Definition: Rh incompatibility is a condition that develops when a pregnant woman has Rhnegative blood and the baby in her

womb has Rh-positive blood. Alternative Names Rh-induced hemolytic disease of the newborn Background The Rh factor (ie, Rhesus factor) is a red blood cell surface antigen that was named after the monkeys in which it was first discovered. Rh incompatibility is a condition that occurs when a woman with Rh-negative blood type is exposed to Rh-positive blood cells, leading to the development of Rh antibodies. Rh incompatibility can occur by 2 main mechanisms. The most common type occurs when an Rh-negative pregnant mother is exposed to Rh-positive fetal red blood cells secondary to fetomaternal hemorrhage during the course of pregnancy from spontaneous or induced abortion, trauma, invasive obstetric procedures, or normal delivery. Rh incompatibility can also occur when an Rhnegative female receives an Rh-positive blood transfusion. In part, this is the reason that blood banks prefer using blood type "O negative" or "type O, Rh negative," as the universal donor type in emergency situations when there is no time to type and crossmatch blood. The most common cause of Rh incompatibility is exposure from an Rhnegative mother by Rh-positive fetal blood during pregnancy or delivery. As a consequence, blood from the fetal circulation may leak into the maternal circulation, and, after a significant exposure, sensitization occurs leading to maternal antibody production against the foreign Rh antigen. Once produced, maternal Rh immunoglobulin G (IgG) antibodies may cross freely from the placenta to the fetal circulation, where they form antigenantibody complexes with Rh-positive fetal erythrocytes and eventually are destroyed, resulting in a fetal alloimmune-induced hemolytic anemia. Although the Rh blood group systems consist of several antigens (eg, D, C, c, E, e), the D antigen is the most immunogenic; therefore, it most commonly is involved in Rh incompatibility.

Epidemiology About 15% of the white population has an RhD-negative blood type. Population data suggest that the incidence of RhD negativity is highest among Basques (36%). Seven percent of black people have this blood type. Less than 1% of the Native American and Asian populations have this phenotype. In the UK, about 16% of the white population is RhD negative. In 2005, it was estimated that about 65,000 RhD-positive babies were born in the UK to women who were RhD negative (accounting for 10% of all births). Causes Factors that influence an Rh-negative pregnant female's chances of developing Rh incompatibility include the following: Ectopic pregnancy Placenta previa Placental abruption Abdominal/pelvic trauma In utero fetal death Any invasive obstetric procedure (eg, amniocentesis) Lack of prenatal care Spontaneous abortion Blighted ovum

Clinical manifestations Jaundice appearing in the 1st 24 hours. Serum bilirubin (unconjugated) rises rapidly. Anemia from hemolysis. Hepatosplenomegaly Hydrops and hypovolumic shock in severe cases Hypoglycemia from pancreatic hyperplasia