Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
Risk factors
- history of an RhD-positive fetus in an RhD-negative mother
- fetomaternal hemorrhage
- invasive fetal procedures
- placental trauma
- abortion
- multiparity
- omission of Rh immunoprophylaxis
- external cephalic version
- molar pregnancy
- ectopic pregnancy
Diagnostic tests
1st tests to order
- maternal blood type
- maternal serum Rh antibody screen
Tests to consider
- maternal serum antibody titer
- paternal blood type
- paternal zygosity
- fetal ultrasound
- Doppler velocimetry of fetal middle cerebral artery (peak systolic velocity)
- fetal blood typing (from amniocentesis or maternal circulation)
- direct assessment of fetal anemia
- rosette test
- Kleihauer-Betke test/flow cytometry
Treatment algorithm
unsensitized RhD-negative mother
sensitized RhD-negative mother
neonate with erythroblastosis
Contributors
Authors
Andrew D. Hull, MD, FRCOG, FACOG
Professor of Clinical Obstetrics, Gynecology, and Reproductive Sciences
Director, UC San Diego Maternal-Fetal Care and Genetics
Division of Maternal-Fetal Medicine
Department of Obstetrics, Gynecology, and Reproductive Sciences
University of California San Diego
La Jolla
CA
Disclosures
ADH declares that he has no competing interests.
Acknowledgements
Dr Andrew D. Hull would like to gratefully acknowledge Dr Karen Fung-Kee-Fung and Dr Felipe Moretti, previous contributors to this topic.
Disclosures
KFKF is an author of a reference cited in this topic. KFKF and FM declare that they have no competing interests.
Peer reviewers
Alan Cameron, MD
Honorary Professor of Medicine
University of Glasgow
Glasgow
UK
Disclosures
AC is an author of several references cited in this topic.
Liakat Ali Parapia, MD, FRCP
Consultant Hematologist
Bradford Teaching Hospitals NHS Trust
Yorkshire Clinic
Bingley
Bradford
UK
Disclosures
LAP declares that he has no competing interests.
Kenneth J. Moise, Jr., MD
Professor of Obstetrics and Gynecology
Texas Children's Fetal Center
Baylor College of Medicine/Texas Children's Hospital
Houston
TX
Disclosures
KJM declares that he has no competing interests.
References
Key articles
Brennand J, Cameron A. Fetal anaemia: diagnosis and management. Best Pract Res Clin Obstet Gynaecol. 2008 Feb;22(1):15-29. Abstract
American College of Obstetrics and Gynecology. ACOG practice bulletin no. 181: prevention of Rh D alloimmunization. Obstet Gynecol. 2017 Aug;130(2):e57-70. Abstract
American Congress of Obstetrics and Gynecology. ACOG practice bulletin no. 192: management of alloimmunization during pregnancy. Obstet Gynecol. 2018 Mar;131(3):e82-90. Abstract
Qureshi H, Massey E, Kirwan D, et al. BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn. Transfus Med. 2014 Feb;24(1):8-20.Full text Abstract
Visser GHA, Thommesen T, Di Renzo GC, et al. FIGO/ICM guidelines for preventing Rhesus disease: a call to action. Int J Gynaecol Obstet. 2021 Feb;152(2):144-7.Full text Abstract
Whyte RK, Jefferies AL; Canadian Paediatric Society, Fetus and Newborn Committee. Red blood cell transfusion in newborn infants. Paediatr Child Health. 2014 Apr;19(4):213-22.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Nonimmune fetal hydrops
- Parvovirus infection
- Non-RhD hemolytic disease
More DifferentialsGuidelines
- ACOG clinical practice update: paternal and fetal genotyping in the management of alloimmunization in pregnancy
- ACOG clinical practice update: Rh D immune globulin administration after abortion of pregnancy loss at less than 12 weeks of gestation
More Guidelines
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