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Dr.Suresh Babu Chaduvula
Professor
Department of Obs & Gyn
College of Medicine
KKU, Abha, Saudi Arabia
 Karl Landsteiner – Proposed Blood Group
Sysytem
 Awarded Nobel prize in 1930
 Landsteiner and S.Weiner – discovered
Rh...
 RBC cell surface has antigens called
Agglutinogens or isoagglutinogens and
plasma contains antibodies called
Agglutinins...
 There are 5 Rhesus antigens – D, C,c,E and e.
 Out of which D antigen is most powerful
antigen.
 Other antigens like K...
 Sensitization of maternal immune system to
produce antibodies after exposure to fetal
RBC antigens.
 Allo or Isoimmunis...
 1. Mismatched blood transfusion
 2.Feto maternal hemorrhage following
delivery, ectopic pregnancy, abortions.
 3. Inva...
 Feto-maternal hemorrhage of Rh positive cells
enter into maternal circulation and will produce
anti – D antibodies Ig M ...
 In a mother who is already sensitised will
have a very severe hemolytic anemia and
hyperbilirubinemia called Icterus Gra...
 Antenatally at 28 and 34 weeks Anti D
Immunoglobulin of 300 micrograms should be
given.[ decreases immunization by 0.2%]...
 1. Increases with each subsequent pregnancy
 2. Depends on paternal zygosity
 3. Amount of feto-maternal bleeding
 4....
 Initially sensitization occurs in 1st pregnancy.
 Later due to memory in the immune system
response for antibodies will...
 Amount of antibody production varies with
the amount of fetal RBCs entered into
maternal circulation.
 Quantity tests f...
 It occurs in mothers with ‘O’ blood group.
 The antibodies in this group are weak
hemolysins.
 These can attach to onl...
 Do Blood group and type of partners
 Anti D immunoglobulin at 28/ 34 weeks
 Anti D immunoglobulin within 72 hours
 As...
 Assess accurately gestational age by USG
 Blood group and typing of partners
 Assess Antibody titer – by Indirect Coom...
 To determine the amount of bilirubin which
is produced by fetal hemolysis and is
secreted by secretions from fetal body....
 Delta OD at 450 should be plotted in Liley
chart.[used between 27 to 41 weeks]
 I t has X axis –indicates gestation in ...
 Low zone indicates - mild anemia -
 Mid zone –mild to severe anemia
 High zone – severe anemia and impending
fetal dea...
 Like a normal pregnancy deliver at 38 weeks
 Do regular ultrasound and may have to
repeat amniocentesis.
 Fetal well b...
 High mid and High zone will require
CORDOCENTESIS – to assess fetal hemoglobin,
hematocrit , platelets and group and typ...
 1. Intra peritoneal
 2. Intra vascular – umbilical vein
 Transfusion can be given till fetal hematocrit
becomes normal...
 A] Ultrasound – to determine hydropic changes
like
1. scalp edema
2. Anasarca
3. Effusions
4. Hepato and spleenomegaly
5...
 Low Zone & Low Mid Zone - – Deliver at 38
weeks.
 High mid zone High Zone – Deliver at 34
weeks electively by cesarean ...
THANK YOU ALL
AND
ALL THE BEST
Rh isoimmunisation
Rh isoimmunisation
Rh isoimmunisation
Rh isoimmunisation
Rh isoimmunisation
Rh isoimmunisation
Rh isoimmunisation
Rh isoimmunisation
Rh isoimmunisation
Rh isoimmunisation
Rh isoimmunisation
Rh isoimmunisation
Rh isoimmunisation
Rh isoimmunisation
Rh isoimmunisation
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Rh isoimmunisation

  1. 1. Dr.Suresh Babu Chaduvula Professor Department of Obs & Gyn College of Medicine KKU, Abha, Saudi Arabia
  2. 2.  Karl Landsteiner – Proposed Blood Group Sysytem  Awarded Nobel prize in 1930  Landsteiner and S.Weiner – discovered Rhesus system in Rhesus monkeys.
  3. 3.  RBC cell surface has antigens called Agglutinogens or isoagglutinogens and plasma contains antibodies called Agglutinins or isoagglutinins.  A positive woman will have A antigen and anti B antibodies.  Rhesus positive mothers means D antigen positive.  Rhesus negative means D antigen negative mothers.
  4. 4.  There are 5 Rhesus antigens – D, C,c,E and e.  Out of which D antigen is most powerful antigen.  Other antigens like Kell and Duffy antigens.  Anti- kell is very serious.
  5. 5.  Sensitization of maternal immune system to produce antibodies after exposure to fetal RBC antigens.  Allo or Isoimmunisation – means immune response to foreign antigens from the same species.  Prevalence is 1%.
  6. 6.  1. Mismatched blood transfusion  2.Feto maternal hemorrhage following delivery, ectopic pregnancy, abortions.  3. Invasive procedures like Chorionic villous sampling, Amniocentesis in pregnant mothers  4. APH – Placenta Previa, Abruption of placenta  5. External cephalic version  6. Intrauterine fetal death
  7. 7.  Feto-maternal hemorrhage of Rh positive cells enter into maternal circulation and will produce anti – D antibodies Ig M type initially called – Sensitisation.  After a minimum period of 3 months IgG antibodies are produced which are capable of crossing placental barrier.  IgG antibodies attack and destroy fetal RBCs in spleen and produce Hemolytic anemia of Newborn.  Anemia will produce erythropoiesis in liver leading to erythroblast production called Erythroblastosis fetalis.
  8. 8.  In a mother who is already sensitised will have a very severe hemolytic anemia and hyperbilirubinemia called Icterus Gravis Neonatorum.  If this unconjugated bilirubin crosses blood brain barrier it will stain basal ganglia called Kernicterus  And hypo-proteinemia which will lead to changes in hemeodynamics results in accumulation of fluid all over the body and also in body cavities called Hydrops fetalis.
  9. 9.  Antenatally at 28 and 34 weeks Anti D Immunoglobulin of 300 micrograms should be given.[ decreases immunization by 0.2%]  Anti D Immunoglobulin of 300 micrograms should be given within 72 hours called RhoGAM.[ decreases immunization by 1.5%]  Following all invasive procedures also it should be given.  300 micrograms can protect from 30 ml of bleed.
  10. 10.  1. Increases with each subsequent pregnancy  2. Depends on paternal zygosity  3. Amount of feto-maternal bleeding  4.ABO incompatibility.
  11. 11.  Initially sensitization occurs in 1st pregnancy.  Later due to memory in the immune system response for antibodies will be very high.
  12. 12.  Amount of antibody production varies with the amount of fetal RBCs entered into maternal circulation.  Quantity tests for FMH is done by 1.Kleihuer-Betke test 2.Flow cytometry
  13. 13.  It occurs in mothers with ‘O’ blood group.  The antibodies in this group are weak hemolysins.  These can attach to only few fetal RBCs  It may produce only mild hyper bilirubinemia but not Hydrops.  These antibodies and mild hemolysis will decrease Rh iso- immunization and hemolysis.
  14. 14.  Do Blood group and type of partners  Anti D immunoglobulin at 28/ 34 weeks  Anti D immunoglobulin within 72 hours  Assess amount of feto-maternal hemorrhage and if amount is more than 30 ml adjust the dose.
  15. 15.  Assess accurately gestational age by USG  Blood group and typing of partners  Assess Antibody titer – by Indirect Coomb’s test – every 2-4 weeks  Amniocentesis – at a critical titer 1:16 to assess the hemolytic anemia
  16. 16.  To determine the amount of bilirubin which is produced by fetal hemolysis and is secreted by secretions from fetal body.  Spectrophotometric analysis is used to find out level of bilirubin in amniotic fluid.  Bilirubin causes shift of optical density from linearity. Shift is greatest at 450 nanometer.  Degree of shift at 450 nm called Delta OD [OD 450] indicates degree of hemolysis.
  17. 17.  Delta OD at 450 should be plotted in Liley chart.[used between 27 to 41 weeks]  I t has X axis –indicates gestation in weeks and Y axis about Delta OD.  It has 3 zones called Low, Mid and High Zone.  Delta OD may fall either of the zones and gives approximate time for time of delivery.  This chart also helpful in preventing iatrogenic preterm delivery.
  18. 18.  Low zone indicates - mild anemia -  Mid zone –mild to severe anemia  High zone – severe anemia and impending fetal death within 7-10 days.
  19. 19.  Like a normal pregnancy deliver at 38 weeks  Do regular ultrasound and may have to repeat amniocentesis.  Fetal well being tests – NST, CTG, Biophysical profile, Doppler study.
  20. 20.  High mid and High zone will require CORDOCENTESIS – to assess fetal hemoglobin, hematocrit , platelets and group and type, reticulocyte count fetal transfusion through umbilical vein and delivery. Transfusion of O negative fresh blood if hematocrit is less than 30%.
  21. 21.  1. Intra peritoneal  2. Intra vascular – umbilical vein  Transfusion can be given till fetal hematocrit becomes normal till the risk of prematurity is crossed.
  22. 22.  A] Ultrasound – to determine hydropic changes like 1. scalp edema 2. Anasarca 3. Effusions 4. Hepato and spleenomegaly 5. Umbilicalomegaly 6. Placentomegaly B] Doppler Velocimetry – Assess peak systolic velocity in middle cerebral artery, aorta, vena cava and umbilical vein. It will be increased in severe anemia. C] CTG – NST D] Biophysical profile
  23. 23.  Low Zone & Low Mid Zone - – Deliver at 38 weeks.  High mid zone High Zone – Deliver at 34 weeks electively by cesarean section .  Arrange adequate amount of O negative fresh blood for the newborn.  Inform the neonatologist prior to the delivery.  Higher tertiary centers is ideal place for delivery.
  24. 24. THANK YOU ALL AND ALL THE BEST
  • Farid65

    Oct. 4, 2021
  • JoshuaIdegbere

    Jan. 26, 2021
  • psahagal

    Feb. 17, 2016

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