Rh incompatibility
- Article
- 2021-02-27
Rh incompatibility is a condition that occurs during pregnancy when a woman has Rh negative blood and her baby has Rh positive blood.
"Rh negative" and "Rh positive" refer to whether your blood has Rh factor. Rh factor is a protein found on red blood cells. If you have Rh factor, you are Rh positive. If you don't have it, you are Rh negative. Rh factor is inherited (passed on from parents to children via the genes). Most people are Rh positive.
Whether you have Rh factor will not affect your general health. However, it can cause problems during pregnancy.
Overview
If you are pregnant, blood from your baby can get into your bloodstream, especially during labor. If you are Rh negative and your baby is Rh positive, your body reacts to the baby's blood as a foreign substance.
Your body makes antibodies (proteins) against the baby's Rh positive blood. These antibodies usually do not cause problems during a first pregnancy. This is because the baby is often born before many of the antibodies develop.
However, the antibodies remain in your body after they form. So, Rh incompatibility causes more problems in second or later pregnancies (if the baby is Rh positive).
The Rh antibodies can cross the placenta and attack the baby's red blood cells. This can lead to hemolytic anemia (HEE-moh-lit-ick uh-NEE-me-uh) in the baby.
Hemolytic anemia is a condition in which red blood cells are destroyed faster than the body can replace them. Red blood cells carry oxygen to all parts of the body.
Without enough red blood cells, your baby will not get enough oxygen. This can lead to serious problems. Severe hemolytic anemia can even be fatal to the child.
Symptoms
Rh incompatibility does not cause any 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 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 will not get enough oxygen.
Hemolytic anemia can cause mild to severe signs and symptoms in a newborn, such as jaundice and fluid retention.
Jaundice is a yellowish color of the skin and the 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.
Fluid build-up is the result of heart failure. Without enough hemoglobin-carrying red blood cells, the baby's heart has to work harder to keep oxygenated blood flowing around the body. This stress can lead to heart failure.
Heart failure can cause fluid to build up in many parts of the body. When this happens in a fetus or newborn, the condition is called hydrops fetalis (HI drops fe-TAL-is).
Severe hemolytic anemia can be fatal to a newborn at birth or shortly thereafter.
Therapy
Rh incompatibility is treated with a drug called Rh immunoglobulin. The treatment of a baby with hemolytic anemia will vary based on the severity of the condition.
Goals of the treatment
The goal of treating Rh incompatibility is to make sure your baby is healthy and to lower your risk of the condition in future pregnancies.
Treatment for Rh incompatibility
If Rh incompatibility is diagnosed during your pregnancy, you will receive Rh immunoglobulin in your seventh month of pregnancy and again within 72 hours of giving birth.
You may also be given Rh immunoglobulin if the risk of blood transfer between you and the baby is high (for example, if you have had a miscarriage, an ectopic pregnancy or bleeding during pregnancy).
Rh immunoglobulin contains Rh antibodies that attach to the Rh positive blood cells in your blood. When this happens, your body does not respond to the baby's Rh positive cells as a foreign substance. As a result, your body does not make Rh antibodies. Rh immunoglobulin must be given at the right times for it to work properly.
Once you have Rh antibodies, the medicine will no longer help. That is why a woman with Rh negative blood should be treated with the drug in any pregnancy or any other event that allows her blood to mix with Rh positive blood.
Rh immunoglobulin is injected into the muscle of your arm or buttock. Side effects may include injection site pain and mild fever. The medicine can also be injected into a vein.
Treatment for hemolytic anemia
Several options are available to treat hemolytic anemia in a baby. In mild cases, treatment may not be necessary. If treatment is needed, the baby may be given a medicine called erythropoietin and iron supplements. These treatments can trigger the body to make red blood cells.
If the hemolytic anemia is severe, the baby may receive a blood transfusion through the umbilical cord. If the hemolytic anemia is severe and the baby is nearing term, your doctor may give birth early. This allows the baby's doctor to begin treatment right away.
A newborn with severe anemia can be 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 can also be treated with special lamps 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.
Lowering the levels of bilirubin in the blood is important because high levels of this substance can cause brain damage. High levels of bilirubin are often seen in babies with hemolytic anemia. This is because the compound is formed when red blood cells are broken down.
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