Red Cell Isoimmunization: Rhesus factors are antigens normally present in the RBCs when administered to person who lacks them lead to antibody formation.
Incidence: 85% of population are Rh positive and 15% are Rh negative. The incidence of sensitization is 0.1-0.2%
Pathology:
When the mother Rh negative got pregnancy by an Rh positive fetus ,normally there s leakage of RBC from fetal capillaries to the maternal blood in the intervillus space ,these RBC engulf by the lymphocytes of the mother and the immune system recognized them so antibodies will form which are of two types IgM, IgG.IgG cross the placenta to the fetus lead to destruction of fetal RBC causing hemolysis.
Management:
History: blood group and Rh of the mother and her husband.
Complication during pregnancy increase sensitization.
Her obstetrical history.
Examination:
General and obstetrical exam.
Investigations:
Blood group and Rh of the mother and her husband.
Indirect Coomb s test: If negative means non immunized ,while if it is positive means immunized
Ultrasound: for gestational age, viability ,any abnormality.
Management of non immunized pregnant:
-regular visits and regular checking for sensitization ,if no problem the role of giving prophylactic Anti-D.
-Our aim delivery at term and according to the blood group and Rh of the neonate to give the Anti-D after checking indirect Coomb s test.
Management of Immunized pregnant :
Depending on her obstetrical history and the severity of sensitization.
Follow up her pregnancy by antibodies titer.
Fetal middle cerebral artery velocimetry
The role of intrauterine transfusion.