Hemolytic Disease of the Fetus and Newborn in 2026: Still a Life-threatening Disease

Proposed Session Description: Recent publications have advocated for the use of RhD positive red blood cells and whole blood in patients of childbearing potential in bleeding emergencies, with the implication that hemolytic disease of the fetus and newborn (HDFN) is a mild disease when properly managed ante, peri- and postpartum. This program will describe the care of patients at risk of HDFN from all clinically significant alloantibodies (not just anti-D) from the perspective of a maternal-fetal medicine specialist who practices at a referral center for pregnant patients with clinically significant red cell alloantibodies and a neonatologist who treats neonates affected by this disease.

Our first speaker is a maternal-fetal medicine specialist at a regional referral center. He will detail the steps a maternal-fetal medicine specialist takes the diagnosis of alloimmunzation is made and the process in determining fetal risk. This speaker will also discuss the considerations involved in deciding when to perform an intrauterine transfusion on an at-risk fetus and what factors go into decision for delivery. He will also detail indications for referral to a high risk center for continued management.

Our second speaker is a neonatologist who manages the care of neonates affected with HDFN. She will review the spectrum of clinical presentations observed in these infants and provide an overview of postnatal management. This will include delivery room stabilization, neonatal interventions during hospitalization, and the need for structured outpatient follow-up and ongoing monitoring after discharge. This specialist will outline key laboratory and clinical parameters that guide therapeutic decision making, including thresholds for initiating phototherapy, simple transfusion, and red cell exchange transfusion. She will also briefly touch on the most severe presentation of hydrops fetalis, in the setting of early life-threatening anemia.