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ABO HDFN: Treatment

Prenatal treatment
Prenatal management and treatment of ABO HDFN is not routinely done because:
  • Titers of anti-A and anti-B do not correlate well with severity of disease;
  • The risks of fetal monitoring (eg, amniocentesis, cordocentesis) and fetal transfusion are greater than the risk of ABO HDFN since it is usually mild and subclinical.
However, if a woman has a history of infants with moderate to severe ABO HDFN requiring treatment, she may be monitored so that the infant can be treated for possible HDFN as soon as possible.
Postnatal Treatment
Treatment of ABO HDFN usually consists of phototherapy in which the newborn is placed under a "blue light" that chemically alters bilirubin in the surface capillaries to a harmless substance. For more severe cases, exchange transfusion may be performed.
Donor RBC for exchange transfusion in cases of ABO HDFN must meet these criteria:
  1. Group O
  2. Rh compatible with infant
  3. Crossmatch compatible with maternal serum*
  4. No more than 7 days old
  5. Reconstituted with AB FFP to obtain a prescribed hematocrit
  6. Cytomegalovirus (CMV) "safe" (leukoreduced and/or CMV seronegative)
  7. Negative for hemoglobin S to prevent blood from sickling under conditions of reduced oxygen concentration in the newborn
  8. Irradiated to prevent transfusion-associated graft-versus-host disease
*Red Blood Cells are crossmatched with maternal plasma, although the infant's plasma can be used if a maternal blood specimen is unavailable.