BSV launches the 'Voice of Africa' series to raise public awareness of HDFN

LAGOS, Nigeria, Aug. 22, 2025 /PRNewswire/ -- BSV has launched a "Voice of Africa" awareness campaign in African countries to publicise HDFN.

What is HDFN and why is it essential to understand it? Haemolytic disease neonatal (HDFN), also known as erythroblastosis foetalis, is a blood disorder that occurs when the blood groups of the mother and child are incompatible. This incompatibility is also known as Rh incompatibility. When a Rh-negative woman becomes pregnant with a Rh-positive child, she may be exposed to the Rhesus antigen (foreign to her body) during childbirth or miscarriage. In response, the woman develops antibodies against the Rh antigen.

So what's the problem?

In Nigeria, women with a negative rhesus blood group account for between 0.8% and 8.4% of all pregnancies, as shown by studies carried out in different regions of the country. This figure appears to be in line with the number of women affected worldwide. The proportion of these women who develop antibodies following exposure to the Rh antigen is less than 2%. The actual number of babies affected is unclear. Diagnosis is often made by the indirect Coomb test performed on the mother's blood at least once every three months and by the direct Coomb test on umbilical cord blood at the time of delivery. Unaffected mothers receive anti-D immunoglobulin 1,500 μg at 28 weeks in some centres and within 72 hours of delivery, where appropriate, to prevent haemolytic disease. Women are also expected to receive anti-D after a miscarriage or termination of pregnancy. There are as yet no standardised guidelines or protocols for the management of Rh-negative pregnant women in Nigeria.

"Screening tests and anti-D immunoglobulin are expensive and not readily available or affordable. It is therefore necessary to tackle this problem because of its effects on pregnancy outcomes," said Dr Joy Onyinyechi Chionuma.

If the woman is pregnant the next time with an Rh-positive baby, the antibodies she has developed can enter the foetus and attack the Rh antigen on the foetus' RBCs (red blood cells). When the mature red blood cells break down, only immature red blood cells remain. They are less able to transport oxygen to all parts of the body and the foetus develops anaemia. This is known as haemolytic disease of the newborn.

The foetus may then suffer heart failure, leading to an accumulation of fluid in various parts of the body. In addition, bilirubin is formed as a result of the destruction of red blood cells. The baby's liver is not sufficiently developed to eliminate bilirubin. Bilirubin can therefore reach toxic levels and lead to jaundice.

Excess bilirubin can also affect the brain, causing fever, loss of appetite and energy, uncontrollable movements, seizures, deafness, slurred speech and mental retardation.

This disease can be fatal and requires either a blood transfusion or a procedure in which the plasma is completely replaced, eliminating all toxins (plasmapheresis). Phototherapy is another treatment option. Some research suggests that an early liver transplant may be useful.

The Rh disease scenario in Ghana

To prevent or reduce these complications, Rh-negative pregnant women routinely receive Rh immune globulin at 28 weeks' gestation and within 72 hours of delivering an Rh-positive baby, or after any event likely to mix foetal blood with maternal blood (e.g. miscarriage, amniocentesis).

"According to unpublished data from the Department of Obstetrics and Gynaecology's annual records from 2013, the rate of Rh D-negative mothers consulting Korle-Bu Teaching Hospital (KBTH) was 4.3%," said Dr Isaac O. Koranteng.

It would be unfair not to mention the pain felt by the family of a baby affected by this disease. The child will need constant care in a neonatal intensive care unit. The emotional, physical and financial burden can be considerable.

The role of antenatal care in reducing potentially sensitising events in Rhesus-negative pregnant women

RHESUS ALLO IMMUNISATION IN THE AFRICAN CONTEXT

Introduction

Maternal fetal alloimmunisation (MFAE) is defined as the presence on the fetal red blood cell of maternal alloantibodies transmitted in utero [EMC OBSTETRICS]. Rhesus system antibodies (Rh D, C, c, E, e) are the most frequently implicated [CNTS CI]. The immune complexes formed may be responsible for foetal and/or neonatal erythrocyte haemolysis, the most serious of which are linked to anti-D (Rh1), c (Rh4) or Kell alloimmunisation. Rhesus alloimmunisation is thus a major cause of foetal anaemia and perinatal mortality [CNGOF]. Our study was particularly interested in Rhesus anti-D alloimmunisation because it is the only erythrocyte alloimmunisation that can be prevented by medication.

1 - Problems

Rhesus alloimmunisation accounts for 61.1% of all erythrocyte alloimmunisations in the general population in Côte d'Ivoire [CNTS CI]. At the CHU de Cocody, 19 cases of Rhesus anti-D allo immunisation were recorded over a 3-year period from January 2017 to December 2019. The prevalence of Rhesus alloimmunisation in Africa remains poorly documented. The few studies on the subject estimate prevalence at between 1 and 4% of all pregnancies [ ]. The low prevalence observed at the CHU de Cocody may be underestimated due to insufficient diagnosis of anti-D alloimmunisation during pregnancy.

2 - Our practice

• Diagnosis

Screening begins with the determination of the maternal Rhesus blood group during the prenatal check-up in the 1st trimester of pregnancy. If the woman is Rh-negative, it is recommended that the spouse's Rh blood group be checked. If the partner is Rh D negative, there is no need for immunoprophylaxis. On the other hand, if the partner is Rh D positive or unknown, an irregular agglutinin test (RAI) or an indirect Coombs test should be carried out in the 1st trimester and 9th month of pregnancy. In our practice, this test is only carried out in 37% of Rh-negative patients. Today, the CNGOF recommends foetal Rh D genotyping on maternal blood in the 1st trimester of pregnancy. However, this test is not available in Côte d'Ivoire.

• Prevention

"During pregnancy, systematic prevention at 28 weeks' gestation, as recommended by several learned societies, is not carried out in our practice because of the exorbitant cost of anti-D serum for the vast majority of our patients. Instead, we carry out targeted prevention in situations where there is a risk of maternal-fetal haemorrhage, using 200 micrograms of anti-D serum .

After delivery, we systematically inject 300 micrograms of anti-D serum within 72 hours of delivery, with a catch-up dose within 30 days if the injection was not given on time.

However, this dosage of injected serum remains subjective due to the fact that the Kleihauer test is not carried out because of the lack of laboratories throughout the country and our patients' lack of financial resources," said Professor Boni Ehouman Serge Auguste.

The good news is that all this can be avoided. If a pregnant woman has Rh-negative blood, she should receive medical assistance in all situations where she is likely to be sensitised by the blood of the foetus. This may include childbirth, miscarriage, abortion or any invasive test or procedure. The administration of Rhesus immune globulin to the mother is recommended within 72 hours of such an event. This immunity will neutralise the Rh antigen in the baby's blood even before the mother has a chance to develop antibodies against it.

How is Rh incompatibility managed?

If an Rh-negative woman is pregnant and has already given birth to an Rh-positive child, the doctor can test her blood for Rh-positive antibodies, carry out an ultrasound scan (USG) to detect signs of heart failure and even take a sample of amniotic fluid to check the foetus's bilirubin level (amniocentesis). It is also possible to take a sample of foetal blood from the umbilical cord.

Once the diagnosis has been made, depending on the severity of the disease, the foetus may require one or more intrauterine blood transfusions, or early delivery may be necessary to deal with complications.

Haemolytic disease of the newborn is a devastating condition for babies and their families and presents an enormous challenge. But it doesn't have to be that way. To be forewarned is to be forearmed, and raising awareness of this disease can go a long way towards saving lives.

Reference

^1. Akaba GO, Ubong IA, Olateju EK. Prevalence and fetal outcome of Rh-negative pregnancy in a tertiary health care institution in Abuja. Afri J Fetomaternal Med 2023; 2(1):63-75
^2. Eleje GU, Ijike CP, Ezeama CO, Umeobike JC, Oguajiofor CB. Fetomaternal outcomesof women with Rhesus-isoimmunization in a tertiary healthcare centre. J Preg Neonatal Med 2017; 1(1):21-27
^3. Otomewo, L, John-Olabode, S, Okunade, K1, Olorunfemi, G3; Ajie, I. Prevalence of Rhesus C and D Alloantibodies among Rhesus-Negative Women of Child Bearing Age at a Tertiary Hospital in South-West Nigeria. Nigerian Journal of Clinical Practice 23(12):p 1759-1766, December 2020 DOI : 10.4103/njcp.njcp_114_20 
^4. Allagoa DO, Orji PC, Briggs DC, et al. Rhesus negative pregnancy: Prevalence and foetomaternal outcomes in a tertiary hospital in south-south Nigeria. European Journal of Medical and Health Sciences 2021;3(5):123-131

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