rh negative disease

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Rh negative disease

1

Overview

Rh incompatibility is a condition that occurs during pregnancy if

a woman hasRh-negative blood and

her baby has Rh-positive blood.

"Rh-negative" and "Rh-positive" refer to

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Overview

whether your blood has Rh factor. Rh factor is a protein on red blood cells. If

you have Rh factor, you're Rh-positive. If you don't have it, you're

Rh-negative. Rh factor is inherited (passed from parents to children through

the genes). Most people are Rh-positive.

3

Overview

Whether you have Rh factor doesn't affect your general health.

However, it can cause problems during pregnancy.

4

Causes

A difference in blood type between a pregnant woman and her baby

causes Rh incompatibility. The condition occurs if a woman is Rh-negative and

her baby is Rh-positive.

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Causes

When you're pregnant, blood from your baby can cross into your

bloodstream, especially during delivery. If you're Rh-negative and your baby is

Rh-positive, your body will react to the baby's blood as a foreign substance.

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Causes

Your body will create antibodies (proteins) against the baby's

Rh-positive blood. These antibodies can cross the placenta and attack the

baby's red blood cells. This can lead to hemolytic

anemia in the baby.

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Causes

Rh incompatibility usually doesn't cause problems during a first

pregnancy. The baby often is born before many of the antibodies develop.

However, once you've formed Rh antibodies, they remain in your

body. Thus, the condition is more likely to cause problems in second or later

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Causes

pregnancies (if the baby is Rh-positive).

With each pregnancy, your body continues to make Rh antibodies. As

a result, each Rh-positive baby you conceive becomes more at risk for serious

problems, such as severe hemolytic anemia.

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Risks

An Rh-negative woman who conceives a child

with an Rh-positive man is at risk for Rh incompatibility.

Rh factor is inherited (passed from parents

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Risks

to children through the genes). If you're Rh-negative and the father of your

baby is Rh-positive, the baby has a50 percent or more chance of having

Rh-positive blood.

Simple blood tests can

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Risks

show whether you and the father of your baby areRh-positive or

Rh-negative.

If you're Rh-negative, your risk of

problems from Rh incompatibility is higher if you were exposed to Rh-positive blood

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Risks

before the pregnancy. This may have happened during:

-- An earlier pregnancy (usually during

delivery). You also may have been exposed to Rh-positive blood if you had

bleeding or abdominal trauma (for example, from a car accident) during the

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Risks

pregnancy.

-- An ectopic pregnancy, a miscarriage, or an

induced abortion. (An ectopic pregnancy is a pregnancy that starts outside of

the uterus, or womb.)

-- A mismatched blood

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Risks

transfusion or blood and

marrow stem cell transplant.

-- An injection or puncture with a needle or

other object containing Rh-positive blood.

Certain tests also can expose you to

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Risks

Rh-positive blood. Examples include amniocentesis (AM-ne-o-sen-TE-sis) and

chorionic villus (ko-re-ON-ik VIL-us) sampling (CVS).

Amniocentesis is a test that you may have

during pregnancy. Your doctor uses a needle to remove a small amount of fluid

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Risks

from the sac around your baby. The fluid is then tested for various reasons.

CVS also may be done during pregnancy. For

this test, your doctor threads a thin tube through the vagina and cervix to the

placenta. He or she removes a tissue sample from the placenta using gentle

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Risks

suction. The tissue sample is tested for various reasons.

Unless you were treated with the medicine

that prevents Rh antibodies (Rh immune globulin) after each of these events,

you're at risk for Rh incompatibility during current and future pregnancies.

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Symptoms

Rh incompatibility doesn't cause signs or

symptoms in a pregnant woman. In a baby, the condition can lead to hemolytic

anemia. Hemolytic anemia is a condition in which red blood cells are

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Symptoms

destroyed faster than the body can replace them.

Red blood cells contain hemoglobin

(HEE-muh-glow-bin), an iron-rich protein that carries oxygen to the body.

Without enough red blood cells and hemoglobin, the baby won't get enough

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Symptoms

oxygen.

Hemolytic anemia can cause mild to severe

signs and symptoms in a newborn, such as jaundice and a buildup of fluid.

Jaundice is a yellowish color of the skin

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Symptoms

and whites of the eyes. When red blood cells die, they release hemoglobin into

the blood. The hemoglobin is broken down into a compound called bilirubin. This

compound gives the skin and eyes a yellowish color. High levels of bilirubin

can lead to brain damage in the baby.

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Symptoms

The buildup of fluid is a result of heart failure.

Without enough hemoglobin-carrying red blood cells, the baby's heart has to

work harder to move oxygen-rich blood through the body. This stress can lead to

heart failure.

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Symptoms

Heart failure can cause fluid to build up

in many parts of the body. When this occurs in a fetus or newborn, the

condition is called hydrops fetalis (HI-drops fe-TAL-is).

Severe hemolytic anemia can be fatal to a

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Symptoms

newborn at the time of birth or shortly after.

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Diagnosis

If you're pregnant, your doctor will order

a simple blood test at your first prenatal visit to learn whether you're

Rh-positive or Rh-negative.

If you're Rh-negative, you also may have

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Diagnosis

another blood test called an antibody screen. This test shows whether you have

Rh antibodies in your blood. If you do, it means that you were exposed to

Rh-positive blood before and you're at risk for Rh incompatibility.

If you're Rh-negative and you don't have Rh

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Diagnosis

antibodies, your baby's father also will be tested to find out his Rh type. If

he's Rh-negative too, the baby has no chance of having Rh-positive blood. Thus,

there's no risk of Rh incompatibility.

However, if the baby's father is

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Diagnosis

Rh-positive, the baby has a 50 percent or more chance of having Rh-positive

blood. As a result, you're at high risk of developing Rh incompatibility.

If your baby's father is Rh-positive, or if

it's not possible to find out his Rh status, your doctor may do a test called

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Diagnosis

amniocentesis.

For this test, your doctor inserts a hollow

needle through your abdominal wall into your uterus. He or she removes a small

amount of fluid from the sac around the baby. The fluid is tested to learn whether

30

Diagnosis

the baby is Rh-positive. (Rarely, an amniocentesis can expose you to

Rh-positive blood).

Your doctor also may use this test to

measure bilirubin levels in your baby. Bilirubin builds up as a result of red

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Diagnosis

blood cells dying too quickly. The higher the level of bilirubin is, the

greater the chance that the baby has hemolytic anemia.

If Rh incompatibility is known or

suspected, you'll be tested for Rh antibodies one or more times during your

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Diagnosis

pregnancy. This test often is done at least once at your sixth or seventh month

of pregnancy.

The results from this test also can suggest

how severe the baby's hemolytic anemia has become. Higher levels of antibodies

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Diagnosis

suggest more severe hemolytic anemia.

To check your baby for hemolytic anemia,

your doctor also may use a test called Doppler ultrasound. He or she will use

this test to measure how fast blood is flowing through an artery in the baby's

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Diagnosis

head.

Doppler ultrasound uses sound waves to

measure how fast blood is moving. The faster the blood flow is, the greater the

risk of hemolytic anemia. This is because the anemia will cause the baby's

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Diagnosis

heart to pump more blood.

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Treatment

Rh incompatibility is treated with a

medicine called Rh immune globulin. Treatment for a baby who has hemolytic

anemia will vary based on the severity of the condition.

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Treatment**Goals of Treatment**

The goals of treating Rh incompatibility

are to ensure that your baby is healthy and to lower your risk for the

condition in future pregnancies.

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Treatment**Treatment for Rh Incompatibility**

If Rh incompatibility is diagnosed during

your pregnancy, you'll receive Rh immune globulin in your seventh month of

pregnancy and again within 72 hours of delivery.

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Treatment**Treatment for Rh Incompatibility**

You also may receive Rh immune globulin if

the risk of blood transfer between you and the baby is high (for example, if

you've had a miscarriage, ectopic pregnancy, or bleeding during pregnancy).

Rh immune globulin contains Rh antibodies

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Treatment**Treatment for Rh Incompatibility**

that attach to the Rh-positive blood cells in your blood. When this happens,

your body doesn't react to the baby's Rh-positive cells as a foreign substance.

As a result, your body doesn't make Rh antibodies. Rh immune globulin must be

41

Treatment**Treatment for Rh Incompatibility**

given at the correct times to work properly.

Once you have formed Rh antibodies, the

medicine will no longer help. That's why a woman who has Rh-negative blood must

be treated with the medicine with each pregnancy or any other event that allows

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Treatment**Treatment for Rh Incompatibility**

her blood to mix with Rh-positive blood.

Rh immune globulin is injected into the

muscle of your arm or buttock. Side effects may include soreness at the

injection site and a slight fever. The medicine also may be injected into a

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Treatment**Treatment for Rh Incompatibility**

vein.

**Treatment for Hemolytic Anemia**

Several options are available for treating

hemolytic anemia in a baby. In mild cases, no treatment may be needed. If

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Treatment**Treatment for Rh Incompatibility**

treatment is needed, the baby may be given a medicine called erythropoietin and

iron supplements. These treatments can prompt the body to make red blood cells.

If the hemolytic anemia is severe, the baby

may get a blood

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Treatment**Treatment for Rh Incompatibility**

transfusion through the umbilical cord. If the hemolytic anemia is

severe and the baby is almost full-term, your doctor may induce labor early.

This allows the baby's doctor to begin treatment right away.

A newborn who has severe anemia may be

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Treatment**Treatment for Rh Incompatibility**

treated with a blood exchange transfusion. The procedure involves slowly

removing the newborn's blood and replacing it with fresh blood or plasma from a

donor.

Newborns also may be treated with special

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Treatment**Treatment for Rh Incompatibility**

lights to reduce the amount of bilirubin in their blood. These babies may have

jaundice (a yellowish color of the skin and whites of the eyes). High levels of

bilirubin cause jaundice.

Reducing the blood's bilirubin level is

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Treatment**Treatment for Rh Incompatibility**

important because high levels of this compound can cause brain damage. High

levels of bilirubin often are seen in babies who have hemolytic anemia. This is

because the compound forms when red blood cells break down.

49

Living and coping

If you have Rh-negative blood, injections

of Rh immune globulin can reduce your risk of Rh incompatibility in future

pregnancies. It's important to get this medicine every time you give birth to

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Living and coping

an Rh-positive baby or come in contact with Rh-positive blood.

If you're Rh-negative, your risk of

problems from Rh incompatibility is higher if you were exposed to Rh-positive

blood before your current pregnancy. This may have happened during:

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Living and coping

-- An earlier pregnancy (usually during

delivery). You also may have been exposed to Rh-positive blood if you had

bleeding or abdominal trauma (for example, from a car accident) during the

pregnancy.

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Living and coping

-- An ectopic pregnancy, a miscarriage, or an

induced abortion. (An ectopic pregnancy is a pregnancy that starts outside of

the uterus, or womb.)

-- A mismatched blood

transfusion or blood and marrow

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Living and coping

stem cell transplant.

-- An injection or puncture with a needle or

other object containing Rh-positive blood.

You also can be exposed to Rh-positive

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Living and coping

blood during certain tests, such as amniocentesis and chorionic villus

sampling. (For more information, go to "Who

Is At Risk for Rh Incompatibility?")

Unless you were treated with Rh immune

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Living and coping

globulin after each of these events, you're at risk for Rh incompatibility

during current and future pregnancies.

Let your doctor know about your risk early

in your pregnancy. This allows him or her to carefully monitor your pregnancy

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Living and coping

and promptly treat any problems that arise.