ABO and Rh Blood Group

Systems

4 Basic Blood Types

What is Rh
Isoimmunization?

Rh Isoimmunization
Is an immunologic disease that occurs when a Rh ve
mother carries a Rh +ve fetus from a Rh +ve father.

Incidence of Rh
isoimmunization

In mothers who do not receive

prophylaxis with Rh immunoglobulin,
the overall risk of isoimmunizations is
about 16%. Of which:
1.52% of reactions will occur
antepartum
7% within 6 months of delivery
7% manifest early in the second
pregnancy

Pathogenesis

Pathogenesis

Isoimmunization may occur by 2

mechanisms:
(1) following incompatible blood transfusion
or
(2) following fetomaternal hemorrhage
between a mother and an incompatible fetus.
Fetomaternal hemorrhage may occur
during pregnancy or at delivery.
6.7% of women during the first trimester,
15.9% during the second trimester, and
28.9% during the third trimester.

Contd

Predispositions to fetomaternal
hemorrhage:
spontaneous or induced abortion
Amniocentesis
chorionic villus sampling
abdominal trauma
placenta previa or abruptio placentae,
fetal death
cesarean section.

Contd

1.

1.
2.

Protective factors:
30% of Rh-negative persons never
become sensitized (nonresponders)
when given Rh-positive blood.
Maternal immune response to Rh
sensitization:
Initial response - Immunoglobulin (Ig) M
Secondary response - IgG antibodies

Fetal & Neonatal Effects

During pregnancy while the fetus still in the uterus
The bilirubin in the fetal blood will be removed by the
placenta to the maternal circulation and part of it go to
the liquor
The fetus will be anemic
.. If the degree of anemia is severe
fetus may die in utero because of heart failure
After delivery
The neonate will affected by
The degree of the anemia
The amount of bilirubin

Management of Rh-ve
pregnant women

1. Management of non sensitized Pregnancy

Blood Group typing at 1st visit, If negative
Check husbands Blood Group typing.
If husband is also Rhesus negative then no rhesus
complication and manage as other pregnant women

Contd
If husband is Rh Positive then
Check for maternal antibodies by indirect Comb's test
if antibodies detected treat as sensitized
If no antibodies repeat ICT at 28 and 32 weeks
provided that theres no bleeding.

Contd
Bleeding before 20 weeks of gestation
Check for maternal antibodies ( ICT )
if negative --- Give anti D to the mother within 72 hours
from the bleeding.

Contd
Bleeding after 20 weeks of gestation
Check for maternal antibodies ( ICT )
if negative --- anti D to the mother within 72 hours from
the bleeding

Prophylactic Management of non sensitized Pregnancy

During antenatal period Prophylactic

(Anti D is recommended to be given to
all at 28weeks

Indications for prophylaxis of non sensitized pregnancy

At 28weeks to a Rh ve non sensitized woman whose
husband is Rh +ve
Postpartum if the woman remains non sensitized and
delivers a Rh +ve fetus
Following:
amniocentesis or chorionic villus sampling
evacuation of a molar pregnancy or termination of Px
ectopic pregnancy, abruptio placenta or undiagnosed
uterine bleeding

Investigations at birth
Maternal blood sample for
antibodies by indirect Comb's test ( ICT )
fetal red blood cells in maternal circulation
Cord blood sample ( Neonatal blood sample ) for
antibodies by Direct Comb's test ( DCT )
Infant blood group
Infant bilirubin level
Infant Hb & Hct level

Postpartum management of non sensitized Pregnancy

If fetal blood group is rh +ve and No antibodies detected:

Give full dose of Anti D ( 500 IU / 100 mcg )

to the mother within 72 hours after delivery.

Dont give Anti D:

If fetal blood group is rhesus negative
If Antibodies are detected

Management of Sensitized Pregnancy

Check quantitative antibodies level @ 1st visit

Recheck the level every 2 weeks

Serial U/S Scan monitoring every 2 weeks

If antibodies level continue at the same level and no

fetal compromise deliver at term

Contd

Preterm fetus with:

mild neonatal effect

Cordocentesis blood sample Hb > 10g/dl

No U / S Scan evidence of Hydropic

changes
Consider conservative management with regular
follow up of fetal and maternal conditions till the fetal
lung maturity is assured . Then deliver

Contd
Daily maternal clinical assessments
Fetal Movements Chart
Serial U / S Scan for fetal growth and amniotic fluid
Regular cheek of the amniotic fluid bilirubin level by
repeated amniocentesis every 2 weeks until the lung
maturity reached
Regular cheek of the fetal Hb and Hct values, if the
facilities available