Maʻi Hemolytic o ka hānau hou

ʻO ka maʻi hemolytic o ke keiki hānau hou (HDN) he maʻi maʻi koko i loko o kahi ʻōpū a i ʻole keiki pēpē hou. I kekahi mau pēpē, hiki ke make.

ʻO ka maʻamau, mau ke koko ʻulaʻula (RBC) ma kahi o 120 mau lā i ke kino. I kēia maʻi, hoʻopau koke ʻia nā RBC i ke koko a no laila ʻaʻole lōʻihi ke lōʻihi.

I ka wā hāpai, hiki i nā RBC mai ka pēpē i hānau ʻole ke hele i loko o ke koko o ka makuahine ma o ka placenta. Hana ʻia ʻo HDN ke ʻike ka ʻōnaehana pale o ka makuahine i nā RBC o kahi pēpē he haole. Hoʻokumu nā Antibodies e kūʻē i nā RBC o ka pēpē. Hoʻopilikia kēia mau mea ʻino i nā RBC i ke koko o ka pēpē a hoʻomaka lākou e wāwahi i ka wanaʻao.

Hiki i ka HDN ke ulu i ka wā he ʻano like ʻole ke koko o ka makuahine a me kāna pēpē i hānau ʻole ʻia. Hoʻokumu ʻia nā ʻano ma nā mea liʻiliʻi (antigens) ma ka ʻili o nā huna koko.

Aia ma mua o hoʻokahi ala kahi e kūlike ʻole ai ke ʻano o ke koko o ka pēpē i hānau ʻole ʻia me ka makuahine.

• ʻO A, B, AB, a me O nā anetene hui koko ʻehā a i ʻole ʻāpana. ʻO kēia ka ʻano maʻamau o kahi like ʻole. I ka hapanui o nā hihia, ʻaʻole koʻikoʻi loa kēia.
• Pōkole ʻo Rh no ka antigen "rhesus" a i ʻole ke ʻano koko. He maikaʻi a maikaʻi ʻole paha ka poʻe no kēia antigen. Inā Rh-maikaʻi ʻole ka makuahine a ʻo ka pēpē i loko o ka ʻōpū he Rh-positive cells, hiki i kāna mau antibodies i ka Rh antigen keʻaʻa i ka placenta a hōʻeha i ka anemia koʻikoʻi loa i ka pēpē. Hiki ke pale ʻia i ka nui o nā hihia.
• Aia kekahi, ʻoi aku ka liʻiliʻi o ka maʻamau, ʻano o ka mismatch ma waena o nā antigens pūʻulu koko liʻiliʻi. Hiki i kekahi o kēia mau mea ke hoʻopilikia i nā pilikia.

Hiki iā HDN ke hoʻopau i nā hunaola o ke pēpē hou me ka wikiwiki loa, kahi e kumu ai nā ʻōuli e like me:

• Edema (hoʻāhu ma lalo o ka ʻili o ka ʻili)
• ʻO ka jaundice hānau hou e kū koke a ʻoi aku ka paʻakikī ma mua o ka maʻamau

ʻO nā hōʻailona o HDN me:

• Anemia a i ʻole helu helu haʻahaʻa
• Hoʻonui ākea a ʻōpala paha
• Hydrops (kahe i loko o nā aʻa o ke kino, me nā wahi i piha i ka akemāmā, ka puʻuwai, a me nā ʻōpū o nā ʻōpū), hiki i ka puʻuwai puʻuwai a i ʻole ka hanu maikaʻi ʻole mai ka nui o ka wai.

Hana ʻia nā hoʻokolohua e pili ana i ke ʻano o ka hui pū ʻole o ke koko a me ke koʻikoʻi o nā ʻōuli, akā hiki ke hoʻopili ʻia:

• Heluhelu piha i ke koko a me ka helu ʻulaʻula o ke koko ʻulaʻula ʻole (retikulite)
• Pae Bilirubin
• Kikokiko kikokiko

Hiki ke mālama ʻia nā pēpē me HDN me:

• ʻO ka hānai pinepine a me ka loaʻa ʻana o nā wai keu.
• ʻO ka light therapy (phototherapy) e hoʻohana ana i nā kukui polū kūikawā e hoʻolilo i ka bilirubin i ʻano i maʻalahi no ka heʻe ʻana o ke kino o ka pēpē.
• Nā Antibodies (immunoglobulin intravenous, a i ʻole IVIG) e kōkua i ka pale ʻana i nā hunaola ʻulaʻula o ka pēpē mai ka luku ʻia.
• ʻO nā lāʻau e hoʻāla i ke kahe o ke koko inā hāʻule haʻahaʻa ia.
• I nā hihia koʻikoʻi, pono e hoʻokō ʻia kahi transfusion exchange. Hoʻopili kēia i ka wehe ʻana i kahi nui o ke koko o ka pēpē, a pēlā ke bilirubin keu a me nā mea ʻino. Hoʻokomo ʻia ke koko hāʻawi hou.
• Transfusion maʻalahi (me ka hoʻololi ʻole). Pono paha e hana hou i kēia ma hope o ka hoʻi ʻana o ka pēpē mai ka haukapila.

Hiki ke loli ke koʻikoʻi o kēia ʻano. ʻAʻohe ʻōuli o kekahi pēpē. I nā hihia ʻē aʻe, hiki i nā pilikia e like me hydrops ke make i ka pēpē ma mua, a i ʻole ma hope koke iho, ka hānau ʻana. Hiki ke mālama ʻia ʻo HDN nui ma mua o ka hānau ʻana e nā transfusions o ke koko intrauterine.

ʻO ke ʻano koʻikoʻi loa o kēia maʻi, i kumu ʻia e Rh incompatibility, hiki ke pale ʻia inā e hoʻāʻo ʻia ka makuahine i ka wā hāpai. Inā pono, hāʻawi ʻia iā ia kahi kī o ka lāʻau i kapa ʻia ʻo RhoGAM i kekahi mau manawa i ka wā a ma hope o kona hāpai ʻana. Inā loaʻa iā ʻoe kahi pēpē me kēia maʻi, e kamaʻilio pū me kāu kahu mālama ola inā ʻoe e hoʻolālā e loaʻa i kahi pēpē hou.

Maʻi Hemolytic o ka fetus a me ka hānau hou (HDFN); Erythroblastosis fetalis; Anemia - HDN; Kūlike ʻole ke koko - HDN; Kūlike ʻole o ABO - HDN; Rh incompatibility - HDN

• Hoʻopiʻi Intrauterine
• Nā Antibodies

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ʻO Niss O, Ware RE. Nā maʻi koko. I: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. ʻO Puka Textbook of Pediatrics ʻo Nelson. 21st ed. Piladelapia, PA: Elsevier; 2020: chap 124.

ʻO Simmons PM, Magann EF. ʻO nā immune a me nā non-immune hydrops fetalis. I: Martin RJ, Fanaroff AA, Walsh MC, hua. ʻO Fanaroff a me Neonatal-Perinatal Medicine: Nā maʻi o ka Fetus a me ka pēpē. 11th hua. Piladelapia, PA: Elsevier; 2020: chap 23.