38. Rh and Other Blood Group Alloimmunizations
- John T. Queenan MD2,
- Catherine Y. Spong MD3,
- Charles J. Lockwood MD4
Published Online: 4 JAN 2012
DOI: 10.1002/9781119963783.ch38
Copyright © 2012 John Wiley and Sons, Ltd
Book Title
Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition
Additional Information
How to Cite
Moise, K. J. (2012) Rh and Other Blood Group Alloimmunizations, in Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition (eds J. T. Queenan, C. Y. Spong and C. J. Lockwood), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119963783.ch38
Editor Information
- 2
Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA
- 3
Bethesda, MD, USA
- 4
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
Publication History
- Published Online: 4 JAN 2012
- Published Print: 24 FEB 2012
ISBN Information
Print ISBN: 9780470655764
Online ISBN: 9781119963783
- Summary
- Chapter
- References
Keywords:
- Rh and other blood group alloimmunizations;
- flow cytometry, fetal red cell, red cell precursor detection;
- HDFN;
- prophylactic immunoglobulin;
- RhD or “rhesus” antigen, maternal alloimmunization prevention;
- maternal antibody titer, first level surveillance in the USA;
- fetal surveillance in RhD alloimmunization, noninvasive approach;
- fetal blood typing through DNA analysis;
- hemolytic disease of fetus, newborn by non-RhD, antibody screening;
- critical titer of 8, and Kell antibodies
Summary
The time-honored concept that the placenta is relatively impervious to cell trafficking between the fetus and its mother is no longer accepted. Flow cytometry can detect fetal red cell and red cell precursors in the maternal circulation in virtually all pregnancies. In some patients, this exposure to fetal red cell antigens produces an antibody response that can be harmful to future offspring. The process is known as red cell alloimmunization (formerly isoimmunization). Active transplacental transport of these antibodies leads to their attachment to fetal red cells and sequestration in the fetal spleen. The quantity of the maternal antibody, the subclass of immunoglobulin G, and even the response of the fetal reticuloendothelial system have roles in the development of fetal anemia — a disease state known as hemolytic disease of the fetus and newborn. In extreme cases, this severe anemia is associated with the accumulation of extracellular fluid in the form of ascites, pleural effusions, and scalp edema, a condition termed hydrops fetalis.