38. Rh and Other Blood Group Alloimmunizations

  1. John T. Queenan MD2,
  2. Catherine Y. Spong MD3 and
  3. Charles J. Lockwood MD4
  1. Kenneth J. Moise Jr MD

Published Online: 4 JAN 2012

DOI: 10.1002/9781119963783.ch38

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

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

  1. 2

    Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA

  2. 3

    Bethesda, MD, USA

  3. 4

    Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Author Information

  1. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas School of Medicine at Houston and the Texas Fetal Center of Memorial Hermann Children's Hospital, Houston, TX, USA

Publication History

  1. Published Online: 4 JAN 2012
  2. Published Print: 24 FEB 2012

ISBN Information

Print ISBN: 9780470655764

Online ISBN: 9781119963783

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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.