A newborn girl is admitted to the neonatal intensive care unit with jaundice, hepatomegaly, and generalized edema. She was born by vaginal delivery to a 32-year-old woman, gravida 2, para 2, who received minimal prenatal care. The infant's laboratory results show a hemoglobin level of 6 g/dL and a positive direct Coombs test. A peripheral blood smear shows many nucleated erythrocytes. The infant has significant respiratory distress due to pleural effusions and ascites and dies soon after birth. Autopsy shows areas of extramedullary hematopoiesis in many tissues. Which of the following is the most likely cause of this patient's condition?

Question

A newborn girl is admitted to the neonatal intensive care unit with jaundice, hepatomegaly, and generalized edema.  She was born by vaginal delivery to a 32-year-old woman, gravida 2, para 2, who received minimal prenatal care.  The infant's laboratory results show a hemoglobin level of 6 g/dL and a positive direct Coombs test.  A peripheral blood smear shows many nucleated erythrocytes.  The infant has significant respiratory distress due to pleural effusions and ascites and dies soon after birth.  Autopsy shows areas of extramedullary hematopoiesis in many tissues.  Which of the following is the most likely cause of this patient's condition?

Quizplus · Accepted Answer

Eductional Objective: Hemolytic disease of the newborn most commonly occurs from maternal sensitization to Rh antigens during a prior pregnancy with an Rh(D)+ fetus.  In subsequent Rh(D)+ pregnancies, maternal anti-Rh(D) IgG antibodies cross the placenta and cause a severe autoimmune hemolytic anemia in the fetus and life-threatening hydrops fetalis.

A Newborn Girl Is Admitted to the Neonatal Intensive Care