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3 RH Isoimmunisation

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11 views13 pages

3 RH Isoimmunisation

Uploaded by

hemofreh14
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Rh

Isoimmunization
Haemolytic
disease of fetus
and newborn
(HDFN)
When RhD negative mother
Carries an RhD Positive Fetus
Definition: maternal circulation is in contact with fetal cells, maternal
antibodies can be formed against the paternally derived antigenThe
Red Cells Of The Fetus Or Newborn Are Destroyed By
The Antibodies Arise In The Mother As The Direct Result
Of A Blood Group Incompatibility Between The Mother
And Fetus Antibodies

Antibodies That Are Responsible For HDN


Anti-C, Anti-D, Anti-E, And Anti-k,which antiD is the most common.
Isoimmunization is precipitated by fetomaternal hemorrhage(FMH).
Most commonly at delivery ,in the majority does not affect first
pregnancy but is a risk for subsequent pregnancies
The Primary Response: is a slow response (6 weeks to 6
months).
IgM antibodies
molecular weight of 900,000 that does not cross the placenta.
The Secondary Response: is a Rapid response
IgG antibodies molecular weight of 160,000 that cross the
placenta
If these antibodies are present in sufficient quantities
fetal hemolysis may occur, leading severe anemia lead to
heart failure,edema,hydrops fetalis,fetal death and in newborn a
risk of kernicterus.
The Risk of development of Fetal Rh-disease is
affected by:

 The Husband Phenotype And Genotype (40 % Of Rh Positive Men Are


Homozygous And 60% Are Heterozygous).

 The Antigen Load And Frequency Of Exposure. Prevalence of rhesus


disease

 ABO Incompatibilityof D negativity is 15%in Caucasian


population, lower in all other ethnic groups.
In
Rhesus disease is most common in countries where anti D prophylaxis
is not widespread.
Preventing rhesus iso immunization

 the process of iso-immunization can be nipped in the bud


by the intramuscular administration of anti-D
immunoglobulin to a mother, preferably within 72 hours of
exposure to fetal red cells.

 anti-D must be given after any potentially sensitizing event.


a dose of 500units of anti D will neutralize an FMH OF UP TO
4ML.the exact dose is determined by the gestation at which
sensitization has occurred and the size of fetomaternal
haemorrage,on the basis that 125IUantiD will neutralize

1mlofFMH

postnatal anti –D should be given within72 hours of


delivery to a woman after estimation of FMH

• in the first trimester because volume of fetal blood is so
small therefore standard does of 250IU anti-D is given
before 20weeks.
• After 20 weeks fetal blood volume is greater therefore a
larger dose is given and a kleihauer test performed.
• A kleihuaer test is a test of maternal blood to determine
the proportion of fetal cell present(ability to resist
denaturation by acid). It will allow calculation of the
amount of extra anti-D required.
• In many countries Rheus- negative women are given
anti-D at 28 and 34 weeks prophylactically.
Antenatal sensitizing events with
risk of isoimmunisation
• Miscarriage more than 12 weeks gestation.
• Medical or surgical termination of pregnancy at any
gestation.
• Ectopic pregnancy.
• Hyditidiform mole.
• Prenatal diagnostic procedures.(CVS,amniocentesis)
• Abdominal trauma
• External cephalic version
• Antepartum hemorrhage
• Still birth
• Traumatic delivery including caesarean section
• Manual removal of placenta.
management of rhesus disease in a
sensitized women.
• once a women who is D negative sensitized to D antigen
no amount of anti-D will ever turn the clock back. The
management depends on :
• The father of the next baby is D negative.There is no
chance of rhesus disease.
• The father of the next baby is D positive. He may be
heterozygous The Rh status of the fetus should be
determined by testing for free fetalDNA In Maternal blood.
• In a sensitized woman if the father is D positive or unknown
standard management involves anti body level every 2 to 4
weeks from booking. By using titar or IU as a standard
quantification.
• <4IU/ml HDFN unlikely
• >15IU/ml high risk of hydrops fetalis
• If antibody levels rise the baby should be examined for
signs of anemia..
• Middle cerebral artery(MCA) Doppler's (peak velocity
measurement) correlate reliably with fetal anemia.
• A fetus with raised MCA has a high probability of anemia
and treatment should be at fetal medicine centers
Treatment options
• Delivery of the fetus is an option if the fetus is
sufficiently mature. Must take place in a unit
where adequate neonatal support and expertise
is available.
• Fetal blood transfusion is life saving in a
severely anemic fetus that is to premature for
delivery. The aim is to restore hemoglobin level
reversing or preventing hydrops or death.
• It also suppress fetal erythropoiesis which
reduce antigen positive cells.
Blood can be transfused into a fetus in various
ways. Into umbilical vein at the point of the cord
insertion.
Into intrahepatic vein. Into peritoneal cavity, Into the fetal
heart.

•
At delivery
• Neonatologist must be present at delivery should
exchange transfusion be required.
• All babies born to have cord blood taken at delivery for a
blood count blood grouping,bilirubin and direct coomb's
test.
• Parents should be carefully counselled about risk of
recurrence in subsequent pregnancies.
ABO
• ABO blood group iso immunization may occur when the
mother is blood group O and the baby is blood group A
or B.
• This means ABO incompatibility may occur. However
most anti A and anti B are mainly IGM. Do not cross the
placenta therefore may cause mild hemolytic disease of
the baby.

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