Doença hemolítica perinatal e suas principais ferramentas de diagnóstico laboratorial: uma revisão de literatura

Abstract

Perinatal hemolytic disease (HDFN), previously known as erythroblastosis fetalis, is a disease that affects fetuses and newborns and is characterized by red blood cell destruction, mediated by maternal red cell alloantibodies of the IgG class that are actively transported across the placenta and destroy fetal erythroid cells carrying the involved antigen and leads to anemia and hyperbilirubinemia. This work sought to describe general aspects concerning HDFN, as well as emphasize the pathophysiology and importance of laboratory diagnosis for disease prevention, as well as relate therapeutic and prophylactic measures. Bibliographic research was conducted from February to September 2022, in national and international databases, by gathering the information relevant to the theme by using isolated and combined descriptors, such as “pregnancy alienization, hemolytic disease of the newborn, blood groups and neonatal jaundice” in Portuguese, English and Spanish languages. The research showed that HDFN is a hemolytic disease that affects the fetus and newborn and has as its main pathophysiological mechanisms maternal alloimmunization by Rh- incompatibility or with antigens from other blood groups and the ABO incompatibility between ABO fetal antigens and natural and regular maternal antibodies. Laboratory tests such as blood classification ABO and Rh, direct antiglobulin test, indirect antiglobulin test, indirect bilirubin dosage, free fetal DNA, blood count, hemoglobin and reticulocytes are useful in diagnosis, as well as image exams such as dopplervelocymetry. Treatment can be performed through phototherapy and in more severe cases, exsanguineotransfusion and intrauterine transfusion may be recommended. Existing prophylaxis consists of administration of anti-D immunoglobulin in negative pregnant women/mothers in order to prevent maternal alloimmunization by antigen D, but evidence suggests the need for further studies to reduce the number of cases caused by other antigens. In addition, it is important to engage governmental programs that make women increasingly aware of the importance of carrying out prenatal care, considering that it is possible to identifiy mothers at risk for the development of HDFN.