ERYTHROBLASTOSIS FETALIS

Case study
Submitted by: Maricel Gallato
 Overview of the Disease
• Erythroblastosis Fetalis is a hemolytic disease of fetal or
neonatal life due to fetal-maternal blood group
incompatibility.

• It is now recognized that Erythroblastosis Fetalis is

caused by incompatibility of several other of the 9 blood
grouping systems.
 Continuation...
• If the mother is Rh-negative, her immune system treats
rh-positive fetal cells as if they were a foreign substance
and makes antibodies against the fetal blood cells. These
anti Rh antibodies may cross back through the placenta
into the developing baby and destroy the baby’s
circulating red blood cells.
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• Signs and symptoms
• Before your baby is born:
• Fast heart rate
• Enlarged organs, such as the heart, liver, or spleen
• Swelling of your baby's body
• After your baby is born:
• Pale skin caused by anemia
• Jaundice (yellowing of your baby's skin or the whites of his eyes)
• Small red or brown spots, or purple patches on your baby's skin
• Swelling of your baby's body
• Trouble breathing
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• Prevention involves giving the Rh-negative mother
Rho(D) immune globulin at the following times:
• Delivery should be as atraumatic as possible. Manual
removal of the placenta should be avoided because it
may force fetal cells into maternal circulation.
• Maternal sensitization and antibody production due to Rh
incompatibility can be prevented by giving the woman
Rho(D) immune globulin.
 Anatomy and Physiology
• Erythrocytes (RBCs) -RBCs contain hemoglobin
molecules which bind to oxygen so it can be transported
to tissues.
• Leukocytes (WBCs) -They destroy and remove old or
aberrant cells and cellular debris, as well as attack
infectious agents (pathogens) and foreign substances.
• Thrombocytes (Platelets) -These membrane-bound cell
fragments lack nuclei and are responsible for blood
clotting (coagulation)
 Pathology and Physiology
Fetus Rh(+) blood

Mother Rh (-) blood

Rh antibodies form in mother’s blood within 72 hours after delivery or abortion of Rh ↓(+)

Fetus in subsequent pregnancy

Increase Hemolysis of RBC

Destroy of RBC
Increase production of immature RBS (erythroblast) Increase serum bilirubin

Enlarged liver and spleen Unconjugated bilirubin pass

Jaundice to brain

Erythroblastosis fetalis
Kernicterus
ASSESSMEN NURSING
Nursing Care Plan
PLANNING NURSING RATIONALE EVALUATION
T DIAGNOSIS INTERVENTION
Objective:Clin Risk for fluid The infant will Independent Initiated To increase intestinal motility and Goal met The
ical jaundice volume deficit exhibit no signs early feedings and offer promote the excretion of unconjugated infant exhibited
evident within related to of dehydration, feeding over 2-3 hours bilirubin through the clearance of stools no signs of
24 hour of birth phototherapy clear amber Monitored urine specific and decrease the potential for dehydration, clear
urine output of gravity Administered dehydrationUrine specific gravity can be amber urine
1-3 ml/kg/hr, fluid intake that is 25% indicator of dehydration.Additional fluids output of 1-3
and will display above normal will help compensate for the increased ml/kg/hr, and will
appropriate requirements. Assessed water that is lost through the skin and in display
weight gain. for signs of dehydration the stools.Phototherapy treatment may appropriate
such as poor skin turgor, cause liqiuid stools and increased weight gain.
depressed fontanels, insensible water loss which increases risk
sunken eyes, decreased of dehydrationIncreased fluid excretion in
urine output, weight loss the stools and a decrease in fluid intake
and changes in may put the newborn at risk for weight
electrolytes Monitored loss. Daily weights can provide accurate
daily weight Assessed determination fluid intake and insensible
quantity and water loss that is caused by
characteristics of the stool phototherapyLoose stools indicate fluid
loss which may lead to volume deficit.
With an increase in stools per day.
Dehydration is possible.
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ASSESSMENT NURSING PLANNING NURSING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

Objective:- Risk for infection After 1 hour nursing Independent Monitored vital For baseline data Partially met After 1
Invasive related to impaired interventions, the signs and assess patient’s With the onset of hour nursing
procedures primary defense patient will conditionObserved and report infection the immune interventions, the
(amniocentesis or demonstrate signs of infection such as system is activated patient partially
intrauterine blood techniques in redness, warmth, discharge and and signs of demonstrated
transfusion)- reducing risk of increased body infection appearA techniques in
insufficient having infection. temperatureStressed the first line defense reducing risk of
knowledge to importance of proper against nosocomial having infection.
avoid exposure to handwashing to SO Stricted infection to cross
pathogen- compliance to hospital control, contaminationTo
inadequate sterilization and aseptic policies establish mechanism
secondary Told patient/SO to comply to to prevent
defenses-rupture antibiotic therapy as occurrence of
of amniotic prophylaxisMonitored infectionTo prevent
membranes medication regimen the occurrence of
infectionTo
determine
effectiveness of
therapy
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ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION
Objective:-skin Risk for injury related to After the nursing Independent Note the May aids in diagnosing After the nursing
appearing light to prematurity interventions, the infant’s ageAssist underlying cause in interventions, the
bright color- patient skin color phototherapy connection with the patient skin color
sclerae appearing will be normal treatmentHave the appearance of jaundiceTo become normal
yellow-dark amber infant completely allow utilization of
urine undressedKeep the alternate pathways for
eyes and gonads bilirubin excretionTo
coveredDevelop a expose the entire skin in
systemic schedule of phototherapyTo protect
turning the infant them from the constant
Collaborative Obtain exposure to high intensity
bilirubin level as lightIdeally every 2 hours
directedAdminister so that all the surfaces are
fluids as directed exposed To have
baseline data if the
therapeutic regimen is
effectiveTo ensure
adequate hydration
 Drug Study
DRUG NAME MECHANIS INDI- CONRA- SIDE ADVERSE NURSING
M OF CATION INDICATION EFFECTS EFFECTS RESPONSIBI
ACTION LITY
BRAND Act by Pregnancy/deli Rh-positive Fever, back Injection site For Im use
NAME:Rhoga suppressing the very of an Rh individuals and pain, nausea reaction, only. Do not
m GENERIC immune positive baby in patients with and vomiting, muscle pain, inject
NAME:Rhoph response of irrespective of known history hypo or fever, intravenously.
ylac Rh-negative ABO groups of of anaphylactic hypertension dizziness, In the case of
DOSE:300 individuals to the mother and or severe tiredness, postpartum
microgramCL Rh-positive red baby, systemic weakness and use, the
ASSIFICATI blood cells. abortion/threat reactions to the itching product is
ON:Immune ened abortion, administration intended for
globulin ectopic of human maternal
pregnancy, immune administration.
antepartum globulin Do not inject
fetal-maternal products the newborn
hemorrhage infant.
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DRUG NAME MECHANISM OF INDICATION CONTRAINDICA SIDE/ ADVERSE NURSING
ACTION TION EFFECTS RESPONSIBILIT
Y
Generic name: Prevent production IM/IV: administer to Contraindicated in: AnemiaIntravascula Observe patient for
RhogamBrand of anti- Rh0 (D) Rh0(D) negative Rh0(D) or Du r hemoysisPain at 20 minutes after
name: antibodies in Rh0 patients who have been positive patients. IM sitefever injection.Instruct
RhogamClassifi (D)- negative exposed to Rh0 positive Patients previously patient to report
cation: patients who were blood by delivering an sentized to Rh0(D) early signs of
immunizing exposed to Rh0 (D)- Rh0(D) positive infant, or Du. hypersensitivity,
agents positive blood. miscarrying or aborting hives, generalized
Increase platelets an Rh0(D) positive urticaria, tightness
count inpatient with fetus, having of chess,wheezing
ITP. amniocentesis or intra- hypotension, and
abdominal trauma while anaphylaxis.Treatme
carrying Rh0(D) nts depends on
positive, following severity of reaction.
accidental transfusion of
Rh(D) postive blood to
an Rh0(D) negative
patients.