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Haemolytic Disease of the Newborn, Jaundice & Rhesus

From Mediwikis

There are three rhesus groups; C,D & E. Mismatch between fetus and mother mean any leaking fetal red cells into maternal circulation sensitize the maternal immune system potentially leading to haemolytic disease

Rhesus Iso-Immunisation

Pathology

  1. Conception of Rhesus positive fetus (inherited from father) by Rhesus negative mother
  2. Fetal Red Blood Cells leak into maternal circulation in sufficient quantities to induce response
    1. Miscarriage, Termination
    2. Antepartum haemorrhage
    3. Labour
    4. Invasive testing (amniocentesis)
  3. Delayed production of IgG Antibodies affect next pregnancy

Risk of producing hetero-rhesus fetus is 15% in caucasians.

Management

Treat with IM Anti-D after any potentially sensitizing event, for instance after the birth of a Rhesus positive child, or during pregnancy[1]. This "cleans up" any fetal blood cells before they can provoke a response. Give a kelihauer test to determine the proportion of fetal cells present.

Note that once sensitized, a woman cannot be desensitized for her next pregnancy, so test the father, and test the mother for anti-D

References

  1. McBain RD, Crowther CA, Middleton P. Anti-D administration in pregnancy for preventing Rhesus alloimmunisation. Cochrane Database of Systematic Reviews 2015, Issue 9 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000020.pub3/abstract