understanding of this disease and I feel like going forward I will be able to provide others with a rationale.