Rh Incompatibility

Published on 31/05/2015 by admin

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Last modified 31/05/2015

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Chapter 221 Rh Incompatibility

INTRODUCTION

Description: Isoimmunization to any fetal blood group not possessed by the mother is possible. The most common example is the Rh (D) factor. What was once a common cause for intrauterine fetal death has largely been eradicated by prophylactic administration of immune globulin to those at risk.
Prevalence: Uncommon since the routine use of D immune globulin therapy.
Predominant Age: Reproductive.
Genetics: Mothers who are Rh (D) negative. (The genes for the CDE blood groups are inherited separately from the ABO groups and are located on the short arm of chromosome 1.)

ETIOLOGY AND PATHOGENESIS

Causes: Antibody formation against the D antigen.
Risk Factors: Any process that exposes the woman to blood carrying the D antigen including blood transfusion, miscarriage, ectopic or normal pregnancy, trauma, amniocentesis during pregnancy, and others.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Elevated serum titers of anti-D immunoglobulin (IgM)
• Fetal hydrops, erythroblastosis fetalis, hemolytic disease of the newborn
• Intrauterine fetal demise

DIAGNOSTIC APPROACH

Differential Diagnosis

• Other isoimmunizations (most frequently Lewis, Kell, or Duffy antigens)
• Iron-deficiency anemia (maternal)
• Hemoglobinopathy

Associated Conditions: Polyhydramnios.

Workup and Evaluation

Laboratory: Serum antibody titers (at first visit, 20 weeks, and approximately every 4 weeks thereafter), testing of baby’s father’s antibody status. Emerging data suggest that it may be possible to determine the Rh status of the fetus directly from fetal cells circulating in maternal blood.
Imaging: Ultrasonography is useful to establish gestational age and monitor amniotic fluid volume and fetal growth. Some studies have assessed the ability of ultrasonography to monitor the degree of fetal anemia, but this technique has not gained wide usage.
Special Tests:

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