Addressing Hemolysis in an Infant Due to Mother-Infant ABO Blood Incompatibility

Article excerpt

INTRODUCTION

This issue of the Journal of the Medical Library Association (JMLA) honors the life of and contributions to medical librarianship of Estelle Brodman, PhD. Dr. Brodman's interests in medical bibliography, automation, international collaboration, education, the history of medicine, and the profession were far reaching, and her ideas reflected innovation and a strong desire to grow the profession and skills of medical librarians [1, 2]. Since that time, medical librarianship has continued to evolve, realizing many of the ideas Dr. Brodman and others advocated. For example, the availability of medical databases and widespread use of computers in libraries have improved library processes and the ability to quickly locate information. With her strong advocacy of lifelong learning, Dr. Brodman also serves as an important role model as a librarian/educator, and she would likely have been pleased to see the profession's emphasis on continuing education and research [3, 4].

As McClure noted in her discussion of Dr. Brodman as a historian, Dr. Brodman found that the study of history "often illuminates the meaning of the present and indicates logical possibilities for the future" [5]. The history of the development of neonatal critical care, like that of medical librarianship, has doubtless been influenced and evolved by pioneering thinkers. One such thinker and contemporary of Dr. Brodman, Mildred T. Stahlman, MD, was also a leader in education, practice, and research in her chosen field, neonatal critical care medicine. In 1961, Dr. Stahlman, known as the pioneer of modern neonatal intensive care, led a National Institutes of Health research project to explore the physiological aspects of the developing fetus and changes that occur at birth [6, 7]. At a critical point in her research, Dr. Stahlman made the groundbreaking decision to adapt a scaled-down respirator, a breathing machine originally developed for polio patients, to assist breathing in an infant born with severe hyaline membrane disease, a lung disease seen in premature infants whose lungs have not yet fully developed. The infant, who previously faced certain death, was able to survive with this first-ever respiratory therapy that gave a viable treatment option for preterm babies with underdeveloped lungs [6, 8]. This groundbreaking research led Dr. Stahlman to develop the first modern neonatal intensive care unit (NICU) at Vanderbilt University Medical Center [6].

Today, NICUs have become an essential part of health care in the United States for critically ill infants and their families, providing constant observation and care for these babies. Premature babies, infants born earlier than thirty-seven weeks gestation (the typical threshold for defining normal gestation) [9], represent a high percentage of those cared for by a NICU. These babies often have a variety of developmental issues requiring intensive treatment. Given the constantly evolving state of clinical research, NICU teams frequently encounter information needs requiring consultation of the medical literature.

THE CASE

You are a librarian collaborating with the clinical team in your hospital's NICU, who round at the bedside of a thirty-six- week gestation infant girl. Although the baby was premature, the diagnosis that prompted her admission to the NICU was ABO incompatibility, a condition that can appear in both premature and fullterm babies and part of a broader family of conditions that includes Rh incompatibility [10].

The human ABO system includes four blood groups: A, B, AB, and O [10]. Blood cells of individuals with type A or B blood have small molecules on their surfaces called antigens. The human body generates antibodies against whichever blood group antigens it does not have [H]. Humans with group A generate anti-B antibodies; those with group B generate anti-A antibodies; AB individuals have both antigens so they do not produce anti-A or anti-B antibodies; and individuals with type O blood do not have these surface antigens, so they create antibodies against both A and B [11, 12]. …