| Basic Information |
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| Description |
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Incompatibility between an infant's blood type and that of its
mother, resulting in destruction of the infant's red blood cells
(hemolytic anemia) during pregnancy and after birth by antibodies
from its mother's blood.
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| Frequent Signs and Symptoms |
Signs during pregnancy:
- Decreased fetal growth.
- Decreased fetal movement.
Signs in a newborn:
- Paleness.
- Jaundice (yellow skin and eyes) that begins within 24 hours after
delivery.
- Unexplained bruising or blood spots under the skin.
- Tissue swelling (edema).
- Breathing difficulty.
- Seizures.
- Lack of normal movement.
- Poor reflex response.
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| Causes |
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The fetus of an Rh-negative (blood type) mother and an Rh-positive father may be Rh-positive. If the father is known to be Rh negative, there is no concern. During delivery, a small amount of the
infant's blood is absorbed by the mother through the placenta,
stimulating her body to produce antibodies against Rh-positive
blood. The antibodies are produced after delivery, so the first
infant is not affected. With succeeding pregnancies, the antibodies
in the mother's blood can potentially destroy fetal blood cells.
With subsequent pregnancy, anti-Ah antibodies cross the placenta
and may destroy fetal blood cells. The resulting anemia can be
severe enough to cause fetal death. If the fetus survives, antibodies
can cross to the baby during birth, causing jaundice and other
symptoms shortly after birth.
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| Risk Increases With |
- Each pregnancy after the first involving different blood
types.
- Previous blood transfusions. These might have contained
unidentified, incompatible blood types.
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| Preventive Measure |
- Obtain prenatal care throughout pregnancy. Medical supervision
early in pregnancy is essential to determine the risk of Rh incompatibility.
- Special anti-Rh gamma globulin (RhoGAM) is given to the mother at 28 weeks' gestation and within 72 hours after delivery, miscarriage, ectopic pregnancy or abortion. This prevents formation
of antibodies that might affect future infants. In women who are
already producing antibodies, there is no benefit to using
RhoGAM.
- Amniocentesis beginning at 16 to 20 weeks if indicated by elevated antibody titers in the mother. Amniocentesis can be used in
specialized laboratories to determine the fetal blood type.
- Cordocentesis (percutaneous umbilical blood sampling or PUBS)
may be recommended, despite some risks, to determine fetal
blood type and the degree of anemia.
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| Expected Outcome |
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With prompt recognition of the disorder, damage to the infant can
be prevented with exchange transfusions. These transfusions are
administered directly into fetal circulation by PUBS.
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| Possible Complications |
- Permanent neurological damage, such as cerebral palsy or
hearing loss (rare).
- Blood-transfusion reaction.
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| Treatment/Post Procedure Care |
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| General Measures |
- Blood tests to type the mother's, father's and infant's blood,
measure the mother's Rh-positive antibodies, and detect hemobytic
anemia in the infant's blood
- Amniocentesis (a small amount of amniotic fluid is withdrawn
from the amniotic sac that surrounds the unborn child in the
uterus for a diagnostic procedure).
- Intrauterine blood transfusions (sometimes).
- Transfusion to completely exchange the infant's blood after
birth.
- Hospitalization. The newborn child will remain in the hospital
up to 2 weeks after an exchange transfusion.
- If you have an Rh-negative blood type, tell any doctor or medical
professional who treats you. Make sure this information is in your
medical records. Wear a medical alert type bracelet or pendant
identifying your medical problem.
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| Medication |
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If you are pregnant and have Rh-negative blood type, you will be
prescribed an anti-Ah gamma globulin injection (RhoGAM) at 28
weeks and again within 72 hours after delivery or termination of a
pregnancy for any reason. You may also have antibody titer drawn
during pregnancy to see if you are producing anti-Ah antibodies.
You do not need RhoGAM if your fetus is Rh negative.
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| Activity |
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No restrictions after treatment.
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| Diet |
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he infant may be breast-fed or bottle-fed normally.
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| Notify Your Healthcare Provider If |
Your baby has any of the following after returning home:
- Fever.
- Jaundice.
- Poor appetite or poor weighs gain.
- Excessive crying that does not stop when the baby is held.
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