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RH Incompatibility

Kirsten A. Winnie, MD and Jennifer G. Chang, MD Reviewed 06/2018
 


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

  • Fetal hydrops or fetal death in utero if severe (see “Erythroblastosis Fetalis” topic)

DIFFERENTIAL DIAGNOSIS

  • ABO incompatibility

  • Other blood group (n...

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 wee...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

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

  • Antibody titer measured monthly until 24 weeks and e...

REFERENCES

1
Crowther CA, Middleton P, McBain RD. Anti-D administration in pregnancy for preventing Rhesus alloimmunisation. Cochrane Database Syst Rev.  2013;(2):CD000020. [View Abstract on Ovid...

ADDITIONAL READING

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

  • American College of Obstetricians and Gynecologists. ACOG P...

SEE ALSO

  • Anemia, Autoimmune Hemolytic; Erythroblastosis Fetalis

  • Algorithm: Jaundice

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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