Information Sheet for Candidates

Your next patient in a general practice setting is a 25 year old Mr. Jones who got married
1 year ago and they are planning to start a family. He is a bit concerned about the fact that
he is Rh+ and his wife is RH-.
He would like to get some advice what this means.

How do you respond to the patients request?

Information Sheet for Candidates
Your next patient in a general practice setting is a 25 year old Mr. Jones who got married
1 year ago and they are planning to start a family. He is a bit concerned about the fact that
he is Rh+ and his wife is RH-.
He would like to get some advice what this means.

How do you respond to the patients request?

Information Sheet for Candidates
Your next patient in a general practice setting is a 25 year old Mr. Jones who got married
1 year ago and they are planning to start a family. He is a bit concerned about the fact that
he is Rh+ and his wife is RH-.
He would like to get some advice what this means.

How do you respond to the patients request?

Information Sheet for Candidates
Your next patient in a general practice setting is a 25 year old Mr. Jones who got married
1 year ago and they are planning to start a family. He is a bit concerned about the fact that
he is Rh+ and his wife is RH-.
He would like to get some advice what this means.

How do you respond to the patients request?

Information Sheet for Candidates
Your next patient in a general practice setting is a 25 year old Mr. Jones who got married
1 year ago and they are planning to start a family. He is a bit concerned about the fact that
he is Rh+ and his wife is RH-.
He would like to get some advice what this means.

How do you respond to the patients request?

Information Sheet for Candidates
Your next patient in a general practice setting is a 25 year old Mr. Jones who got married
1 year ago and they are planning to start a family. He is a bit concerned about the fact that
he is Rh+ and his wife is RH-.
He would like to get some advice what this means.

How do you respond to the patients request?

The rhesus factor is a part of our blood group system (A, B, AB, O, Rh+ and Rh-).
About 16% of people are Rh-!
The ABO blood groups are determined by testing for the presence or absence of A and B
antigens on the red blood cells and by testing for Anti-A and Anti-B (antibodies) in the
serum.
Rh- means that the patient does not have the rhesus factor in the blood, and Rh+ means
that the patient carried the factor.
If a woman who is Rh- conceives by a man who is Rh+, the fetus may be Rh- or Rh+
depending on whether the man is heretozygous or homozygous for the rhesus antigen.
If the fetus is Rh+, its red blood cells have the group D Rhesus antigen. Fetal blood
cells can cross the placenta during the pregnancy or, 3more often, during labour and thus
they cause antibody production in the maternal blood against the Rh+ antigen (Anti-Dantibodies)
This process is called ISOIMMUNISATION!
If the mother becomes pregnant again, her anti-D-antibodies can cross the placenta from
her to the fetus and can form an antigen-antibody complex which in turn can cause
haemolysis and other complications in the fetus!
TESTING:
We routinely test for blood group and Rh factor at the first antenatal visit. If the woman is
Rh- and there are no anti-Rh antibodies detected by the indirect Coombs technique (that
means no fetal blood has crossed into the maternal circulation!), we test her again after 28
and 34 weeeks!
If Rh antibodies are detected at a titre of 1:8 or greater, the next step is an amniocentesis
to test the amniotic fluid for the level of bilirubin, which correlates with the degree of
destruction of the fetal red blood cells, as consequence of the incompatibility reaction.
In a second pregnancy fetal cord sampling should be performed even before the 24th
week.
Rhesus isoimmunisation prophylaxis for Rh- women (the aim is to prevent
development of anti_D antibodies!:
If abort or requirement of a curettage (trauma), they are given an injection of 50125 microgram rhesus anti-D IgG within 72 hours of the abortion! The anti-D IgG
simulates maternal antibodies so that her own immune mechanisms do not initiate
antibody production. The anti-D IgG are gradually destroyed over the next 3 to 6
months, and the mother remains unsensitised!
In cases of chorionic villus sampling, amniocentesis, ectopic pregnancy,
threatened miscarriage, antepartum haemorrhage, abdominal trauma or external
cephalic version, rhesus anti-D IgG is given. Before the 20th week 250 IU, after 20
weeks 625 IU.
All Rh- women who are not sensitized and progress with the pregnancy to the 28th
week are given an injection of 625 IU rhesus anti-D IgG, repeated at 34 weeks!
This prophylaxis reduces the risk of antenatal isoimmunisation by over 50%!!!
All Rh- unsensitised women who give birth to a Rh+ baby, are given an injection
of 625IU rhesus anti-D IgG within 72 hours of birth if the Coombs test is negative
(indicating no circulating anti-D IgG!).

A special test, the KLEIHAUER TEST, can determine the number of fetal red
blood cells present in the mothers blood, which would confirm feto-maternal
haemorrhage / isoimmunisation and would require the mother to have rhesus antiD IgG!!!! The Kleihauer test is also used to determine the amount of anti-D
dosage!
Fetal effects:
Maternal antibodies can destroy Rh+ fetal red blood cells
Stimulation of extramedullary erythropoietic sites (ERYTHROBLASTOSIS
FETALIS, incl. heart failure, oedema, ascites and disturbed liver function)
Haemolysis produces bilirubin which is usually removed via the placenta but can
be neurotoxic!
TREATMENT:
exchange transfusion (intra-uterine or post delivery)!!!!
The KLEIHAUER test determines the amount of fetal blood cells in the mothers
circulation