Feature Article

Management of red cell antibodies in pregnancy

Feature Article

Management of red cell antibodies in pregnancy

COLIN A. WALSH

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Abstract

An early blood group and antibody screen for maternal red cell antibodies is a standard component of pregnancy management. In proven alloimmunisation, a thorough obstetric and medical history is important. Women with fetuses at high risk of developing fetal anaemia require referral to a maternal–fetal medicine specialist for close antenatal ultrasound surveillance.

Key Points

  • About 1% of pregnant women carry a red cell antibody that has the potential to destroy fetal red blood cells and cause fetal anaemia (alloimmunisation).
  • The three most clinically important antibodies in alloimmunisation are Rhesus D, Rhesus c and Kell antibodies.
  • Alloimmunised pregnant women whose antibody levels exceed a certain critical threshold are at high risk of their baby developing fetal anaemia and warrant prompt referral to a maternal–fetal medicine specialist.
  • Regular in utero ultrasound assessment of the fetal middle cerebral artery is a very sensitive method of detecting anaemia in the fetus of women with high-risk red cell antibodies.
  • A fetus that becomes anaemic before 34 weeks’ gestation may require a life-saving in utero fetal transfusion.
  • After birth, babies are at increased risk of anaemia and jaundice, which are the neonatal effects of haemolysis.

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