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Rh Incompatibility

Jennifer G. Chang, MD Reviewed 06/2020
 


BASICS

DESCRIPTION

  • Antibody-mediated destruction of red blood cells (RBCs) that bear Rh-surface antigens in individuals who lack the antigens and have become isoimmunized (sensitized) to them

  • System(s) ...

DIAGNOSIS

PHYSICAL EXAM

  • Jaundice of newborn

  • Kernicterus features (choreoathetoid movements, gaze abnormalities, dental enamel dysplasia)

  • Fetal hydrops or fetal death in utero if severe (see “Erythroblast...

TREATMENT

GENERAL MEASURES

  • Depending on severity of involvement, treatment of fetus may include the following:

    • Intrauterine transfusion (3)[B],(4)[A]

    • Early delivery—typically no later than 37 to 38 weeks...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • In most cases, outpatient ambulatory management is appropriate during the antepartum period.

  • Antibody titer measured monthly in isoimmunized wome...

REFERENCES

1
ACOG Practice Bulletin No. 192: Management of Alloimmunization During Pregnancy. Obstet Gynecol.  2018;131(3):e82–e90.
2
Tiblad E, Tuane Wikman A, Ajne G, et al. Targeted routine antena...

ADDITIONAL READING

  • Agre P, Cartron JP. Molecular biology of the Rh antigens. Blood.  1991;78(3):551–563.

  • Bowman J. Thirty-five years of Rh prophylaxis. Transfusion.  2003;43(12):1661–1666.

  • Del...

CODES

ICD10

  • P55.0 Rh isoimmunization of newborn

  • O36.0990 Maternal care for other rhesus isoimmunization, unspecified trimester, not applicable or unspecified

  • T80.40XA Rh incompat react due to tranfs of b...

CLINICAL PEARLS

  • If paternity is certain, determining that the father does not carry the Rh(D) blood group antigen eliminates the need to give RhIG prophylaxis during pregnancy or the need for special ...

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