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Isoimmunization Erythroblastosis Fetalis Hemolytic Disease of the Newborn

Isoimmunization Erythroblastosis Fetalis Hemolytic Disease of the Newborn. Zeev Weiner Director of Ultrasound in Obstetrics and Gynecology Lutheran Medical Center. Rh Isoimmunization. Rh Blood Group System: Cc D d Ee 40 other antigens: Du, Cw,…. The D antigen.

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Isoimmunization Erythroblastosis Fetalis Hemolytic Disease of the Newborn

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  1. IsoimmunizationErythroblastosis FetalisHemolytic Disease of the Newborn Zeev Weiner Director of Ultrasound in Obstetrics and Gynecology Lutheran Medical Center

  2. Rh Isoimmunization Rh Blood Group System: Cc Dd Ee 40 other antigens: Du, Cw,….

  3. The D antigen In 85% the D antigen is present 55% heterozygous Sensitization occurs during blood transfusion and during pregnancy

  4. The D antigen Isoimmunization is dose dependent 0.1 ml is sufficient ABO incompatibility confers partial protection!

  5. Obstetrical risks for Rh isoimmunization Abortions (2-5%) – How early? Pregnancy and delivery (1.6%) Procedures: Amniocentesis Trauma

  6. Rh Hemolytic Disease Mild: Fetal anemia with Hb>12-13g/dl. No sonographic findings.

  7. Rh Hemolytic Disease Moderate: Fetal anemia with Hb between 7-12 g/dl Possible sonographic findings.

  8. Rh Hemolytic Disease Severe: Anemia with Hb < 7g/dl Most of the time there are sonographic findings

  9. Monitoring the sensitization When do we check anti-D titers? At the beginning, 28 wks, after birth What is a significant titer? Above 1:8-1:16 How accurate are the titers? …….. What is the meaning of very low titers and do we have to give prophylaxis? …….

  10. Follow-up patients with sensitization Checking the Rh antigens of the father if negative no need to follow-up? Checking the Rh antigens of the fetus if negative definitely no need to follow-up

  11. Follow-up patients with Rh isoimmunization Follow-up can start at 18 weeks gestation There are 3 options: Amniocentesis Cordocentesis Doppler

  12. Amniocentesis for patients with Rh isoimmunization The Liley or the modified curves. Advantage: less complicated procedure Disadvantage: delta OD may not accurately correlate with the anemia

  13. Cordocentesis for patients with Rh isoimmunization Blood sampling from the umbilical vein, hepatic or portal veins, intracardiac Advantage: more reliable, immediate option for treatment Disadvantage: higher risk

  14. Doppler studies for patients with Rh isoimmunization Peak velocity of the middle cerebral artery (why not other vessels?) Advantage: non invasive Disadvantage: correlation with anemia is still questionable

  15. Treatment of Fetal Anemia Indication: Hb < 10-11 g/L (Hct<30) or fetal hydrops Technique: Intraperitoneal, Intravascular (umbilical vein or others), Intracardiac

  16. Treatment of Fetal Anemia Irradiated O- packed red cells (Hct=0.85-0.9) V =[(Hct-f - Hct-i)xEFWx120]: Hct-d Guidelines for repeat transfusion: 1% decline per day, Hct=25

  17. Treatment of Severe Cases of Rh Isoimmunization Early transfusions starting at 16-18 wks A weekly high-dose of IVIG between 13-18 wks AID

  18. Time and Mode of Delivery 33-34 wks with documented lung maturity 34-36 weeks with no need to document lung maturity No indication for a CS

  19. Prevention of Rh Isoimmunization 300 micrograms of Anti-D Ab At 28 wks and within 72 hrs postpartum Protect against 15 ml of RBC

  20. Other Common antibodies Causing Isoimmunization Kell C E

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