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Rh Isoimmunization

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by

Ahmed Abass

on 7 March 2016

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Transcript of Rh Isoimmunization

Rh System

Rh Iso-Immunization
Ig G can cross placenta.
1st baby usually escape.
Next pregnancy will be affected if ....??
Each pregnant women should know her Rh typing
AntiD immunoglobulin ;
Mechnism?
When?
Does? less , optimum , more?!!
Interval ?
1. Antibody screen :
. At 1st antenatal visit.
. Repeated at 28 weeks.
. Indirect coomb's test
. 4 fold increase is significant.

Rhesus System:
D
c, C, e, E, G
In Caucasians,15% are Negative.
Weak D, Partial D.
Rh Mod, D(el)
Diagnosis
Management
Prevention
Sensitization
PREGNANCY

30 days of gestation.
ONLY on red blood cells.
Mother response if exposed to Rh D antigen??
Maternal Alloimunization:
Inadvertent Rh + blood transfusion.
Injection by Rh + blood contaminated needles.
D-mismatched allogenic stem haematobiotic cell transplacentation
Fetomaternal haemorrhage .
Amount?
Strong response , but may be not ??
when cause of alloimuinization is couldn't be recalled?
The antibody response develops slowly, and is usually not detectable serologically until 5 to 15 weeks after immunization.
AMOUNT....
Frequency...
ABO Compatibility
Immunogenecity of the fetal RBCs
Immune response of the mother
First affected pregnancy
Repeat test MONTHLY till 24 weeks then every 2 WEEKS
Remains below critical value (16)
Titer above critical value (32)

till 24 weeks
Deliver at term

MCA Doppler / 1-2 weeks
Determine fetal RH type
Paternal zygosity
Free fetal DNA
Amniocentesis


Peak MCA velocity less than 1.5 MOM
Antenatal testing at 32 weeks
Deliver at 37-38 weeks
MCA PSV more than 1.5 MOM
Cordocentesis
Fetal HCT more than 30%
Fetal HCT less than 30%
Intrauterine transfusion
Previously affected pregnancy
No need for titer
At 18 weeks
Full transcript