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Chapter 7
ones which attack the red blood cells in the fetal circulation. The red cells are broken down and the
fetus can develop reticulocytosis and anemia. The 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 are present in the fetal blood and so these forms of the disease can be called
erythroblastosis fetalis.
Before birth, options for treatment include intrauterine transfusion or early induction of labor when
pulmonary maturity has been attained, fetal distress is present, or 35 to 37 weeks of gestation have
passed. The mother may also undergo plasma exchange to reduce the circulating levels of antibody by
as much as 75%.
After birth, treatment depends on the severity of the condition, but could include temperature
stabilization and monitoring, phototherapy, transfusion with compatible packed red blood, exchange
transfusion with a blood type compatible with both the infant and the mother, sodium bicarbonate for
correction of acidosis and/or assisted ventilation.
Rh negative mothers who have had a pregnancy with or are pregnant with a Rh positive infant, are
given Rh immune globulin (RhIG) also known as Rhogam, during pregnancy and after delivery to
prevent sensitization to the D antigen. It works by binding any fetal red cells with the D antigen before
the mother is able to produce an immune response and form anti-D IgG. A drawback to pre-partum
administration of RhIG is that it causes a positive antibody screen when the mother is tested which is
indistinguishable from immune reasons for antibody production.
Diseases of the Blood
Disseminated Intravascular Coagulation
Disseminated intravascular coagulation (DIC), also called consumptive coagulopathy, is a
pathological process in the body where the blood starts to coagulate throughout the whole body. This
depletes the body of its platelets and coagulation factors, and there is a paradoxically increased risk of
hemorrhage. It occurs in critically ill patients, especially those with Gram-negative sepsis (particularly
meningococcal sepsis) and acute promyelocytic leukemia.
Hemophilia
Hemophilia is a disease where there is low or no blood protein, causing an inability to produce
blood clots. There are two types of Hemophilia: Type A, which is a deficiency in factor VIII and Type
B, (Christmas disease) a deficiency on factor IX. Because people with hemophilia do not have the
ability to make blood clots, even a little cut may kill them, or the smallest bump or jar to the body
could cause severe bruising that doesn't get better for months.
Hemophilia is passed down from mothers to their sons. Hemophilia is sometimes known as the
"Royal Disease". This is because Queen Victoria, Queen of England (1837-1901), was a carrier of
hemophilia. The hemophilia disease was passed down to her son Leopold who ended up dying at age
31. Queen Victoria also had two daughters who were carriers. These daughters passed hemophilia into
the Spanish, German, and Russian royal families. One of the most famous stories is that of the Russian
130 | Human Physiology