Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Vigan City, Ilocos Sur
College of Nursing
    

A Write-up about
RH INCOMPATIBILITY
(ISOIMMUNIZATION)

In Partial Fulfillment of the Requirements in the course:

NCM 109 Care of Mother and Child at Risk or with
Problems (Acute and Chronic) Lec

Submitted to:
Mrs. Cathlene De Guzman
Clinical Instructor

Submitted by:
Maduli Jr., Marlone G.
BSN 2-C

2023
INTRODUCTION
Rhesus (Rh) incompatibility refers to the discordant pairing of maternal and
fetal Rh types. It is associated with the development of maternal Rh sensitization and
hemolytic disease of the neonate (HDN). An individual can be classified as Rh-
positive if their erythrocytes express the Rh D antigen; otherwise, an individual is Rh-
negative if they do not. This phenomenon becomes clinically significant if a mother
that is Rh-negative becomes sensitized to the D antigen and subsequently, produces
anti-D antibodies (i.e., isoimmunization) that can bind to and potentially lead to the
destruction of Rh-positive erythrocytes. This is of particular concern if an Rh-
negative mother is carrying an Rh-positive fetus, which can result in consequences
along the spectrum of HDN ranging from self-limited hemolytic anemia to severe
hydrops fetalis.
A positive or negative symbol after your blood type indicates your Rh factor.
For example, “blood type: AB+” might be written on your medical record. Your Rh
factor doesn’t directly affect your health. However, Rh factor becomes important
during pregnancy. If a woman is Rh-negative and her baby is Rh-positive, then the
woman’s body will approach the Rh-positive protein as a foreign object, if her
immune system is exposed to it. This means that if blood cells from your baby cross
your bloodstream, which can happen during pregnancy, labor, and delivery, your
immune system will make antibodies against your baby’s red blood cells.
When an Rh-negative mother is exposed to the Rh D antigen, the D antigen is
perceived as a foreign threat similar to how bacteria and viruses are perceived. This
leads to a series of activations of immunogenic pathways that culminates in the
production of anti-D antibodies. Those antibodies can bind to the D antigen present
on the erythrocytes of Rh-positive fetuses to further activate immunologic pathways
that lead to the hemolysis of the fetal erythrocytes. This means that your body might
send these antibodies across the placenta to attack your baby’s red blood cells. Your
placenta is the organ that connects you and your baby.
The risk of Rh incompatibility is higher in an Rh-negative pregnant woman
who had a prior pregnancy to a baby that is Rh-positive. Maternal sensitization
occurs in Rh-negative mothers due to exposure to the Rh D antigen. This typically
occurs when the Rh-negative mother is carrying an Rh-positive fetus or has been
exposed to Rh-positive blood differently. However, if the exposure to the Rh D
antigen occurs during the mother’s first pregnancy, the adverse consequences of Rh
incompatibility do not typically affect that initial pregnancy because the fetus often is
delivered before the development of the anti-D antibodies. Once the mother has
been sensitized, future pregnancies are at risk for the development of HDN
secondary to Rh incompatibility if the fetus is Rh-positive. Another who are at risk are
those who had prior blood transfusion and amniocentesis. Exposure to fetal Rh-
positive blood affects Rh-negative mother for being sensitized with the D antigen.
And lastly, Rh incompatibility affects women who did net get an Rh immunization
during a prior pregnancy with an Rh-positive baby.
There are no physical symptoms that can be seen in Rh incompatibility. But
complications on the baby may occur before or after the delivery. Rh incompatibility
complications in your baby can range from mild to life-threatening. When your
antibodies attack your baby’s red blood cells, hemolytic disease can occur. This
means your baby’s red blood cells are destroyed. When your baby’s healthy red
blood cells are destroyed, bilirubin will build up in their bloodstream. Bilirubin is a
chemical that’s created from the breakdown of red blood cells. Too much bilirubin is a
sign that the liver, which is responsible for processing old blood cells, is having
trouble which can lead to jaundice. Another complication is anemia wherein the fetal
red blood cells are being destroyed faster than they are made. And lastly, there is
swelling in the fetus’s body, heart failure or breathing problems may occur.
Knowing your Rh status is important during pregnancy (or before) because it
can prevent potential complications. That is why pre-natal visits are very important
throughout your pregnancy to determine whether the baby inside your womb is
healthy and in order to avoid several complications that may occur before, during or
after delivery. A blood test to determine your Rh status will likely be done at your first
prenatal visit with your doctor. If you’re Rh-negative, your partner may also be tested.
If your partner is also Rh-negative, you don’t have anything to worry about. If your
partner is Rh-positive and you’re Rh-negative, your doctor will look for the following
signs of Rh incompatibility. A positive indirect Coombs test is a sign of Rh
incompatibility. This test uses a blood sample to look for the presence of cell-
destroying antibodies within the plasma of your blood. Higher-than-normal levels of
bilirubin in your infant’s blood is a sign of Rh incompatibility. In a full-term baby who
is less than 24 hours old, the levels of bilirubin should be less than 6.0 milligrams per
deciliter. Signs of red blood cell destruction in your infant’s blood may indicate Rh
incompatibility. This can be determined by the shape and structure of the red blood
cells when examined under a microscope. Your doctor can test your baby’s blood for
the presence of maternal antibodies that are breaking down the red blood cells.
Your provider treats Rh incompatibility with an injection of Rh immunoglobulin
(RhIg). One of the main principles of the management of Rh incompatibility is the
prevention of maternal sensitization. Rh D immunoglobulin (RhIg) has made a
significant impact on preventing Rh disease. RhIg consists of anti-Rh D antibodies
that target Rh-positive erythrocytes to prevent maternal sensitization. It has reduced
the rate of isoimmunization from 16% to less than 1%. Furthermore, RhIg
immunoprophylaxis has decreased the prevalence of HDN attributed to anti-D
antibodies to less than 1%. If a mother has the potential to have Rh incompatibility
during pregnancy, prophylactic RhIg should be administered to unsensitized Rh-
negative women at 28 weeks gestation. If the neonate is found to be Rh-positive
after delivery, those same unsensitized Rh-negative women should be given RhIg
within 72 hours of delivery.
Treatment focuses on preventing the effects of the incompatibility. In mild
cases, the baby can be treated after birth with exchange transfusion, phototherapy,
and initiation of breastfeeding. Phototherapy involves keeping your baby near
fluorescent lights to help reduce the bilirubin in their blood. These procedures may
be repeated until the Rh-negative antibodies and excess bilirubin have been
removed from your baby’s blood. Whether it must be repeated depends on the
severity of your baby’s condition.
UPDATES
 Rh incompatibility is dependent on the prevalence of Rh-negative blood types,
which varies among different populations. Researchers estimate that the
frequency of the Rh-negativity occurs more frequently among those of
Caucasian (North American and European) descent (15% to 17%) compared
to those of African (4% to 8%) or Asian descent (0.1% to 0.3%). Worldwide,
the prevalence of Rh disease is estimated to be 276 per 100,000 live births,
which is significant considering that an estimated 50% of untreated cases of
HDN will either die or develop brain damage due to the disease. In
comparison, the prevalence of Rh disease in developed countries has been
reduced to 2.5 per 100,000 live births, which can be attributed to higher-
quality perinatal-neonatal care.
 Twenty-four million (18% of 134 million live births ≥ 32 wk gestational age
from 184 countries; uncertainty range: 23-26 million) were at risk for neonatal
hyperbilirubinemia-related adverse outcomes. Of these, 480,700 (0.36%) had
either Rh disease (373,300; uncertainty range: 271,800-477,500) or
developed EHB from other causes (107,400; uncertainty range: 57,000-
131,000), with a 24% risk for death (114,100; uncertainty range: 59,700-
172,000), 13% for kernicterus (75,400), and 11% for stillbirths. Three-quarters
of mortality occurred in sub-Saharan Africa and South Asia. Kernicterus with
Rh disease ranged from 38, 28, 28, and 25/100,000 live births for Eastern
Europe/Central Asian, sub-Saharan African, South Asian, and Latin American
regions, respectively. More than 83% of survivors with kernicterus had one or
more impairments.

References:
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%20baby
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