A total of 27 blood specimen of neonates born at the maternity section of central Hospital Porto Novo by the Rhesus Negative mothers were studied for a period of 12 months. The specimen collection were done within 72 hours of birth, mothers pregnant for the first time without a past history of abortion or transfusion were rejected for the study. Ten (10) blood specimens of the neonates were Rhesus blood group negative and were eliminated from the work whereas the remaining seventeen (17) were recorded Rhesus blood group positive. The results of the 17 specimen of neonates all recorded in mean values showed Hb 17. 23g/dl, Hct 51.56L/L, the mean cell volume was 102.18 FL, mean cell hemoglobin concentration was 33.41% and mean cell hemoglobin recorded 34.12 pg. The red cell count and white cell count were 5.04 × 10 12/L and 16.06 ×10 9/L respectively. The platelet count was 316.53 and red cell distribution width of 17.76% was recorded. The differential leucocytes counts were; Neutrophils 65.35%, Lymphocytes 25.71% and MXD (comprises of monocytes, eosinophils and basophils) recorded 13.48%. The mean results of Bilirubin direct and Bilirubin total were 0.76mg/dl and 4.29mg/dl. The Direct Coombs test (DCT) was positive in one specimen of neonates and this specimen showed Hb value of 13.6g/dl and a total Bilirubin of 27.5mg/dl. All the neonates were of full term with birth weight of 2.5 to 3.5 kg. This work serves as an epidemiological vigilance for haemolytic diseases of the newborn in the Porto Novo province. The incidence of hemolytic Disease of newborn in Porto Novo district was recorded to be 5.8% considering from this work where only a case gave positive Direct Coombs. Although, this work suffers from scarcity of pregnant mothers of Rhesus blood group negative and affects the research because the specimen collected were small for the time period of the work. The Porto Novo experience also showed that good control system is at work by the medical team and technical staff concerned with the testing of all prospective mothers. Another positive aspect is that anti-D is freely and timely available for mothers of D- positive infants and with persistent effort in this regard, the incidence should continue very low or until there is no more case of hemolytic disease of the newborn.
Table of Contents
1. Introduction
2. Antenatal Assessment of the Mother's Blood
3. Partner Testing
4. Testing Fetal Deoxyribonucleic acid (DNA) in the maternal circulation
5. Antenatal Assessment of the severity of HDN
6. Antibody Titrations during pregnancy
7. Antibody Quantitation
8. Method of Assessment of Fetal Anaemia
8.1 Amniocentesis
9. World Health Organization Special Advice on Rhesus Sensitization
10. Source of anti-D
11. Materials and Method
12. Method
12.1 Bilirubin Determination
12.2 Direct Coombs Test
13. Results
14. Discussion
15. Conclusion
Research Objectives and Key Topics
This study aims to conduct an epidemiological analysis of the incidence of Haemolytic Disease of the Newborn (HDN) among neonates born to Rhesus-negative mothers at the Central Hospital in Porto Novo, evaluating the effectiveness of local medical protocols and the management of maternal Rhesus sensitization.
- Incidence rate analysis of HDN in the Porto Novo district.
- Evaluation of maternal screening protocols and antenatal assessment methods.
- Effectiveness of anti-D prophylaxis and medical control systems.
- Clinical correlation between Rhesus-negative status and neonatal outcomes.
Excerpt from the Book
METHOD OF ASSESSMENT OF FETAL ANAEMIA
In a mother with increasing antibody levels and a fetus suspected or known to carry the red cell antigen against which the antibody is directed, an assessment of the severity of haemolysis is required. Traditionally, this was done using amniocentesis to measure the optical density of the amniotic fluid (lilley´s lines) using spectrophotometry. This is an indirect measurement, whereas direct fetal blood sampling by ultrasound guided cordocentesis provides not only direct diagnostic information but also a new approach to fetal therapy by direct fetal intravascular transfusion. However, both of these procedures carry the risk of miscarriage and further fetomaternal haemorrhage. More recently, specialist units have been able to offer noninvasive tests to determine fetal anaemia using middle cerebral artery a method of Doppler(2002)
The incidence and severity of anti-D haemolytic disease of the newborn is declining and the increasingly specialized management of severely affected pregnancies has meant that these women are now being referred to specialist centre dealing with this condition early in pregnancy.
Summary of Chapters
Introduction: Provides a theoretical overview of Rhesus HDN, the role of IgG antibodies, and the historical incidence and clinical management approaches in the UK.
Antenatal Assessment of the Mother's Blood: Outlines standard procedures for screening ABO and Rhesus groups and the importance of testing for red cell antibodies.
Partner Testing: Discusses the significance of paternal phenotype determination and the role of genetic testing in predicting fetal risk.
Testing Fetal Deoxyribonucleic acid (DNA) in the maternal circulation: Explores modern non-invasive techniques for predicting D and K types to reduce the need for invasive testing.
Antenatal Assessment of the severity of HDN: Reviews various diagnostic methods used to evaluate fetal health during pregnancies affected by antibodies.
Antibody Titrations during pregnancy: Details laboratory standards for serial monitoring of antibody concentrations to guide clinical intervention.
Antibody Quantitation: Evaluates automated quantification methods as accurate predictors for fetal investigation.
Method of Assessment of Fetal Anaemia: Compares traditional invasive diagnostic tools like amniocentesis with newer non-invasive Doppler ultrasound techniques.
World Health Organization Special Advice on Rhesus Sensitization: Summarizes international recommendations for anti-D prophylaxis administration timing and dosage.
Source of anti-D: Explains the process of obtaining anti-D from immunized volunteer donors.
Materials and Method: Lists the specific equipment, reagents, and laboratory tools utilized for the study.
Method: Provides step-by-step procedures for Bilirubin determination and the Direct Coombs Test.
Results: Presents the gathered data on complete blood counts, bilirubin levels, and Coombs test results from the study group.
Discussion: Interprets the findings regarding the 5.8% incidence rate and assesses the local control systems in Porto Novo.
Conclusion: Synthesizes the study results and emphasizes the importance of continued vigilant monitoring and prophylaxis management.
Keywords
Haemolytic Disease of Newborn, Rhesus Negative, Anti-D, Neonates, Bilirubin, Direct Coombs Test, Porto Novo, Fetal Anaemia, Amniocentesis, Prophylaxis, Pregnancy, Rhesus Sensitization, Maternal Screening, Red Cell Antibodies, Haematocrit
Frequently Asked Questions
What is the primary focus of this study?
The study investigates the incidence of Haemolytic Disease of the Newborn (HDN) among neonates born to Rhesus-negative mothers at the Central Hospital in Porto Novo.
Which clinical markers are used to assess the neonates?
The research utilizes complete blood counts (CBC), Bilirubin determination, and the Direct Coombs Test (DCT) to assess neonatal health.
What is the main goal of the research?
The goal is to perform an epidemiological evaluation of HDN in the Porto Novo district and to verify the efficacy of the local medical and technical management of Rhesus-negative pregnancies.
What scientific methods were employed?
The study utilized automated hematological profiling, bilirubin colorimetry, and standard Direct Coombs Testing on blood specimens collected from newborns within 72 hours of birth.
What is covered in the main body of the work?
The main body covers the theoretical background of HDN, existing antenatal assessment methods, specific lab protocols for the study, and an analysis of the results obtained from 17 neonates.
What are the key terms defining this work?
Key terms include Rhesus-negative, Haemolytic Disease of the Newborn, Anti-D prophylaxis, maternal antibodies, and neonatal hyperbilirubinaemia.
What was the specific incidence of HDN found in this study?
The research recorded an incidence of 5.8% for Haemolytic Disease of the Newborn in the Porto Novo district during the 12-month study period.
Why was the sample size for this study limited?
The sample size was affected by the relative scarcity of Rhesus-negative pregnant women in the population and the study criteria which excluded first-time pregnant mothers without a history of transfusion or abortion.
How does the author evaluate the local control system in Porto Novo?
The author concludes that the local control system is highly effective, citing the diligent identification and follow-up of D-negative mothers and the availability of anti-D as key factors in keeping the incidence low.
- Quote paper
- Peter Okeke (Author), 2010, The Rhesus Negative Pregnant Mothers and Haemolytic Disease of Newborn (HDN) among Neonatals born in Central Hospital Porto Novo , Munich, GRIN Verlag, https://www.grin.com/document/163579
