RH

INCOMPATABILITY
• LANDSTEINER & WEINER in the year 1940,
discovered specific antigen in the human red
cells , as it was also present in the rhesus
monkey, the antigen was named as “Rh”

• Their experiments involved in rabbits

which,when injected with the Rhesus monkey's
red blood cells, produced an antigen that is
present in the red blood cells of many humans.
• First demonstrated in rhesus monkey

• Blood groups are classified as Rh positive

and Rh negative.
Cont.,.,
Rh +ve(Presence
of antigen D in
the blood)
Rh –ve(Absence
of antigen Din
the blood)
• The Rh factor , Rh+ and Rh- usually refers
specifically to the presence or absence of
antigen-D

•There are two alleles, or genetic variants , of

this antigen: D and d.

•A person who is Rh- has two recessive traits,

dd. Anyone who has at least one D-DD or Dd-is
Rh+
 Rh incompatibility is a condition which develops when
there is a difference in Rh blood type b/w that of
pregnant mother (Rh –ve) and that of the fetus
(Rh+ve).
Incidence:
 In India : 5-10%.
 South India : 5%.
 North India : 10%.
Causes:
 Rh –ve woman bearing a Rh +ve fetus.
RISK OF FETOMARENAL BLEED IN FOLLOWING
CONDITIONS:
 Miscarriage.
 MTP.
 Genetic amniocentesis.
 Ectopic pregnancy.
 IUFD.
 Placenta previa with bleeding.
 Placental abruption.
Cont.,.,
 Hydatiform mole.
 Abdominal trauma.
 External cephalic version(ECV).
Pathophysiology
Rh –ve mother with Rh +ve fetus

During pregnancy or birth, Fetomaternal hemorrhage

(FMH) or abortion.

The positive antigen from the fetus triggers the antibody

in the mother.

Antibodies are produce against the antigen.

Cont.,.,
Rh-ve mother during her 2nd pregnancy with Rh+ve fetus

Antibodies in the mother mixes with the fetus antigen.

So, ANTIGEN-ANTIBODY REACTION occurs in RBC.

Increased destruction of RBC

Cont.,.

ANEMIA.
HYPERBILIRUBINEMIA.
HYDROPS FETALIS.
ERYTHROBLASTOSIS FOETALIS.
Cont.,.,
Signs & Symptoms:
• Rh incompatibility can cause symptoms ranging from
very mild to fatal.

• Mildest form- Rh incompatibility:

1-Hemolysis (Destruction of the red blood cells) with the
release of free hemoglobin into the infant's circulation.
2- Jaundice (Hemoglobin is converted into, bilirubin
which causes an infant to become yellow.
Cont.,..
Fetal Hemolysis Jaundice
 Severe form- Rh
incompatibility

1- Hydrops fetalis (Massive

fetal red blood cell
destruction).

2- It causes Severe
anemiaFetal heart
failure Death of the infant
shortly after delivery.
2- Total body swelling.
3- Respiratory distress (if the infant has been
delivered)

4- Circulatory collapse.

5- Kernicterus. (Neurological syndrome in extremely

jaundiced infants)

6- Lethargy.

7- Pale skin & mucous membranes.

LATER 
 At last it may lead to death of the child
immediately after its birth
DETECTION OF Rh INCOMPATIBILITY:
1-There are no any physical symptoms can be seen
in Rh incompatibility.

2-If the woman just found out she is pregnant, she

should undergo blood-type test. This test
determines her blood type and Rh factor.

3-Blood test that will determine whether she is Rh

positive or Rh negative.
Treatment:
 Antenatal:

-Intrauterine blood transfusion.

-Intraperitoneal transfusion - Blood transfused into
fetal abdomen.
-Intravascular transfusion - Blood transfused into
fetal umbilical vein.
This is more effective than
intraperitoneal transfusion.
•Postnatal:

-Phototherapy for neonatal jaundice in mild

disease

-Exchange transfusion if the neonate has

moderate or severe disease.
PREVENTION:
-By using special immune globulins,
called “Rhogam” at 28 weeks of
pregnancy (300 mu gm – IM).
-If the baby is born Rh positive,
another dose is administered within 72
hours after delivery or abortion.
-This will prevent her body from
creating any future antibodies that
could cause harm during a pregnancy.