medical notes

Apr 17th, 2015
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RH ISOIMMUNIZATION AND OTHER BLOOD GROUP IN COMPATIBILITIESGeneral considerationsExplain inheritanceRh antigens - Dd, Cc, Ee (Rho - ie D main concern)Father Rh +vehomozygous D 45%heterozygous D 55%Populations differCaucasians higher incidence15 - 16%USA blacks 8%African blacks 4%American Indians 1%Mongoloid races - nil or very low Overall risk of isoimmunization for Rh +ve infant with Rh negative mother equal to 16%Occurrence of reactions (of 16%)1.5 - 2% antepartum7% within 6 months of delivery7% early in 2nd pregnancy.ABO incompatibility between Rh - positive fetus and Rh - negative mother provides protection against Rh isoimmunization (overall incidence 1.5 - 2%) due to haemolysis of ABO incompatible cellsPathogenesisRh antigen lipoproteins attached to RBC membraneMechanismsfollowing incompatible transfusion (30% do not get sensitized; non-responders)Foeto-maternal haemorrhage (during pregnancy or delivery)NB: With no apparent predisposing factors foetal RBCs detected in maternal blood in 6.7% in 1st trimester15.9% in 2nd trimester28.9% in 3rd trimesterFeto-maternal haemorrhage may occur after:Induced or spontaneous abortion, Abdominal trauma (e.g. Rta, external version), Amniocentesis, P.praevia, Abruption placentae, IUFD,Multiple pregnancy, Manual removal of placenta and C/sNB 0.1ml of blood with Rh +ve cells will cause sensitizationInitial response to Rh isoimmune - 1gM (low levels) 6/52 - 6/12; after - 1gG detectable (able to

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