Analysis of Clinical Misdiagnosis of Easily Neglected Hemolytic Disease of the Fetus and Newborn

SHI Haiyan; YUAN Shaozhan; WANG Yingying; SUN Jun; TANG Xiaohe

doi:10.3969/j.issn.1002-3429.2025.14.003

Abstract：Objective To analyze the clinical characteristics and common causes of misdiagnosis of hemolytic disease of the fetus and newborn(HDFN),and to summarize the preventive measures of misdiagnosis.Methods A retrospective analysis was conducted on the data of 2 misdiagnosed patients with HDFN admitted from February 2023 to February 2024.Results One child patient developed jaundice on the second day after birth,which gradually worsened and was accompanied by mild anemia.The initial diagnosis was neonatal hepatitis syndrome.Liver-protecting drugs combined with blue light therapy were given for 3 d.However,the jaundice index continued to increase and hemoglobin decreased.Further direct antiglobulin test(DAT)and blood type antibody screening were performed.The results showed that the mother had type O and the child had type A.The mother and baby had incompatible blood types and the child was diagnosed with ABO incompatibility hemolytic disease.The child was treated with intravenous injection of gamma globulin and blood exchange.The jaundice was significantly relieved,and the hemoglobin gradually returned to normal.The child was discharged smoothly on the 21st d of hospitalization.During the 3-month follow-up,there were no abnormalities in growth and development.Another child patient presented with shortness of breath,severe jaundice and anemia on the first day after birth.The initial diagnosis was neonatal sepsis.Empirical anti-infection combined supportive treatment was given for 2 d,but the condition did not improve significantly.The jaundice index did not decrease,and the hemoglobin further decreased.Further examination revealed positive DAT and positive anti-D antibodies in the blood types of both the mother and the baby.Blood type testing indicated Rh blood type incompatibility between the mother and the baby.Eventually,it was diagnosed as Rh blood type incompatibility hemolytic disease.After diagnosis,intravenous injection of gamma globulin,blood exchange therapy and blue light irradiation were administered.The total bilirubin level dropped to the normal range,and the hemoglobin level rose to 130 g/L.The patient was discharged smoothly.At 3-month follow-up,all the growth and development indicators of the child were normal.Conclusion The clinical manifestations of HDFN are complex and are easily confused with diseases such as neonatal hepatitis syndrome and neonatal sepsis.Improving the diagnostic process and strengthening the screening of blood type antibodies and related tests for hemolysis can significantly enhance the accuracy of diagnosis.Early diagnosis and timely treatment can effectively control the progression of the disease,reduce the incidence of complications,and improve the prognosis of children.