ABO and Rhesus
Incompatibility : Management
of Rhesus Negative Mothers
and their Babies
Introduction
• • ABO and Rhesus incompatibility are
significant issues in medicine, especially
during blood transfusions and pregnancy.
• • They occur when the immune system
reacts against foreign blood group
antigens.
• • These conditions can lead to serious
complications like hemolytic disease of
the newborn (HDN) or transfusion
reactions.
Compatibility
of Blood
types
ABO Blood
Group System
• • Four major ABO blood types: A, B,
AB, and O.
• • Determined by presence of
antigens (A or B) on red blood cells
and corresponding antibodies in
plasma.
• • Type A: A antigens, anti-B
antibodies.
• • Type B: B antigens, anti-A
antibodies.
• • Type AB: Both A and B antigens,
no antibodies — universal
recipient.
• • Type O: No antigens, anti-A and
anti-B antibodies — universal
Rhesus (Rh) Blood
Group System
• • Based on the presence or absence
of the Rh(D) antigen.
• • Rh-positive: D antigen present; Rh-
negative: D antigen absent.
• • Most people are Rh-positive.
• • Rh system is crucial in pregnancy
and transfusion compatibility.
Pathophysiology of ABO
Incompatibility
• Occurs mainly when a type O mother carries a type A, B,
or AB fetus.
• Type O mothers have IgG antibodies against A and B
antigens.
• These IgG antibodies cross the placenta and bind to fetal
RBC antigens.
• Results in hemolysis (destruction of fetal RBCs) through:
– Extravascular hemolysis: RBCs removed by fetal
spleen macrophages → anemia, risk of hydrops fetalis.
– Intravascular hemolysis (less common): Complement
activation → direct RBC lysis.
• Clinical signs include jaundice, hyperbilirubinemia, and in
severe cases, hydrops fetalis.
• Treatment may involve phototherapy or exchange
transfusion.
Diagram of ABO blood group
Pathophysiology of Rh
Incompatibility
• Occurs when an Rh-negative mother carries an Rh-positive fetus.
• Step 1 – Sensitization: Fetal Rh-positive RBCs enter maternal
circulation → mother’s immune system forms anti-D antibodies.
• Step 2 – Antibody Production: Initial exposure causes mild
response; stronger response in future pregnancies.
• Step 3 – Fetal Hemolysis: Maternal IgG anti-D antibodies cross
the placenta → bind to fetal RBCs → destruction via immune
mechanisms (ADCC, complement, phagocytosis).
• Step 4 – Fetal Anemia & Complications: Leads to anemia,
hydrops fetalis, heart failure, or fetal death.
• Newborn may develop jaundice or kernicterus if untreated.
•
Rh incompatibility
Mechanism of Sensitization
• • Sensitization = maternal immune system
produces anti-D antibodies after exposure to Rh-
positive blood.
• • Occurs during delivery, miscarriage,
amniocentesis, or abdominal trauma.
• • Anti-D antibodies remain in the mother's
circulation and pose risks in future pregnancies.
Hemolytic Disease of the Newborn
(HDN)
• • Caused by maternal antibodies attacking fetal red
blood cells.
• • Symptoms: anemia, jaundice, hepatosplenomegaly,
hydrops fetalis.
• • Severe cases can result in stillbirth or neonatal death.
• • Most commonly due to Rh incompatibility.
Prevention of Rh Incompatibility
• • Anti-D immunoglobulin (Rhogam) given to
Rh-negative mothers:
• - At 28 weeks of pregnancy
• - Within 72 hours after delivery of Rh-
positive infant
• - After miscarriage, abortion, or procedures
like amniocentesis
• • Prevents maternal sensitization.
Management of a labour of Rh
negative mother
• 1. Initial Screening
• Rh typing at first prenatal visit
• Antibody screening to detect prior sensitization
• 2. Preventing Sensitization
• Rh immunoglobulin (RhIg) given at 28 weeks and within 72 hrs postpartum
• Also given after miscarriage, trauma, or invasive procedures
• 3. Monitoring During Pregnancy
• Antibody titers tracked if sensitized
• Ultrasound to assess fetal health and detect anemia
•
• 4. Managing Rh Incompatibility
• Intrauterine transfusion for fetal anemia
• Early delivery if condition worsens
• Neonatal care: monitor/treat anemia after birth
• 5. Postpartum Care
Case study
• Patient: Mrs. A.O., 28 yrs, G2P1, Blood Group O Rh-negative
• Partner: Rh-positive
• Antenatal Care:
• 12 weeks: Rh typing confirmed; ICT negative
• Education on Rh incompatibility and prophylaxis
• 28 weeks: Repeat ICT negative; anti-D Ig (300 µg) administered
• Delivery:
• 38+2 weeks: Vaginal birth of healthy A Rh-positive male
• Baby’s Direct Coombs Test negative (no hemolysis)
• Postpartum:
• Anti-D Ig given within 72 hours postpartum
• Baby had no jaundice or anemia
• Discharged on day 3 without complications
• Outcome:
• No maternal sensitization
Conclusion
• • ABO and Rh incompatibility are
preventable causes of serious complications.
• • Awareness, routine screening, and
prophylactic treatment (Rhogam) are key.
• • Safe transfusion practices and prenatal
care reduce risks significantly.