Rhesus disease

Question 1

What is rhesus Disease

Answer 1

Development of Rh AB in RhD -ve mother post exposure to RhD blood cells
85% of pop are Rh +ve

Need Rh-ve mother, Rh+ve child
sensising event (simple SVD INST, everything else is_
Mother develops IGM

2nd Rh+ve child– mother IgG cross placenta -Hydrops fetalis

RF- Previous preg with bad antiD prophylaxis, Previous transfuse

Question 2

Sx and sensitising events for Rhesus disease

Answer 2

Potentially sensitising events-
amniocentesis, CVS
APH/PV bleeds
abdo trauma
ectopic
Misscarriage (medical or spontaneous)
Delivery - NOT SVD, SCD/CS/intrumental) 

Ix- father status (explain how kid could be )
Mother anti RhD levels
babyn status
Kleinhaeur test

Question 3

Mx of Rhesus disease

Answer 3

Only for RhD-ve women

routine prophylaxis-
indirect antiglobulun at book
then 2 dose 500IU at 28w and 34w
OR 1dose 1000IU at 28w

Prophylaxis after sensitisating event-
do kleinhauer tests
250IU <20w
500IU>20w

if mother is RhD-ve and had AB at booking- monitor baby with middle cerebral artery dopple (MCA doppler) -if baaby affected consider IU

If continuous bleed- anti D every 6w, kleinhauer every 2w

cell-free foetal DNA testing (cffDNA) testing at 12w can determine baby Rh status If baby is Rh -ve, there is no need for anti-D prophylaxis at 28