Objectives:Describe the etiology of Rh-hemolytic disease.Review the clinical presentation of patients with Rh-hemolytic disease.Outline the management of patients with Rh-hemolytic disease.Summarize the importance of collaboration and communication amongst the interprofessional team to enhance the care coordination of patients with Rh-hemolytic disease.Access free multiple choice questions on this topic.
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Rh-hemolytic disease, also known as Rh incompatibility, is a condition that occurs when a woman with Rhesus-negative blood type is exposed to Rhesus-positive blood cells, leading to the development of anti-D antibodies by a process called isoimmunization. After this sensitization, these maternal alloantibodies (IgG immunoglobulins) may persist for life and move freely across the placenta to the fetal circulation during subsequent pregnancies, where they lead to the destruction of fetal erythrocytes after forming antigen-antibody complexes with their surface D antigen. This results in alloimmune hemolytic anemia in the fetus known as erythroblastosis fetalis. The severity of illness depends greatly on the number of immunoglobulins, the gestational age, and the enzymatic activity of the fetus.[2]
Generally, no effects are seen in first pregnancies for Rh-D mediated disease as IgM is a large pentamer that can not cross the placental barrier. However, during the following pregnancies, subsequent exposure of as little as 0.03mL of Rh-positive cells can lead to the formation of anti-D IgG immunoglobulins, which cross the placenta freely and bind to fetal red blood cells containing D-surface antigen. These antibody-coated cells are recognized by the fetal reticuloendothelial system, and the destruction of these cells causes the release of large amounts of bilirubin in fetal circulation. During the antenatal period, maternal conjugation enzymes remove the excess of bilirubin, but after birth due to early insufficiency of glucuronyltransferase enzymatic activity, neonates present with jaundice or kernicterus and severe hemolytic anemia.
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