Screening

In each pregnancy, a woman should have her Rh type determined and an antibody screen performed at the initial visit with an indirect Coombs' test.

RhoGAM: Treatment for Exposure

If the Rh- mother is exposed to fetal blood, RhoGAM is given. RhoGAM is RhIgG (IgG that will attach to the Rh antigen) and prevent immune response by the mother.

Erythroblastosis fetalis

Hemolytic disease of the newborn/fetal hydrops occurs when the mother lacks an antigen present in the fetus ^ fetal RBCs trigger an immune response when they reach the mother's circulation ^ maternal antibodies cause fetal RBC hemolysis and anemia ^ fetal hyperbilirubinemia ^ kernicterus ^ heart failure, edema, ascites, pericardial effusion.

After Rh sensitization, a Kleihauer—Bettke test is done to determine the amount of fetal RBCs in the maternal circulation. Adjustments in the amount of RhIgG are given to mother accordingly (see RhoGAM below).

RhoGAM is administered to Rh- mothers exposed to fetal blood.

In a first sensitized gestation, the risk of fetal involvement is low.

As long as anti-D titers remain low, there is little risk of fetal anemia.

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