mean that an infant may not need additional transfusions. low retic is observed in infants treated with iut and in those with hdn from anti-kell. neutrophils – as neutropenia is one of the complications of hdn, the neutrophil count should be checked. thrombocytes - as thrombocytopenia is one of the complications of hdn, the thrombocyte count should be checked. bilirubin should be tested from cord blood. ferritin – because most infants affected by hdn have iron overload, a ferritin must be run before giving the infant any additional iron. newborn screening tests – transfusion with donor blood during pregnancy or shortly after birth can affect the results of the newborn screening tests. it is recommended to wait and retest 10–12 months after last transfusion. in some cases, dna testing from saliva can be used to rule out certain conditions. treatment after birth, treatment depends on the severity of the condition, but could include temperature stabilization and monitoring, phototherapy, transfusion with compatible packed red blood, exchange transfusion, sodium bicarbonate for correction of acidosis and/or assisted ventilation. phototherapy – exposure to ultraviolet light (phototherapy) is recommended when the cord bilirubin is 3 or higher. some doctors use it at lower levels while awaiting lab results. this converts unconjugated bilirubin to an conjugated form that is easier for the infant to clear. ivig - ivig has been used to successfully treat many cases of hdn. it has been used not only on anti-d, but on anti-e as well. ivig can be used to reduce the need for exchange transfusion and to shorten the length of phototherapy. the aap recommends "in isoimmune hemolytic disease, administration of intravenousγ-globulin (0.5-1 g/kg over 2 hours) is recommended if the tsb (total serum bilirubin) is rising despite intensive phototherapy or the tsb level is within 2 to 3 mg/dl (34–51 μmol/l) of the exchange level. if necessary, this dose can be repeated in 12 hours (evidence quality b: benefits exceed harms). intravenous γ-globulin has been shown to reduce the need for exchange transfusions in rh and abo hemolytic disease." exchange transfusion – exchange transfusion is used when bilirubin reaches either the high or medium risk lines on the nonogram provided by the american academy of pediatrics (figure 4). cord bilirubin >4 is also indicative of the need for exchange transfusion. transfusion reactions once a woman has antibodies, she is at high risk for a future transfusion reaction if she is in need of a blood transfusion. for this reason, she is advised to carry a medical alert card at all times and inform all doctors and emergency personnel of her antibody status. the absence of antibodies however does not preclude a woman from having a transfusion reaction: "acute hemolytic transfusion reactions may be either immune-mediated or nonimmune-mediated. immune-mediated hemolytic transfusion reactions caused by immunoglobulin m (igm) anti-a, anti-b, or anti-a, b typically result in severe, potentially fatal complement-mediated intravascular hemolysis. immune-mediated hemolytic reactions caused by igg, rh, kell, duffy, or other non-abo antibodies typically result in extravascular sequestration, shortened survival of transfused red cells, and relatively mild clinical reactions. acute hemolytic transfusion reactions due to immune hemolysis may occur in patients who have no antibodies detectable by routine laboratory procedures." for a summary of transfusion reactions in the us, see reference. epidemiology in 2003, the incidence of rh(d) sensitization in the united states was 6.8 per 1000 live births; 0.27% of women with an rh incompatible fetus experience alloimmunization. other animals hemolytic disease of the newborn is most commonly seen in kittens (where it is known as "fading kitten syndrome") and foals. it has also been reported in puppies.