Enfermedad Hemolítica del Feto y del Recién Nacido

Descripción General

Definición

La enfermedad hemolítica del feto y del recién nacido es una anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica del feto o del recién nacido de diversos grados de severidad debida a los LOS Neisseria anticuerpos IgG IgG The major immunoglobulin isotype class in normal human serum. There are several isotype subclasses of igg, for example, igg1, igg2a, and igg2b. Hypersensitivity Pneumonitis maternos contra los LOS Neisseria antígenos de superficie de los LOS Neisseria eritrocitos fetales.

• También conocida como enfermedad hemolítica del feto y del recién nacido aloinmune o eritroblastosis fetal
• Antígenos implicados:
  • ABO
  • Factor Rhesus (Rh) (más comúnmente el antígeno D)
  • Antígenos menores de los LOS Neisseria eritrocitos (antígenos Kell, Duffy, Kidd)

Epidemiología

• La incompatibilidad Rh sigue siendo la causa más común de enfermedad hemolítica del feto y del recién nacido a nivel mundial.
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos, el 15% de la población es Rh negativo.
• La enfermedad hemolítica del feto y del recién nacido por incompatibilidad ABO se produce cuando la madre es del tipo sanguíneo O (tiene anticuerpos anti-A y anti-B):
  • Ictericia (hiperbilirrubinemia) más frecuente frente a la hemólisis
  • La anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types es menos grave en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la incompatibilidad ABO en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la mayoría de los LOS Neisseria casos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum comparación con la incompatibilidad Rh sensibilizada.
• El reconocimiento de factores de riesgo incrementados para la exposición materna a antígenos eritrocitarios ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia mejorado significativamente la prevención y el manejo de la enfermedad hemolítica del feto y del recién nacido.
• Las recomendaciones actuales de Rhogam, cuando se siguen, pueden reducir la aloinmunización RhD al AL Amyloidosis 0,2% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las madres susceptibles.

Etiología

• Los LOS Neisseria anticuerpos maternos deben ser de clase IgG IgG The major immunoglobulin isotype class in normal human serum. There are several isotype subclasses of igg, for example, igg1, igg2a, and igg2b. Hypersensitivity Pneumonitis para atravesar la placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity.
• Los LOS Neisseria anticuerpos maternos (contra antígenos fetales) que se forman dependen del grupo sanguíneo y dan lugar a diferentes tipos de enfermedad hemolítica del feto y del recién nacido:
  • Enfermedad hemolítica ABO:
    • Principales grupos sanguíneos: A, B, AB, O
    • Los LOS Neisseria anticuerpos A y/o B se producen de forma natural contra los LOS Neisseria antígenos que no están presentes de forma innata (e.g., el tipo O tiene anticuerpos anti-A y anti-B).
    • Se ve VE Ventilation: Mechanics of Breathing en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el 15% de los LOS Neisseria embarazos
  • Enfermedad hemolítica RhD:
    • Rh (positivo o negativo según la expresión del antígeno D en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria eritrocitos)
    • La condición de RhD negativo se debe a la ausencia o alteración del gen RHD.
    • La enfermedad hemolítica del feto y del recién nacido suele producirse durante la 2da exposición cuando los LOS Neisseria anticuerpos implicados son IgG IgG The major immunoglobulin isotype class in normal human serum. There are several isotype subclasses of igg, for example, igg1, igg2a, and igg2b. Hypersensitivity Pneumonitis.
  • Grupos sanguíneos menores (33 sistemas de grupos sanguíneos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum total), como:
    • Kell (anticuerpo anti-K: una causa rara, pero grave de enfermedad hemolítica del feto y del recién nacido, que pone en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum peligro la vida)
    • Duffy
    • Kidd
• Otros factores de riesgo para la exposición materna a antígenos eritrocitarios incompatibles:
  • Hemorragia materno-fetal conocida:
    • Desprendimiento de placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity y otras hemorragias o lesiones placentarias
    • Parto de un bebé anterior
    • Bebé anterior con enfermedad hemolítica del feto y del recién nacido
    • Cirugía fetal
  • Posibles eventos de hemorragia materno-fetal que pueden haber pasado desapercibidos:
    • Embarazo ectópico
    • Aborto espontáneo o inducido
    • Inserción anormal de la placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity
    • Muerte fetal
    • Amniocentesis Amniocentesis Percutaneous transabdominal puncture of the uterus during pregnancy to obtain amniotic fluid. It is commonly used for fetal karyotype determination in order to diagnose abnormal fetal conditions. Polyhydramnios y toma de muestra de vellosidades coriónicas
    • Traumatismo abdominal materno
    • Maniobras de versión fetal
  • Antecedentes maternos con posible transfusión (si ocurrió en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la infancia, la madre puede desconocer los LOS Neisseria antecedentes):
    • Superviviente de cáncer infantil
    • Antecedentes de cirugía, especialmente cardíaca u otra cirugía mayor
    • Estancia hospitalaria prolongada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la infancia
    • Esplenectomía sin causa conocida

Fisiopatología

Durante el embarazo, los LOS Neisseria eritrocitos del feto se desplazan a través de la placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity hacia la circulación materna:

• Generalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum volúmenes bajos (< 15 mL)
• Mayor riesgo de hemorragia materno-fetal y mayores volúmenes (10–150 mL) más cerca del parto o en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum determinadas circunstancias
• La incompatibilidad a los LOS Neisseria antígenos expresados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria eritrocitos fetales conduce a la formación de anticuerpos maternos.
• El tipo de incompatibilidad puede influir en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el resultado (varía desde una anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types leve hasta una grave con secuelas).

Incompatibilidad ABO:

• El grupo sanguíneo materno O es el de mayor riesgo:
  • Grupo sanguíneo fetal A o B
  • Las IgG IgG The major immunoglobulin isotype class in normal human serum. There are several isotype subclasses of igg, for example, igg1, igg2a, and igg2b. Hypersensitivity Pneumonitis anti-A o anti-B maternas se dirigen a los LOS Neisseria antígenos de los LOS Neisseria eritrocitos del feto y causan hemólisis → ictericia (más común) y generalmente anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types leve
• Innata, sin necesidad de sensibilización/exposición previa
• Forma más leve de enfermedad hemolítica del feto y del recién nacido
• Anticuerpos anti-A > anticuerpos anti-B

Incompatibilidad Rhesus:

• Contexto: madre RhD negativa y feto RhD positivo
• Es necesario que ocurra una sensibilización previa:
  • 1er embarazo: La madre desarrolla anticuerpos IgM IgM A class of immunoglobulin bearing mu chains (immunoglobulin mu-chains). Igm can fix complement. The name comes from its high molecular weight and originally being called a macroglobulin. Immunoglobulins: Types and Functions (no pueden atravesar la placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la 1era exposición a un feto incompatible con el Rh.
  • El 1er embarazo no se verá afectado.
  • Los LOS Neisseria embarazos posteriores dan lugar a una IgG IgG The major immunoglobulin isotype class in normal human serum. There are several isotype subclasses of igg, for example, igg1, igg2a, and igg2b. Hypersensitivity Pneumonitis anti-D materna que puede atravesar la placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity y dirigirse al AL Amyloidosis antígeno eritrocitario RhD del feto.
  • Hemólisis más grave que causa anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types grave, hidropesía, insuficiencia cardíaca e ictericia severa
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum raras ocasiones, una mujer podría haber sido sensibilizada antes de su 1er embarazo (e.g., transfusión de sangre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum su infancia).

Presentación Clínica

Feto (in utero)

El ultrasonido podría evidenciar hidropesía fetal inmune, una afección potencialmente mortal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la que los LOS Neisseria fetos presentan una acumulación anormal de líquido en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuerpo. Los LOS Neisseria hallazgos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el ultrasonido de la hidropesía fetal inmune pueden incluir:

• Polihidramnios
• Agrandamiento de la placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity
• Hepatomegalia
• Esplenomegalia
• Cardiomegalia
• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema generalizado (incluyendo edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema del cuero cabelludo, derrame pleural, ascitis)

Recién nacido

Enfermedad leve a moderada:

• Sin o con anemia leve (la hemoglobina normal es de 19,9 + 2,2 g/dl al AL Amyloidosis nacer)
• Ictericia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las primeras 24 horas de vida

Enfermedad grave:

• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types severa (< 10 g/dL)
• Ictericia significativa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las primeras 24 horas de vida
• Kernicterus Kernicterus A term used pathologically to describe bilirubin staining of the basal ganglia; brain stem; and cerebellum and clinically to describe a syndrome associated with hyperbilirubinemia. Clinical features include athetosis, muscle spasticity or hypotonia, impaired vertical gaze, and deafness. Nonconjugated bilirubin enters the brain and acts as a neurotoxin, often in association with conditions that impair the blood-brain barrier (e.g., sepsis). This condition occurs primarily in neonates, but may rarely occur in adults. Hyperbilirubinemia of the Newborn (una condición rara en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la que los LOS Neisseria altos niveles de bilirrubina no conjugada se depositan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum partes del cerebro que conducen a encefalopatía)
• Hepatoesplenomegalia
• Ascitis
• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema
• Shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock

Diagnóstico

Principios generales

Es importante identificar los LOS Neisseria posibles factores de riesgo para una sensibilización desconocida, así como antecedentes previos de enfermedad hemolítica del feto y del recién nacido durante el embarazo. Las posibles incompatibilidades sanguíneas son:

• Incompatibilidad ABO:
  • La mayoría de los LOS Neisseria anticuerpos anti-A y anti-B son IgM IgM A class of immunoglobulin bearing mu chains (immunoglobulin mu-chains). Igm can fix complement. The name comes from its high molecular weight and originally being called a macroglobulin. Immunoglobulins: Types and Functions; por lo tanto, la mayoría no atraviesan la placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity.
  • Por ello, la incompatibilidad ABO es más preocupante en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el periodo postnatal.
• Incompatibilidad RhD:
  • Asociada a un riesgo severo de enfermedad hemolítica del feto y del recién nacido
  • Única incompatibilidad que dispone de profilaxis, por lo que es importante el diagnóstico prenatal
• Otros anticuerpos eritrocitarios capaces de causar enfermedad hemolítica del feto y del recién nacido:
  • Duffy
  • Kell
  • Kidd
• Incompatibilidad con grupos sanguíneos menores: en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum general, si se identifica un anticuerpo IgG IgG The major immunoglobulin isotype class in normal human serum. There are several isotype subclasses of igg, for example, igg1, igg2a, and igg2b. Hypersensitivity Pneumonitis eritrocitario, lo mejor es proceder y descartar enfermedad hemolítica

Pruebas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la madre

• Tipo de sangre (ABO)
• Estado del Rh: tamizaje de anticuerpos reflejos (solo para madres RhD negativas)
  • Anticuerpos anti-D negativos: La madre no está sensibilizada.
  • Anticuerpos anti-D positivos: La madre está sensibilizada.
• Tamizaje de anticuerpos para otros anticuerpos eritrocitarios (e.g., anti-Kell) para todas las madres:
  • Identificar el anticuerpo, si se detecta.
  • Los LOS Neisseria anticuerpos IgM IgM A class of immunoglobulin bearing mu chains (immunoglobulin mu-chains). Igm can fix complement. The name comes from its high molecular weight and originally being called a macroglobulin. Immunoglobulins: Types and Functions no atraviesan la placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity y no causan enfermedad hemolítica del feto y del recién nacido.
  • Obtener títulos de anticuerpos de cualquier anticuerpo conocido como causante de la enfermedad hemolítica del feto y del recién nacido → títulos más altos = mayor riesgo de enfermedad hemolítica del feto y del recién nacido

Pruebas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el padre

• Si se detectan anticuerpos maternos, el padre debe someterse a la prueba del antígeno en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cuestión.
• Si el padre resulta negativo, el bebé no tendrá el antígeno:
  • Sin riesgo para enfermedad hemolítica del feto y del recién nacido
  • Proceder con el cuidado de rutina.
• Si el padre resulta positivo (o desconocido), el bebé puede tener el antígeno:
  • El bebé podría estar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum riesgo de padecer enfermedad hemolítica del feto y del recién nacido
  • Intente determinar si el padre es heterocigoto (el bebé podría estar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum riesgo) vs. homocigoto (el bebé está en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum riesgo).
  • Intente determinar el genotipo fetal.

Pruebas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el feto

• Intente determinar el genotipo fetal (y posteriormente el riesgo de enfermedad hemolítica del feto y del recién nacido) mediante:
  • Suero materno
  • Amniocentesis Amniocentesis Percutaneous transabdominal puncture of the uterus during pregnancy to obtain amniotic fluid. It is commonly used for fetal karyotype determination in order to diagnose abnormal fetal conditions. Polyhydramnios
• Monitorear al AL Amyloidosis feto en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum riesgo mediante ultrasonido (determinar la presencia de hidropesía fetal) y títulos de anticuerpos maternos (el aumento de los LOS Neisseria títulos indica hemólisis activa).
• Monitorear el desarrollo de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types fetal mediante:
  • Evaluación con ultrasonido doppler Doppler Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow. Ultrasound (Sonography) de la arteria cerebral media (ACM) del feto
    • ↑ Velocidad sistólica máxima (VSM) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la ACM indica “cefalización de flujo”
    • La “cefalización del flujo” indica anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types fetal y que el bebé está intentando derivar el flujo sanguíneo a su órgano más crítico, el cerebro.
    • ↑ VSM-ACM significa ↓ hemoglobina fetal (HbF)
  • Cordocentesis Cordocentesis The collecting of fetal blood samples typically via endoscopic ultrasound guided fine needle aspiration from the umbilical vein. Hemolytic Disease of the Fetus and Newborn para obtener una muestra de sangre fetal y medir la hemoglobina

Evaluación postnatal

• Examen físico del recién nacido para determinar hemólisis:
  • Estado respiratorio: taquipnea, dificultad respiratoria (puede haber derrame pleural e hipoplasia pulmonar)
  • Cardíaco: soplo
  • Palidez
  • Ictericia (común, pero no presente al AL Amyloidosis nacer en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum bebés normales/sanos)
  • Hepatoesplenomegalia, ascitis
• Buscar evidencia de hemólisis significativa:
  • Hemograma: ↓ hemoglobina después del nacimiento
  • ↑ Niveles de bilirrubina indirecta
  • ↑ Recuento de reticulocitos (a menudo)
  • Prueba de Coombs (+ prueba directa o indirecta)
  • Frotis periférico: ↓ eritrocitos, macrocitosis, reticulocitosis

Tratamiento

Prevención

Las incompatibilidades RhD son las únicas formas de aloinmunización que se pueden prevenir.

• Mujeres RhD negativas con anticuerpos anti-D negativos:
  • Volver a comprobar anticuerpos a las 28 semanas.
  • Administrar RhoGAM (inmunoglobulina anti-D):
    • A las 28 semanas de gestación (momento en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum que los LOS Neisseria eritrocitos fetales expresan antígenos D)
    • Dentro de las 72 horas siguientes al AL Amyloidosis nacimiento
    • Después de amniocentesis Amniocentesis Percutaneous transabdominal puncture of the uterus during pregnancy to obtain amniotic fluid. It is commonly used for fetal karyotype determination in order to diagnose abnormal fetal conditions. Polyhydramnios
    • Tras la toma de muestras de vellosidades coriónicas
    • Si se sospecha de otros riesgos de hemorragia materno-fetal (como los LOS Neisseria enumerados anteriormente)
• La prueba de Kleihauer-Betke (KB) se considera en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos de posible hemorragia materno-fetal (i.e., hemorragia o aborto):
  • Mide la HbF transferida del feto al AL Amyloidosis torrente sanguíneo de la madre
  • Ayuda a decidir la dosis adicional de RhoGAM, si fuese necesario

Tratamiento del feto afectado

• Las personas con riesgo de enfermedad hemolítica del feto y del recién nacido deben someterse a monitoreo fetal recomendado.
• Cuando la VSM-ACM alcanza el umbral indicativo de ↓ hemoglobina, comprobar si hay anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types:
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types leve:
    • Monitoreo por ultrasonido seriado
    • Parto a término o cuando hay una adecuada madurez pulmonar
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types severa:
    • Confirmar anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types severa (hemoglobina < 10 g/dL).
    • ≤ 35 semanas de edad gestacional: transfusión intrauterina de eritrocitos empaquetados (negativos para el antígeno en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cuestión y para citomegalovirus, leucorreducidos e irradiados)
    • > 35 semanas de edad gestacional: Considerar el parto.
• Otras consideraciones:
  • Si se prevé un parto prematuro:
    • Evaluar la madurez pulmonar fetal.
    • Considerar glucocorticosteroides para maduración pulmonar.
  • Prepararse para un parto donde se tenga disponible apoyo obstétrico, de medicina materno-fetal y pediátrico.

Tratamiento del recién nacido afectado

• Enfermedad hemolítica leve del feto y del recién nacido:
• La incompatibilidad ABO provoca ictericia y anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica leve.
  • Estar atento a los LOS Neisseria siguientes síntomas:
    • Empeoramiento de la ictericia
    • Mala alimentación
    • Letargo
    • Irritabilidad
    • Dificultad respiratoria
  • Monitorear:
    • Niveles de bilirrubina (y tratarlos de forma acorde, véase tratamiento más abajo)
    • Hemoglobina, si está clínicamente indicado
• Enfermedad hemolítica grave del feto y del recién nacido (como se observa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la incompatibilidad RhD y la aloinmunización Kell):
  • Equipo de partos de alto riesgo disponible para la reanimación
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types:
    • Exanguinotransfusión para recién nacidos gravemente afectados ( shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock, hidropesía fetal) para reducir la hemólisis y mejorar la oxigenación
    • La transfusión simple es una opción para recién nacidos sin colapso circulatorio.
    • Suplementación de hierro con transfusión de eritrocitos (según la gravedad)
  • Hiperbilirrubinemia:
    • Fototerapia
    • Manejo cuidadoso de los LOS Neisseria fluidos
    • Posible exanguinotransfusión
    • Para los LOS Neisseria casos graves: Inmunoglobulina intravenosa, que puede bloquear los LOS Neisseria receptores de anticuerpos eritrocitarios, lo que provoca una disminución de la hemólisis

Pronóstico

• El pronóstico es excelente si se tiene acceso a atención prenatal, tamizaje del grupo sanguíneo ABO al AL Amyloidosis nacer, y con el uso de Rhogam en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las madres Rh negativas.
• Las formas más raras de enfermedad hemolítica del feto y del recién nacido debido a grupos sanguíneos menores, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum particular el Kell, pueden causar una anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types grave y a menudo mortal.

Diagnóstico Diferencial

• Talasemia: hemoglobinopatías genéticas con presentaciones variables que afectan a las cadenas de globina. Es la hidropesía fetal no inmune más común, puede deberse a causas genéticas que conducen a una sobrecarga de líquidos, incluyendo otras formas de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types grave como la talasemia mayor (forma rara con una falta completa de cadenas alfa).
• Esferocitosis hereditaria: anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica relativamente frecuente, generalmente autosómica dominante, debida a un defecto de la proteína de membrana. Los LOS Neisseria recién nacidos con esta enfermedad suelen presentar anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types e ictericia neonatal. El frotis de sangre periférica muestra microesferocitos.
• Deficiencia de glucosa-6-fosfato deshidrogenasa: anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica intravascular, que se hereda de forma recesiva ligada al AL Amyloidosis cromosoma X. Los LOS Neisseria pacientes presentan hemólisis episódica debido a un factor de estrés oxidativo identificado que provoca daño en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria eritrocitos que carecen de suficiente nicotinamida adenina dinucleótido fosfato ( NADPH NADPH Nicotinamide adenine dinucleotide phosphate. A coenzyme composed of ribosylnicotinamide 5′-phosphate (nmn) coupled by pyrophosphate linkage to the 5′-phosphate adenosine 2. Pentose Phosphate Pathway). Los LOS Neisseria recién nacidos con estrés oxidativo pueden presentar anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types. El frotis periférico muestra microesferocitos y “células mordidas”.
• Infección congénita por TORCH: TORCH significa toxoplasmosis Toxoplasmosis Toxoplasmosis is an infectious disease caused by Toxoplasma gondii, an obligate intracellular protozoan parasite. Felines are the definitive host, but transmission to humans can occur through contact with cat feces or the consumption of contaminated foods. The clinical presentation and complications depend on the host’s immune status. Toxoplasma/Toxoplasmosis, otros (sífilis, virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de la varicela-zóster, parvovirus B19 Parvovirus B19 Primate erythroparvovirus 1 (generally referred to as parvovirus B19, B19 virus, or sometimes erythrovirus B19) ranks among the smallest DNA viruses. Parvovirus B19 is of the family Parvoviridae and genus Erythrovirus. In immunocompetent humans, parvovirus B19 classically results in erythema infectiosum (5th disease) or “slapped cheek syndrome.” Parvovirus B19 y virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de la inmunodeficiencia humana), rubéola, citomegalovirus y herpes simple. Estas infecciones se asocian a pérdidas fetales, mortinatos, retraso del crecimiento intrauterino, anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types fetal, ictericia y hepatoesplenomegalia. Los LOS Neisseria antecedentes, análisis de sangre para detectar infecciones basados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la sospecha clínica y los LOS Neisseria hallazgos típicos al AL Amyloidosis examen físico de las diferentes infecciones, ayudan a dilucidar el diagnóstico.
• Síndrome de Gilbert: enfermedad hereditaria más común asociada a glucuronidación de la bilirrubina. La hiperbilirrubinemia no conjugada es el resultado de una mutación del UGT1A1. A diferencia de la enfermedad hemolítica del feto y del recién nacido, el bebé tiene un hematocrito, un recuento de reticulocitos y un frotis periférico normales.