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RHESUS ISOIMMUNIZATION EVALUATION AND MANAGEMENT

I. PATHOPHYSIOLOGY OF Rh ISOIMMUNIZATION

A. Race classification: Fisher

B. Ethnic distribution

E. Incidence of Rh isoimmunization prior to RHIgG (RhoGAM)

Rh and antibody (ABO) status of fetus

2. Rh-positive ABO incompatible: 1.5-2% sensitized

Pathogenesis of Fetal Anemia (Erythroblastosis Fetalis)

A. Mechanism of RBC destruction

1. Maternal anti-D IgD crosses placenta

2. Anti-D IgG attaches to Rh antigen on fetal RBCs

3. Noncomplement-mediated hemolysis (macrophage attack, causing cell wall

4. Fetal anemia results in extramedullary erythropoiesis

5. Hepatic erythropoiesis results in

6. Fetal anemia may cause hypoxia and capillary leak

7. Combination of above (5 and 6) may result in hydrops fetalis

B. Classification of severity

1. Mild (mild jaundice, no anemia): 50%

2. Moderate (moderate anemia, severe jaundice): 25% (10% of affected

3. Severe (hydrops fetalis): 25%

4.Amniocentesis

5.Antepartum (all Rh-negative mothers unless father of fetus is Rh negative)

6.External cephalic version

7.Postpartum (if neonate is Rh-positive)