RhD isoimmunization and current management modalities

A curious case of anti-D antibody titer

RhD alloimmunization remains a threat to 1% of the 10% of RhD-negative women in the United States who are giving birth to RhD-positive fetuses despite routine antenatal and postpartum administration of Rh(o)D immune globulin (RhIG). This report examines the clinical course of an RhD-negative woman who developed a high anti-D antibody titer during her pregnancy while carrying an RhD-positive female fetus yet had a negative antibody screen at the time she gave birth. Although she delivered a healthy newborn unaffected by hemolytic disease, subsequent pregnancies will be treated as though she is RhD alloimmunized. The discussion below includes possible causes for the abrupt rise in this woman's anti-D antibody titer, a review of the complex Rh system and cellular anamnestic response, and current fetal surveillance for hemolytic disease of the fetus and newborn.

Isoimmunization in pregnancy

Isoimmunization to the Rh(D) antigen and to other red cell antigens remains a potentially severe complication of pregnancy. Although management of this complication is performed best by perinatologists, nurses often are the ones who provide further explanations, answer questions, and assist patients who are trying to understand complex physiology and management plans. Nurses should understand current controversies related to isoimmunization and function as patient advocates if needed. To meet these demands, nurses must continue to refresh their knowledge of isoimmunization and its potential complications and review ever-changing management regimens.

Rh negative status and isoimmunization update: a case-based approach to care

Prior to the 1970s and the advent of Rho (D) immune globulin (RIG) for Rh negative women, hemolytic disease of the newborn led to morbidity, long-term disabilities, and mortality. Antepartum RIG administration has been a standard of practice since 1983. Yet, Rh isoimmunization (sensitization) and its sequelae have not been completely eradicated. Rh-related issues remain clinical challenges facing perinatal and neonatal nurses. Evidence for the administration of RIG prenatally and during the postpartum period is presented including controversies and challenges. Current information about fetal and neonatal care of erythroblastosis fetalis and immune hydrops is also presented.