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Rh (Hemolytic disease in the Newborn (S&S (Anemia, Compensatory…
Rh
Hemolytic disease in the Newborn
S&S
Anemia
Compensatory hyperplasia of blood-forming organs --> enlarged liver and spleen
impaired liver funky --> albumin synthesis cause ascites and generalized edema (hydrous fetalis)
risk or kernicterus (hemolysis --> bilirubin crosses the BB causing brain damage_
Prevention
Rh immune globulin
IgG anti Rh(D) antibody
Given to Rh- mothers at 28weeks
Given to Rh- mothers within 72hours of delivery if the baby is Rh+
Given to Rh- women following an abortion, miscarriage amniocentesis chronic villus sampling or fetal maternal bleeding occurs
given ImM
Binds to any Rh+ RBC that have entered maternal circa, inactivated Rh antigens before the immune system can respond - preventing sensitization. Does not work once sensitization has already occurred.
Dx
All pregnant women get a blood test at their first prenatal visit to determine if they are Rh- or Rh- sensitized
If sensitized : maternal antibody levels are monitored, amniocentesis at 15 weeks to determine fetal blood type and Rh group. Ultrasound to monitor fetus
TX
Intrauterine fetal transfusions (into umbilical vein) & early delivery
After birth: exchange transfusion - remove the infants blood volume and replace with type O Rh- blood, this removes hemolyzed RBC, antibodies and bilirubin
Coded by 3 pairs of which the D antigen is the most significant (immunogenic)
Rh positive (RBC contain D antigen
Rh negative (RBC lack the D antigen)
Blood usually does not contain anti- Rh antibodies --> develop through exposure to Rh+ blood due to pregnancy or transfusions
Pregnancy
Usually no contact between fetal and maternal blood during pregnancy
DURING CHILDBIRTH- fetal blood can leak through the placenta into the maternal blood.
Mother makes anti-Rh antibodies called SENSITIZATION (child is unaffected)
during second childbirth -->
Maternal anti-Rh antibodies cross the placenta and enter the bloodstream of the fetus
React with the antigens of the Rh+ fetus= agglutination and hemolysis
= hemolytic disease of the newborn (or erythroblastosis fettles