Anemia Screening for high risk newborns with ABO/RH Incompatiblity (6-18-18)

As advised by Dr Yang, ABO/RH incompatibility between mother and baby can cause mild Hemolytic Disease of the Newborn, which leads to hyperbilirubinemia, but usually not severe anemia requiring a blood transfusion. However ABO incompatiblity can be associated with late hemolysis around 1 month of age.

IFOH currently have a protocol to automatically check the cord blood for the baby's blood type and Coomb's antibody if mom's blood type is O Rh negative and/or maternal Rh-group antibodies were detected prenatally.

• Babies with early hyperbilirubinemia requiring aggressive phototherapy during the newborn nursery admission or whose mother has Rh type antibodies (i.e. anti-D, -C, -c, -E, -e, or -JK) are at higher risk of more severe anemia later that may require transfusion. Therefore, it is recommended these newborns have a repeat Hgb/Hct and retic count checked at 3-4 weeks of age.
• Babies without early hyperbilirubinemia are at low risk for significant anemia. Therefore, screening of these babies should be guided by clinical symptoms. Hgb/Hct and retic count evaluations should be considered at 3-4 weeks of age or sooner if the baby displays clinical signs/symptoms of anemia.
• Babies with anemia during the newborn nursery admission (Hgb<13.5 or Hct<45) should have their Hgb/Hct and retic checked within 1 week after discharge and again 3-4 weeks of age.
• If Hgb is 8-9, recheck every 1-2 weeks until Hgb >10. If Hgb <8 please refer to to pediatric hematology for further evaluation and management.