Rhesus Haemolytic Disease of the Newborn

Abstract

Rhesus (Rh) haemolytic disease of the newborn arises from maternal anti‐D immunoglobulin (Ig) G antibodies which cross the placenta and are directed against paternally derived D antigens which the fetus carries and the mother lacks. Untreated, this condition can result in intrauterine death from anaemia and cardiac failure (hydrops) or neonatal neurological problems and death following the development of severe jaundice and kernicterus.

Keywords: Rh alloimmunization; anti‐D prophylaxis; hydrops; in‐utero transfusion; kernicterus

References

Avent ND and Reid ME (2000) The Rh blood group system: a review. Blood 95: 375–387.

Bennett PR, Le Van Kim C, Colin Y et al. (1993) Prenatal determination of fetal RhD type by DNA amplification. New England Journal of Medicine 329: 607–610.

Bowman JM (1996) Hemolytic disease of the newborn. Vox Sanguinis 70: 62–67.

Bowman JM (1998) RhD hemolytic disease of the newborn. New England Journal of Medicine 339: 1775–1777.

Clarke CA (1989) Preventing rhesus babies: the Liverpool research and follow‐up. Archives of Disease in Childhood 64: 1734–1740.

Diamond LK, Blackfan KD and Baty JM (1932) Erythroblastosis fetalis and its association with universal edema of the fetus, icterus gravis neonatorum and anaemia of the newborn. Journal of Pediatrics 1: 269–309.

Fisher RA and Race RR (1946) Rh gene frequencies in Britain. Nature 57: 48.

Landsteiner K and Wiener AS (1940) An agglutinable factor in human blood recognizable by immune sera for rhesus blood. Proceedings of the Society for Experimental Biology (NY) 43: 223.

Levine P (1943) Serological factors as possible causes in spontaneous abortions. Journal of Heredity 34: 71–78.

Liley AW (1961) Liquor amnii analysis in the management of the pregnancy complicated by rhesus sensitisation. American Journal of Obstetrics and Gynecology 82: 1359–1370.

Lo YM, Bowell PJ, Selinger M et al. (1993) Prenatal determination of fetal RhD status by analysis of peripheral blood of rhesus negative mothers. Lancet 341: 1147–1148.

Lo YM, Corbetta N, Chamberlain PF et al. (1997) Presence of fetal DNA in maternal plasma and serum. Lancet 350: 485–487.

Mari G (2000) Noninvasive diagnosis by Doppler ultrasonography of fetal anaemia due to maternal red‐cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. New England Journal of Medicine 342: 9–14.

Medical Research Council Working Party (1974) Report on the use of anti‐D immunoglobulin for the prevention of isoimmunisation of Rh‐negative women during pregnancy. Controlled trial of various anti‐D dosages in suppression of Rh sensitisation following pregnancy. British Medical Journal ii: 75–80.

Mollison PL (1997) Haemolytic disease of the fetus and newborn. In: Mollison PL, Engelfriet CP and Contreras M (eds) Blood Transfusion in Clinical Medicine, pp. 390–424. Oxford: Blackwell Science

Race RR and Sanger R (1950) Blood Groups in Man. Oxford: Blackwell Scientific Publications.

Rodeck CH, Holman CA, Karnicki J et al. (1981) Direct intravascular fetal blood transfusion by fetoscopy in severe rhesus isoimmunisation. Lancet i: 625–628.

Schumacher B and Moise KJ (1996) Fetal transfusion for red blood cell alloimmunization in pregnancy. Obstetrics and Gynecology 88: 137–150.

Whitecar PW and Moise KJ (2000) Sonographic methods to detect fetal anemia in red blood cell alloimmunization. Obstetrical and Gynecological Survey 55: 240–250.

Further Reading

American College of Obstetricians and Gynecologists Committee on Practice Bulletins (1999) Prevention of Rh D Alloimmunization. ACOG Practice Bulletin No. 4 – Clinical Management Guidelines for Obstetrician‐Gynecologists. Washington, DC: American College of Obstetricians and Gynecologists.

Berkowitz RL, Chitkara U, Goldberg JD et al. (1986) Intrauterine intravascular transfusions for severe red blood cell isoimmunization: ultrasound guided percutaneous approach. American Journal of Obstetrics and Gynecology 155: 574–581.

Bianchi DW (1999) Fetal cells in the maternal circulation: feasibility for prenatal diagnosis. British Journal of Haematology 105: 574–583.

Daffos F, Capella‐Pavlovsky M and Forestier F (1985) Fetal blood sampling during pregnancy with use of a needle guided by ultrasound: a study of 606 consecutive cases. American Journal of Obstetrics and Gynecology 153: 655–660.

Hadley AG (1995) In vitro assays to predict the severity of hemolytic disease of the newborn. Transfusion Medicine Reviews IX: 302–313.

Queenan JT (1999) Management of Rh‐immunized pregnancies. Prenatal Diagnosis 19: 852–855.

Royal College of Obstetricians and Gynaecologists (1999) Use of Anti‐D Immunoglobulin for Rh Prophylaxis – Greentop Guidelines No. 22. London: RCOG.

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How to Cite close
Letsky, Elizabeth A(Apr 2001) Rhesus Haemolytic Disease of the Newborn. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1038/npg.els.0002290]