Treatment of the established disease

Transfusion with Rh-negative blood is the keynote. Exchange transfusion after birth is still used, because free maternal Rh antibody continues to act for several days after birth.

Before birth, intraperitoneal transfusion (blood is absorbed through the lymphatic vessels of the fetus) arrests the deterioration of the fetus and gains a few weeks gestation. More recently, direct intravascular fetal blood transfusion of Rh-negative blood, using ultrasound to guide the needle into the umbilical vein, is used. The quantity of blood to be transfused and the volume to be exchanged is calculated with the goal of achieving a hematocrit of 30-40%.

Plasmapheresis is popular but the beneficial effects are not proven. Phototherapy is of much more use in the jaundice associated with prematurity than in that due to Rh.

Figure 2 Fetal cells in the maternal circulation demonstrated by the Kleihauer technique. The adult hemoglobin in the mother's red cells is eluted by an acid phosphate buffer and they appear as ghosts', whereas the fetal hemoglobin is not eluted and the cells therefore stand out and can be readily counted.

Figure 2 Fetal cells in the maternal circulation demonstrated by the Kleihauer technique. The adult hemoglobin in the mother's red cells is eluted by an acid phosphate buffer and they appear as ghosts', whereas the fetal hemoglobin is not eluted and the cells therefore stand out and can be readily counted.

regimen to primigravidae because with this a woman is highly likely to have at least two babies free of RhHDN.

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