Hemolytic disease of the newborn (HDN)
Neonatal bleeding due to vitamin K deficiency.
K dependent clotting factors are- II, VII, IX, X.
Types of Hemolytic disease of the newborn (HDN).
Early HDN- occurs within first 24 hours of birth. Most
common causes are maternal drug effect.
Classical HDN- occurs at 2-7 days of age. Most common in
term baby.
Late HDN- occurs between 2 weeks – 6 months of age. Causes
of late HDN are undiagnosed hepatobiliary disease (hepatitis, biliary atresia,
cystic fibrosis), use of broad spectrum antibiotics.
Clinical feature of Hemolytic disease of the newborn (HDN).
- bleeding from all orifices.
- Healthy baby.
- Usually male child.
- Umbilical bleeding.
- Per rectal bleeding.
- Bloody vomiting.
- Nose bleeding.
- Per vaginal bleeding.
- Hematuria.
D/D of Hemolytic disease of the newborn (HDN).
- Hemophilia.
- DIC.
- Swallowed maternal blood.
Investigations of Hemolytic disease of the newborn (HDN).
- CBC with CPBF.
- Bleeding time- normal.
- Clotting time- prolonged.
- Platelet count.
- PT- prolonged.
- APTT - prolonged.
- Thrombin time.
-Factor VIII assay.
- Apt test.
- Factors II, VII, IX, and X (Thrombo test) are significantly
reduced.
Vitamin K facilitates post-transcriptional carboxylation of
factors II, VII, IX, and X. In the absence of carboxylation, such factors form
PIVKA (protein induced in vitamin K absence), which is a sensitive marker for
vitamin K status. The platelet level is normal.
Treatment of Hemolytic disease of the newborn (HDN).
a. Vitamin K1 1-5 mg. IM or IV single dose.
If there is active bleeding or PT is greatly prolonged, give
FFP 10 ml/kg with an IV dose of 1 mg of vitamin K.
b. In cases where blood loss is severe and sudden, transfusion
of fresh blood (20 ml/kg) is life-saving.
c. Vitamin K1, 1 mg/week for the first 3 months of life, may
prevent late onset hemorrhagic disease of newborn.
Prevention of Hemolytic disease of the newborn (HDN).
a. Prophylactic vitamin K1, 2 mg orally at 4 hours, 4th day and
4th week of life.
b. If the mother has been treated with phenytoin,
phenobarbitone, INH orri fampicin, mother should be given, vitamin K1 10-20 mg IM 24 hours prior to delivery.
c. The baby should be given one dose of vitamin K1, 1 mg at birth and repeated
after 24 hours.
Causes of Bleeding in Children.
A. In neonates
a. If baby is sick-
Menomic- senadol
꞉ Septicemia ꞉ NEC
꞉ DIC
꞉ Liver disease
b. If baby is healthy-
Menomic- HEAVY HAPPY.
꞉ HDN
꞉ Von willebrand disease
꞉ Hemophilia
꞉ Platelet disorder
꞉ swallowed maternal blood
B. In older children-
Menomic- HE IS NIRAB
- HDN.
- hemophilia.
- HSP.
- HUS.
- hemorrhoid.
- Esophageal varices.
- Intussusception.
- Shigellosis.
- Nasal bleeding
- Intestinal bleeding-
- IBD.
- meckel;s diverticulam.
- Mallory Weiss syndrome.
- Rectal polyp.
- Anal fissure.
- Bleeding peptic ulcer.
