PRACTICAL MANAGEMENT OF ERYTHROBLASTOSIS FETALIS IN A COMMUNITY HOSPITAL

Erythroblastosis occurred in 111 of 14,908 live births on which this study was based. The goal of treatment was to avoid kernicterus by keeping the serum indirect bilirubin level from rising above 20 mg. per 100 cc. The bilirubin value was found to be more reliable than the hemoglobin value as an indicator of the severity of the hemolytic process. The most important part of treatment is the exchange transfusion, and it is necessary for all concerned to cooperate with the transfusion team. In the most severe cases, with hydrops fetalis, profound anemia, and cardiac failure, the only hope lies in immediate exchange transfusion followed by a second transfusion within three or four hours. Because treatment must be prompt, the authors believe that it should be given in the local hospital, provided laboratory facilities are adequate. In this series there were six deaths, of which five were in infants wth Rh and one in an infant with ABO incompatibility.