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For further information, see CMDT Part 19-04: Prevention of Rhesus Alloimmunization

Key Features

  • Anti-Rho(D) antibody causes severe hemolytic disease of the newborn

  • Occurs when a Rho(D)-negative woman carries a Rho(D)-positive fetus and develops antibodies against Rho(D)

  • The antibody developed against Rho(D) persists and poses a threat of hemolytic disease in subsequent Rho(D)-positive fetuses

  • Passive immunization of Rho(D)-negative mothers after delivery destroys fetal Rho(D)-positive cells and prevents formation of antibodies, which would cause disease in subsequent Rho(D)-positive gestations

Clinical Findings

  • Routine antibody screen is positive

Diagnosis

  • Because hemolytic disease may occur in association with Rh subgroups or other red blood cell antigens, atypical antibodies should be assessed at 28 weeks in all pregnancies

Treatment

  • Rho(D) immunoglobulin (Ig) is given to the mother within 72 h after delivery to prevent future erythroblastosis

  • Additional protection is afforded by the routine administration of the Ig at week 28; the passive antibody titer is too low to harm the Rho(D)-positive fetus

  • Rho(D) Ig should also be given after abortion, ectopic pregnancy, placental abruption, other antepartum bleeding

  • Once a woman is alloimmunized, Rho(D) immune globulin is no longer helpful and should not be given

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