Rh Incompatibility
Created by :
Muhammad Dendy Firmansyah
PROGRAM STUDI DIII KEPERAWATAN
STIKES RAFLESIA DEPOK
2018/2019
CONTENT
Content.............................................................................................................................. i
CHAPTER I
A. Background........................................................................................................... 1
B. Problem................................................................................................................. 2
C. Purpose................................................................................................................. 2
CHAPTER II
A. Definition........................................................................................................ 3
B. Causes............................................................................................................. 4
C. Sign and Symptom.............................................................................................
D. Diagnosis...........................................................................................................
E. Treatment...........................................................................................................
F. Nursing intervention..........................................................................................
CHAPTER III
A. Conclusion.......................................................................................................7
REFERENCES
CHAPTER I
A. Background
An Rh factor is a characteristic of a human blood system known as the Rhesus
(Rh) blood group system. An individual is Rh positive or Rh negative, depending
on the presence of the Rh factor on the surface of red blood cells of the individual.
The Rh factor refers to a Dantigen of the Rh blood group. An individual that is Rh
positive has the D antigen on the Surface of his or her red blood cells, and an
individual that is Rh negative does not have the D antigen. 60% of term new-born
have clinical jaundice, in the first week of life. ABO incompatibility is the most
common cause of haemolytic disease of the new-born. 200 new-born with ABO
incompatibility and 20 new-born with Rh incompatibility, causing clinically
significant neonatal hyperbilirubinemia, were recruited for the clinical study
noted. Results: The incidence of ABO incompatibility in our study was 13.79%
and of Rh incompatibility was 1.37%. In ABO incompatibility group, 90% new
born developed clinical jaundice. In treated group, out of 88 new born, 82 were
from O-A and O-B incompatibility group. In ABO incompatibility DCT was
positive in only 9%, whereas in Rh incompatibility it was 25%. In ABO
incompatibility group, majority, 56% did not require treatment, whereas in Rh
incompatibility group 65% required treatment. In ABO incompatibility group
only 1% required exchange transfusion whereas in Rh incompatibility, it was
required in 10%. In ABO incompatibility, all new-born treated well except, 0.5%
developed kernicterus. In Rh incompatibility group, 10% new-born developed
kernicterus Conclusions: In ABO incompatibility, if jaundice develops, it remains
in physiological limits. In presence of some aggravating conditions may present as
pathological jaundice. It results in significant morbidity but no mortality.
B. Problem
C. Purpose
CHAPTER II
A. Definition
Rh incompatibility is a condition that occurs during pregnancy if a woman has
Rh-negative blood and her baby has Rh-positive blood. "Rh-negative" and "Rh-
positive" refer to whether your blood has Rh factor. Rh factor is a protein on red
blood cells. If you have Rh factor, you're Rh-positive. If you don't have it, you're
Rh-negative. Rh factor is inherited (passed from parents to children through the
genes). Most people are Rh-positive. Whether you have Rh factor doesn't affect
your general health. However, it can cause problems during pregnancy.
B. Causes
A difference in blood type between a pregnant woman and her baby causes Rh
incompatibility. The condition occurs if a woman is Rh-negative and her baby is
Rh-positive. When you're pregnant, blood from your baby can cross into your
bloodstream, especially during delivery. If you're Rh-negative and your baby is
Rh-positive, your body will react to the baby's blood as a foreign substance. Your
body will create antibodies (proteins) against the baby's Rh-positive blood. These
antibodies can cross the placenta and attack the baby's red blood cells. This can
lead to hemolytic anemia in the baby. Rh incompatibility usually doesn't cause
problems during a first pregnancy. The baby often is born before many of the
antibodies develop. However, once you've formed Rh antibodies, they remain in
your body. Thus, the condition is more likely to cause problems in second or later
pregnancies (if the baby is Rh-positive). With each pregnancy, your body
continues to make Rh antibodies. As a result, each Rh-positive baby you conceive
becomes more at risk for serious problems, such as severe hemolytic anemia.
C. Sign and symptom
Rh incompatibility doesn't cause signs or symptoms in a pregnant woman. In a
baby, the condition can lead to hemolytic anemia. Hemolytic anemia is a
condition in which red blood cells are destroyed faster than the body can replace
them. Red blood cells contain hemoglobin (HEE-muh-glow-bin), an iron-rich
protein that carries oxygen to the body. Without enough red blood cells and
hemoglobin, the baby won't get enough oxygen. Hemolytic anemia can cause mild
to severe signs and symptoms in a newborn, such as jaundice and a buildup of
fluid. Jaundice is a yellowish color of the skin and whites of the eyes. When red
blood cells die, they release hemoglobin into the blood. The hemoglobin is broken
down into a compound called bilirubin. This compound gives the skin and eyes a
yellowish color. High levels of bilirubin can lead to brain damage in the baby. The
buildup of fluid is a result of heart failure. Without enough hemoglobin-carrying
red blood cells, the baby's heart has to work harder to move oxygen-rich blood
through the body. This stress can lead to heart failure. Heart failure can cause
fluid to build up in many parts of the body. When this occurs in a fetus or
newborn, the condition is called hydrops fetalis (HI-drops fe-TAL-is).Severe
hemolytic anemia can be fatal to a newborn at the time of birth or shortly after.
D. Diagnosis
Rh incompatibility is diagnosed with blood tests. To find out whether a baby is
developing hemolytic anemia and how serious it is, doctors may use more
advanced tests, such as ultrasound.
E. Treatment
If Rh incompatibility is diagnosed during your pregnancy, you'll receive Rh
immune globulin in your seventh month of pregnancy and again within 72 hours
of delivery. You also may receive Rh immune globulin if the risk of blood
transfer between you and the baby is high (for example, if you've had a
miscarriage, ectopic pregnancy, or bleeding during pregnancy). Rh immune
globulin contains Rh antibodies that attach to the Rh-positive blood cells in your
blood. When this happens, your body doesn't react to the baby's Rh-positive cells
as a foreign substance. As a result, your body doesn't make Rh antibodies. Rh
immune globulin must be given at the correct times to work properly. Once you
have formed Rh antibodies, the medicine will no longer help. That's why a woman
who has Rh-negative blood must be treated with the medicine with each
pregnancy or any other event that allows her blood to mix with Rh-positive blood.
Rh immune globulin is injected into the muscle of your arm or buttock. Side
effects may include soreness at the injection site and a slight fever. The medicine
also may be injected into a vein.
F. Nursing Intervention
The primary role of the nurse is that education and support. The patient must be
aware of her condition and the need for continuos follow up, The patient will be
need a support if the patient baby does become anemic and needs to be delivered
prematurely. The patient will need the coping, The nurses can be very supportive
during this time.
CHAPTER III
A. Conclusion
in order to reduce the occurrence of alloimmunization of the mother to erythrocyte
antigens of the newborn that can lead to major complications in subsequent
pregnancies of Rh D: negative mothers and HDN constant monitoring in order to
prevent them is necessary.
REFERENCES
Mubarak Aljuhaysh, R., Mohamed Abo El-Fetoh, N., Ibrahim Alanazi, M., Shuaib Albaqawi, A.,
Mohammed Alanazi, W., Salah Alanazi, N., Muqbil Alanazi, R., Mutab Alanazi, A., Mohammad
Alnemer, E., Abdulhadi Alenezi, R., Khoudier Alabdullatif, T., Abdallah Alanazi, R., Sarhan
Alanazi, S., Saeed Alsultan, K., Matan Alanazi, I., & Sami Alsunayni, D. (2017). Maternal-fetal
Rhesus (Rh) factor incompatibility in Arar, northern Saudi Arabia. Electronic Physician, 9(12),
5908–5913. [Link]
View, M., View, M., View, M., David, E., & View, M. (2017). ( 12 ) Patent Application
Publication ( 10 ) Pub . No .: US 2017 / 0215756A1. 1(19), 2015–2018.
[Link]