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Rhesus isoimmunization
Basic – Blood group & Rhesus ,[object Object],[object Object],[object Object]
ABO blood group No No Yes Yes AB Yes Yes No No O No Yes Yes No B Yes No No Yes A Anti-B Anti-A Antigen B Antigen A ABO blood type
Rhesus blood group No No Rhesus  –ve No Yes Rhesus  +ve D-antibody D-Antigen D D D D D D D D D D D D D D D D
Epidemiology <1% Asians 5-10% African-Americans (Blacks) 15% Caucasian Racial variation in incidence of Rh negative
Basic - isoimmunization ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Basic - Isoimmunization Fetomaternal haemorrhage – fetal RBC enter maternal circulation Formation of antibodies to D antigen (anti-D) -  sensitization Later in pregnancy or next pregnancy, anti-D crosses placenta Anti-D attacks fetal Rh +ve RBCs and are destroyed by the immune system –  haemolytic anaemia
Importance ,[object Object],[object Object]
How to prevent isoimmunization? ,[object Object]
Why RhoGAM? ,[object Object]
Rhesus +ve men ,[object Object],[object Object]
Risk of isoimmunisation 0.1-0.2% Postpartum + antepartum RhoGAM 1-2% Postpartum RhoGAM 8% Subsequent pregnancy - untreated 16% 1 st  Rh-incompatible pregnancy – untreated Risk of isoimmunisation
Indications for RhoGAM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Indications for RhoGAM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Not indicated ,[object Object],[object Object],[object Object]
RhoGAM – Dosage & administration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RhoGAM – Dosage & administration ,[object Object],[object Object],[object Object]
Clinical setting ,[object Object],[object Object],[object Object]
Clinical setting ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical setting ,[object Object],[object Object],[object Object],[object Object]
Oxford Rhesus Therapy Unit mx guidelines 34+ Yes 2 > 16.0 34-38 Yes 2 10.1-16.0 36-38 No 2 4.1-10.0 Term No 2 0.5 - 4.0 Term No 4 < 0.5 Gestation at which delivery advised Invasive testing Repeat antibody quantitation (weeks) Anti-D quantitation (IU/ml)
Non-invasive fetal monitoring ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thank you

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Rhesus Isoimmunisation

  • 2.
  • 3. ABO blood group No No Yes Yes AB Yes Yes No No O No Yes Yes No B Yes No No Yes A Anti-B Anti-A Antigen B Antigen A ABO blood type
  • 4. Rhesus blood group No No Rhesus –ve No Yes Rhesus +ve D-antibody D-Antigen D D D D D D D D D D D D D D D D
  • 5. Epidemiology <1% Asians 5-10% African-Americans (Blacks) 15% Caucasian Racial variation in incidence of Rh negative
  • 6.
  • 7. Basic - Isoimmunization Fetomaternal haemorrhage – fetal RBC enter maternal circulation Formation of antibodies to D antigen (anti-D) - sensitization Later in pregnancy or next pregnancy, anti-D crosses placenta Anti-D attacks fetal Rh +ve RBCs and are destroyed by the immune system – haemolytic anaemia
  • 8.
  • 9.
  • 10.
  • 11.
  • 12. Risk of isoimmunisation 0.1-0.2% Postpartum + antepartum RhoGAM 1-2% Postpartum RhoGAM 8% Subsequent pregnancy - untreated 16% 1 st Rh-incompatible pregnancy – untreated Risk of isoimmunisation
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21. Oxford Rhesus Therapy Unit mx guidelines 34+ Yes 2 > 16.0 34-38 Yes 2 10.1-16.0 36-38 No 2 4.1-10.0 Term No 2 0.5 - 4.0 Term No 4 < 0.5 Gestation at which delivery advised Invasive testing Repeat antibody quantitation (weeks) Anti-D quantitation (IU/ml)
  • 22.