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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 biological father is Rh-D positive.
Cell-free DNA can be used the determine the Rh antigen of the fetus when the mother is Rh negative. Blood is taken from the mother during the pregnancy, and using PCR, can detect the K, C, c, D, and E alleles of fetal DNA. This blood test is non-invasive to the fetus and is an easy way of checking antigen status and risk of HDN.
The Kleihauer–Betke test is a blood test used to measure the amount of foetal hemoglobin transferred from a foetus to its mother's bloodstream. [4] It takes advantage of the differential resistance of foetal hemoglobin to acid. A standard blood smear is prepared from the mother's blood, and exposed to an acid bath.
This is a shortened version of the fifteenth chapter of the ICD-9: Certain Conditions originating in the Perinatal Period. It covers ICD codes 760 to 779. The full chapter can be found on pages 439 to 453 of Volume 1, which contains all (sub)categories of the ICD-9. Volume 2 is an alphabetical index of Volume 1.
The mother can make IgG anti-Rhc antibodies, which are able to pass through the placenta and enter the fetal circulation. If the fetus is Rhc positive alloimmune hemolysis can occur leading to HDN. This is similar as for Rh disease, which is usually caused when a RhD negative mother is sensitised by her first pregnancy with a RhD positive fetus.
Rh(D) status of an individual is normally described with a positive (+) or negative (−) suffix after the ABO type (e.g., someone who is A+ has the A antigen and Rh(D) antigen, whereas someone who is A− has the A antigen but lacks the Rh(D) antigen). The terms Rh factor, Rh positive, and Rh negative refer to the Rh(D
[9]: 130 Not all Rh-negative patients are capable of being immunized to the RhD antigen, and mothers may only become immunized after many repeated pregnancies. The risk of hemolytic disease (including due to RhD) significantly increases if the mother has had a past transfusion of Rh-positive blood. [10]
In some cases, the direct Coombs will be negative but severe, even fatal HDN can occur. [29] An indirect Coombs needs to be run in cases of anti-C, [30] anti-c, [30] and anti-M. Anti-M also recommends antigen testing to rule out the presence of HDN. [22] Hgb – the infant's hemoglobin should be tested from cord blood. [3]