RH Incompatibility

Tuesday, 15 February 2022 8:44 am

Rh or Rhesus Factor
• A type of protein that is found outside or on the surface of the red blood cells.
• Usually, the protein is genetically inherited from our parents.
• If you have this protein, then your blood type is RH positive.
• If you have not inherited this, you are negative.
• All cells in our body, including the RBCs have protein markers on their walls which are
known as antigens.

Antigens
• Serves the purpose of differentiating our cells and foreign cells or objects such as
microbes.
• Once our body recognizes cells that are foreign to us, it will try to fight them of using
the antibodies.

Antibodies
• Also a protein
• They will attach to antigens on foreign substances and cause their destruction.
 In the case of RBCs, the breakage or destruction of cells is known as hemolysis

Rh Systems
• Relies on numerous antigens
 Antigen D, C, E
• The presence of Antigen D determines if the individual is RH + or -
• Antigen D is the strongest of all antigens; even as a small amount of blood (like 0.1
mL), it can make mothers against it.

RH Incompatibility is not common in the Philippines

• RH+ is predominant all over the world.
• The percentage of people who have Rh-negative blood is small and varies by ethnicity:
 White people in North America and Europe: About 15%
 African Americans: About 4 to 8%
 People of Chinese descent: About 0.3% (and Asia)
 People of Indian descent: About 5%
 They mostly have Rh Negative blood type.
• Estimated worldwide increase of Rh disease is 276 cases per 100,000 births.
 The prevalence of this disease in countries with advanced health care is only 2.5
cases per 1,000 births.

RH Incompatibility
• When a pregnant woman and her unborn baby carries different Rhesus factor.
• Mother is negative while baby is positive.
• The fetus of a woman with Rh-negative blood may have Rh-positive blood if the father
has Rh-positive blood.

Sensitize
• She will develop antibodies against the antigens.
• Happens 72 hours (3 days) after birth.
Remember:
• Rapid hemolysis will lead to high bilirubin levels and anemia

Coombs Test
• Most common method to check for RH incompatibility
• Extract blood sample to check if the antibodies attach to the RBC surface
• A method to check if there's decrease in the bilirubin level of the newborn and if there's
hemolysis in the newborn.
 If there's increases bilirubin, hemolysis, and antibodies are attached to the RBCs,
then it could be interpreted that there is a risk of incompatibility.

Rho Immune Globulin (RHIG or RhoGAM)

• Passive Rh Antibody
• To prevent the recurrence of RH incompatibility and to stop the process of sensitization
of antibody formation, the doctor orders RhoGAM
• Injected to the mother
• To prevent antibody formation
• If woman has been detected early on that there's a risk for Rh Incompatibility, it is
given during 28 Weeks of Gestation (1st shot)
 2nd Shot = Within delivery or 72 hours after birth
• Also to prevent recurrence of Rh incompatibility in the next pregnancy.