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Exposure to fetal blood cells that can cause RhD alloimmunization can happen during normal pregnancy and delivery, miscarriage, amniocentesis, cordocentesis, chorionic villus sampling, external cephalic version, or trauma. [3] [8] 92% of women who develop an anti-D during pregnancy do so at or after 28 weeks gestation. [11] [9] [12]
The term "Rh Disease" is commonly used to refer to HDFN due to anti-D antibodies, and prior to the discovery of anti-Rh o (D) immune globulin, it was the most common type of HDFN. The disease ranges from mild to severe, and occurs in the second or subsequent pregnancies of Rh-D negative women when the biologic father is Rh-D positive.
An indirect coombs needs to be run in cases of anti-C, [13] anti-c, [13] and anti-M. Anti-M also recommends antigen testing to rule out the presence of HDN. [26] Hgb - the infant's hemoglobin should be tested from cord blood. [1] Reticulocyte count - Reticulocytes are elevated when the infant is producing more blood to combat anemia. [1]
In 1970, it began production of anti-D human immunoglobulin for the treatment of rhesus negative (blood type) mothers who, having previously given birth to rhesus positive babies, could have anti-bodies that would cause haemolytic disease (HDFN) in the foetus of future pregnancies.
Mothers who are negative for the Kell 1 antigen develop antibodies after being exposed to red blood cells that are positive for Kell 1.Over half of the cases of hemolytic disease of the newborn owing the anti-Kell antibodies are caused by multiple blood transfusions, with the remainder due to a previous pregnancy with a Kell 1 positive baby.
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The anti-RhE antibody can be naturally occurring, or arise following immune sensitization after a blood transfusion or pregnancy. The anti-RhE antibody is quite common especially in the Rh genotype CDe/CDe; it usually only causes a mild hemolytic disease, but can cause a severe condition in the newborn.
Hemolytic disease of the newborn, also known as hemolytic disease of the fetus and newborn, HDN, HDFN, or erythroblastosis fetalis, [1] [2] is an alloimmune condition that develops in a fetus at or around birth, when the IgG molecules (one of the five main types of antibodies) produced by the mother pass through the placenta.