Rhesus (Rh) isoimmunization commonly presents with anemia and jaundice of varying intensity in the early postnatal period and is usually treated with phototherapy and exchange transfusion. Rarely, babies with mild or no symptoms at birth may present later with severe hemolytic anemia. This report describes a newborn infant with no postnatal jaundice who presented during the second week of life with severe anemia. These findings indicate the importance of regular follow-up and close monitoring of Rh-isoimmunized infants during the first two months of life for delayed onset anemia.
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| http://dx.doi.org/10.7759/cureus.6559 | DOI Listing |
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Prevention of Maternal Rh D Alloimmunization: A Comparative Review of Guidelines.
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Associate Professor.
Importance: Rhesus alloimmunization refers to the sensitization of an Rh D-negative mother after exposure to D-positive fetal red blood cells, which can lead to significant fetal and neonatal morbidity and mortality.
Objective: The aim of this study was to review and compare the most recently published international guidelines on the prevention of maternal alloimmunization.
Evidence Acquisition: A comparative review of guidelines from the American College of Obstetricians and Gynecologists, the British Committee for Standards in Hematology, the International Federation of Gynecology and Obstetrics, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, and the Society of Obstetricians and Gynecologists of Canada regarding the prevention of maternal Rh D alloimmunization was conducted.
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Immunohematology
December 2024
Department of Pathology, University of Wisconsin Hospital, Madison, WI.
Distinguishing anti-D, anti- C, and anti-G specificities is particularly essential in antenatal cases to ensure proper patient management. The clinical management as well as Rh immune globulin (RhIG) prophylaxis depend on the accurate identification of these distinct antibodies. D- pregnant women with anti-G, but without anti-D, in their serum need RhIG prophylaxis at 28 weeks of gestation, at delivery if the infant is D+, and when clinically indicated to prevent the formation of anti-D and potential hemolytic disease of the fetus and newborn (HDFN).
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Background: Hemolytic disease of the fetus and newborn (HDFN) is a condition due to maternal blood group antibodies targeting antigens in fetal red blood cells, with significant prenatal/perinatal morbidity and mortality. Severe HDFN cases are often associated with alloimmunization against Rhesus D (RhD) or Kell antigens. Information about HDFN epidemiology and treatment in Latin American countries is limited.
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We report a case of severe neonatal hyperbilirubinaemia (NNH) in a term neonate due to rhesus isoimmunisation resulting in classical clinical features of acute bilirubin encephalopathy and its sequel, kernicterus. Though NNH is common, its complications are less often encountered today with the widespread availability of effective phototherapy. It is important not to miss the clinical signs of this preventable cause of neuro-disability.
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Article Synopsis
- Aiming to standardize care for Rh-D negative pregnant women, a panel of 23 experts developed guidelines focused on prevention and management of Rh isoimmunization and related conditions to improve perinatal outcomes.* -
- Utilizing a modified Delphi method, the panel assessed 22 questions across eight key areas, including Rh-D testing, prenatal care, and treatment strategies for affected fetuses, reaching an 80% consensus on recommendations.* -
- Key recommendations include encouraging preconception consultations for Rh-D negative women, determining maternal Rh-D status during initial healthcare visits, and ascertaining the father's Rh-D status early in prenatal care.*
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