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Rh incompatibility
Rh-induced hemolytic disease of the newborn; Erythroblastosis fetalis

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Rh incompatibility is a condition that develops when a pregnant woman has Rh-negative blood and the baby in her womb has
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Rh-positive blood.

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Antibodies from an Rh negative mother may enter
the blood stream of her unborn Rh positive infant,
damaging the red blood cells (RBCs). The infant
responds by increasing RBC production and sending
out immature RBCs that still have nuclei. This
photograph shows normal RBCs, damaged RBCs,
and immature RBCs that still contain nuclei.
Newborn jaundice (producing yellow skin) can have
many causes, but the majority of these infants have Antigens are large molecules (usually proteins) on
a condition called physiological jaundice, a natural the surface of cells, viruses, fungi, bacteria, and pe
occurrence in the newborn due to the immature some non-living substances such as toxins, redu
liver. This type of jaundice is short term, generally chemicals, drugs, and foreign particles. The immune bili
lasting only a few days. Jaundice should be system recognizes antigens and produces
evaluated by a physician until decreasing or normal antibodies that destroy substances containing ch
levels of bilirubin are measured in the blood. antigens. Biliru
c

Causes

During pregnancy, red blood cells from the unborn baby can cross into the mother's blood through the placenta.

If the mother is Rh-negative, her immune system treats Rh-positive fetal cells as if they were a foreign substance. The mother's
body makes antibodies (/health-library/special-topic/antibody) against the fetal blood cells. These antibodies may cross back
through the placenta into the developing baby. They destroy the baby's circulating red blood cells.

When red blood cells are broken down, they make bilirubin (/health-library/tests/bilirubin-blood-test). This causes an infant to
become yellow (jaundiced). The level of bilirubin in the infant's blood may range from mild to dangerously high.

Firstborn infants are often not affected unless the mother had past miscarriages or abortions. This would sensitize her immune
system. This is because it takes time for the mother to develop antibodies. All children she has later who are also Rh-positive
may be affected.

Rh incompatibility develops only when the mother is Rh-negative and the infant is Rh-positive. This problem has become less
common in places that provide good prenatal care. This is because special immune globulins called RhoGAM are routinely
used.

Symptoms

Rh incompatibility can cause symptoms ranging from very mild to deadly. In its mildest form, Rh incompatibility causes the
destruction of red blood cells. There are no other effects.

After birth, the infant may have:

Yellowing of the skin and whites of the eyes (jaundice)

Low muscle tone (/health-library/symptoms/hypotonia) (hypotonia) and lethargy

Exams and Tests

Before delivery, the mother may have more amniotic fluid around her unborn baby (polyhydramnios (/health-
library/symptoms/polyhydramnios)).

There may be:

 A positive direct Coombs (/health-library/tests/coombs-test) test result
Higher-than-normal levels of bilirubin in the baby's umbilical cord blood
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Signs of red blood cell destruction in the infant's blood

Treatment

Rh incompatibility can be prevented with the use of RhoGAM. Therefore, prevention remains the best treatment. Treatment of
an infant who is already affected depends on the severity of the condition.
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Infants with mild Rh incompatibility may be treated with phototherapy using bilirubin lights (/health-library/special-topic/bili-
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lights). IV immune globulin may also be used. For infants severely affected, an exchange transfusion of blood may be needed.
This is to decrease the levels of bilirubin in the blood.

Outlook (Prognosis)

Full recovery is expected for mild Rh incompatibility.

Possible Complications

Complications may include:

Brain damage due to high levels of bilirubin (kernicterus)

Fluid buildup and swelling in the baby (hydrops fetalis)
Problems with mental function, movement, hearing, speech, and seizures

When to Contact a Medical Professional

Contact your health care provider if you think or know you are pregnant and have not yet seen a provider.

Prevention

Rh incompatibility is almost completely preventable. Rh-negative mothers should be followed closely by their providers during
pregnancy.

Special immune globulins, called RhoGAM, are now used to prevent RH incompatibility in mothers who are Rh-negative.

If the father of the infant is Rh-positive or if his blood type is not known, the mother is given an injection of RhoGAM during the
second trimester. If the baby is Rh-positive, the mother will get a second injection within a few days after delivery.

These injections prevent the development of antibodies against Rh-positive blood. However, women with Rh-negative blood
type must get injections:

During every pregnancy

After a miscarriage or abortion
After prenatal tests such as amniocentesis and chorionic villus biopsy
After injury to the abdomen during pregnancy

 References

Kaplan M, Wong RJ, Burgis JC, Sibley E, Stevenson DK. Neonatal jaundice and liver diseases. In: Martin RJ, Fanaroff AA, Walsh
MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 91.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Blood disorders. In: Kliegman RM, St. Geme JW, Blum NJ,
Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 124.

Moise KJ. Red cell alloimmunization. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem
Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 40.
  Hemoglobin (/health-library/tests/hemoglobin)
 Bilirubin blood test Your Opinion Matters!
(/health-library/tests/bilirubin-blood-test)
 Anemia (/health-library/diseases-conditions/anemia)
 Heart failure (/health-library/diseases-conditions/heart-failure-overview)
 Seizures (/health-library/symptoms/seizures)
 Newborn jaundice - discharge (/health-library/discharge-instructions/newborn-jaundice-discharge)
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