Knowledge (XXG)

Hemolytic disease of the newborn (anti-Rhc)

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245:"In only 2 situations are patients not monitored identically to patients who are Rh sensitized. The first is that of alloimmunization to the c, E, or, C antigens. Some concern exists that hemolysis may occur in these patients with a lower than 1:16 titer. Thus, if the initial titer is 1:4 and stable but increases at 26 weeks' gestation to 1:8, assessment with MCA Doppler velocity at that point is reasonable. However, if the patient presents in the first trimester with a 1:8 titer that remains stable at 1:8 throughout the second trimester, continued serial antibody titers are appropriate. The second situation in which patients should not be treated identically to patients who are Rh D sensitized is that of Kell isoimmunization because several cases of severe fetal hemolysis with anti-Kell antibodies have occurred in the setting of low titers." 181:"Acute hemolytic transfusion reactions may be either immune-mediated or nonimmune-mediated. Immune-mediated hemolytic transfusion reactions caused by immunoglobulin M (IgM) anti-A, anti-B, or anti-A,B typically result in severe, potentially fatal complement-mediated intravascular hemolysis. Immune-mediated hemolytic reactions caused by IgG, Rh, Kell, Duffy, or other non-ABO antibodies typically result in extravascular sequestration, shortened survival of transfused red cells, and relatively mild clinical reactions. Acute hemolytic transfusion reactions due to immune hemolysis may occur in patients who have no antibodies detectable by routine laboratory procedures." 242:
anemia and hydrops. Titers of 1:8 or higher is considered critical for Kell. Titers of 1:16 or higher are considered critical for all other antibodies. After critical titer is reached, care is based on MCA scans. If antibodies are low and have a sudden jump later in pregnancy, an MCA scan is warranted. If the titer undergoes a 4 fold increase, it should be considered significant regardless of if the critical value has been reached. Maternal titers are not useful in predicting fetal anemia after the first affected gestation and should not be used for the basis of care. Titers are tested monthly until 24 weeks, after which they are done every 2 weeks.
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Isoimmunization occurs when the maternal immune system is sensitized to red blood cell surface antigens. The most common causes of isoimmunization are blood transfusion, and fetal-maternal hemorrhage. The hemolytic process can result in anemia, hyperbilirubinemia, neonatal thrombocytopenia, and neonatal neutropenia. With the use of RhD Immunoprophylaxis, (commonly called Rhogam), the incidence of anti-D has decreased dramatically and other alloantibodies are now a major cause of HDN.
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routinely done in the UK at the International Blood Group Reference Laboratory in Bristol. Sanequin laboratory in Amsterdam, Netherlands also performs this test. For US patients, blood may be sent to either of the labs. In the US, Sensigene is done by Sequenome to determine fetal D status. Sequenome does not accept insurance in the US, but US and Canadian patients have had insurance cover the testing done overseas.
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intravenousγ-globulin (0.5-1 g/kg over 2 hours) is recommended if the TSB is rising despite intensive phototherapy or the TSB level is within 2 to 3 mg/dL (34-51 μmol/L) of the exchange level . If necessary, this dose can be repeated in 12 hours (evidence quality B: benefits exceed harms). Intravenous γ-globulin has been shown to reduce the need for exchange transfusions in Rh and ABO hemolytic disease."
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Blood is generally drawn from the father to help determine fetal antigen status. If he is homozygous for the antigen, there is a 100% chance of all offspring in the pairing to be positive for the antigen and at risk for HDN. If he is heterozygous, there is a 50% chance of offspring to be positive for
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IVIG - IVIG has been used to successfully treat many cases of HDN. It has been used not only on anti-D, but on anti-E as well. IVIG can be used to reduce the need for exchange transfusion and to shorten the length of phototherapy. The AAP recommends "In isoimmune hemolytic disease, administration of
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Mari, Giancarlo; Deter, Russell L.; Carpenter, Robert L.; Rahman, Feryal; Zimmerman, Roland; Moise, Kenneth J.; Dorman, Karen F.; Ludomirsky, Avi; Gonzalez, Rogelio; Gomez, Ricardo; Oz, Utku; Detti, Laura; Copel, Joshua A.; Bahado-Singh, Ray; Berry, Stanley; Martinez-Poyer, Juan; Blackwell, Sean C.
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IVIG - IVIG stands for Intravenous Immunoglobulin. It is used in cases of previous loss, high maternal titers, known aggressive antibodies, and in cases where religion prevents blood transfusion. Ivig can be more effective than IUT alone Fetal mortality was reduced by 36% in the IVIG and IUT group
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MCA scans: Middle cerebral artery - peak systolic velocity is changing the way sensitized pregnancies are managed. This test is done noninvasively with ultrasound. By measuring the peak velocity of blood flow in the middle cerebral artery, a MoM (multiple of the median) score can be calculated. MoM
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There are 3 possible ways to test the fetal antigen status. Free Cell DNA, Amniocentesis, and Chorionic Villus Sampling (CVS). Of the three, CVS is no longer used due to risk of worsening the maternal antibody response. Once antigen status has been determined, assessment may be done with MCA scans.
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Blood testing for the mother is called an Indirect Coombs Test (ICT) or an Indirect Agglutination Test (IAT). This test tells whether there are antibodies in the maternal plasma. If positive, the antibody is identified and given a titer. Critical titers are associated with significant risk of fetal
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Cell-free DNA can be run on certain antigens. Blood is taken from the mother, and using PCR, can detect the K, C, c, D, and E alleles of fetal DNA. This blood test is non-invasive to the fetus and is an easy way of checking antigen status and risk of HDN. Testing has proven very accurate and is
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Newborn Screening Tests - Transfusion with donor blood during pregnancy or shortly after birth can affect the results of the Newborn Screening Tests. It is recommended to wait and retest 10–12 months after last transfusion. In some cases, DNA testing from saliva can be used to rule out certain
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Hemolytic disease of the fetus and newborn (HDN) is a condition where the passage of maternal antibodies results in the hemolysis of fetal/neonatal red cells. The antibodies can be naturally occurring such as anti-A, and anti-B, or immune antibodies developed following a sensitizing event.
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Reticulocyte count - Reticulocytes are elevated when the infant is producing more blood to combat anemia. A rise in the retic count can mean that an infant may not need additional transfusions. Low retic is observed in infants treated with IUT and in those with HDN from
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Ruma, Michael S.; Moise, Kenneth J.; Kim, Eunhee; Murtha, Amy P.; Prutsman, Wendy J.; Hassan, Sonia S.; Lubarsky, Suzanne L. (2007). "Combined plasmapheresis and intravenous immune globulin for the treatment of severe maternal red cell alloimmunization".
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Exchange transfusion - Exchange transfusion is used when bilirubin reaches either the high or medium risk lines on the nonogram provided by the American Academy of Pediatrics (Figure 4). Cord bilirubin >4 is also indicative of the need for exchange
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Voto, L. S.; Mathet, E. R.; Zapaterio, J. L.; Orti, J; Lede, R. L.; Margulies, M (1997). "High-dose gammaglobulin (IVIG) followed by intrauterine transfusions (IUTs): A new alternative for the treatment of severe fetal hemolytic disease".
344:(IUT) is done either by intraperitoneal transfusion (IPT) or intravenous transfusion (IVT). IVT is preferred over IPT. IUTs are only done until 35 weeks. After that, the risk of an IUT is greater than the risk from post birth transfusion. 257:
the antigen. This test can help with knowledge for the current baby, as well as aid in the decision about future pregnancies. With RhD, the test is called the RhD genotype. With RhCE, and Kell antigen it is called an antigen phenotype.
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In some cases, the direct coombs will be negative but severe, even fatal HDN can occur. An indirect coombs needs to be run in cases of anti-C, anti-c, and anti-M. Anti-M also recommends antigen testing to rule out the presence of HDN.
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Scheffer, PG; Van Der Schoot, CE; Page-Christiaens, Gcml; De Haas, M (2011). "Noninvasive fetal blood group genotyping of rhesus D, c, E and of K in alloimmunised pregnant women: Evaluation of a 7-year clinical experience".
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Palfi, Miodrag; Hildén, Jan-Olof; Matthiesen, Leif; Selbing, Anders; Berlin, Gösta (2006). "A case of severe Rh (D) alloimmunization treated by intensive plasma exchange and high-dose intravenous immunoglobulin".
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CVS is possible as well to test fetal antigen status but is not recommended. CVS carries a higher risk of fetal maternal hemorrhage and can raise antibody titers, potentially worsening the antibody effect.
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Plasmapheresis - Plasmapheresis aims to decrease the maternal titer by direct plasma replacement. Plasmapheresis and IVIG together can even be used on women with previously hydropic fetuses and losses.
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Heddle, N. M.; Wentworth, P.; Anderson, D. R.; Emmerson, D.; Kelton, J. G.; Blajchman, M. A. (1995). "Three examples of Rh haemolytic disease of the newborn with a negative direct antiglobulin test".
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positive blood for similar reasons). This would require a lot of extra work in blood transfusion departments and it is considered not economical to do the blood group screening at the present time.
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Once a woman has antibodies, she is at high risk for a transfusion reaction. For this reason, she must carry a medical alert card at all times and inform all doctors of her antibody status.
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Novak, Deborah J.; Tyler, Lisa N.; Reddy, Ramakrishna L.; Barsoom, Michael J. (2008). "Plasmapheresis and intravenous immune globulin for the treatment of D alloimmunization in pregnancy".
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Rath, M. E. A.; Smits-Wintjens, V. E. H. J.; Oepkes, D.; Walther, F. J.; Lopriore, E. (2013). "Iron status in infants with alloimmune haemolytic disease in the first three months of life".
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Finning, Kirstin; Martin, Peter; Summers, Joanna; Daniels, Geoff (2007). "Fetal genotyping for the K (Kell) and Rh C, c, and E blood groups on cell-free fetal DNA in maternal plasma".
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Rimon, E.; Peltz, R.; Gamzu, R.; Yagel, S.; Feldman, B.; Chayen, B.; Achiron, R.; Lipitz, S. (2006). "Management of Kell isoimmunization — evaluation of a Doppler-guided approach".
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Antenatal & neonatal screening (second edition). Chapter 12: Rhesus and other haemolytic diseases, by E.A. Letsky, I. Leck, J.M. Bowman. 2000. Oxford University Press.
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Early Delivery - Delivery can occur anytime after the age of viability. Emergency delivery due to failed IUT is possible, along with induction of labor at 35–38 weeks.
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Amniocentesis is another recommended method for testing antigen status and risk for HDN. Fetal antigen status can be tested as early as 15 weeks by PCR of fetal cells.
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It is theoretically likely that IgG anti-Rhc antibody injections would prevent sensitization to RBC surface Rhc antigens in a similar way that IgG anti-D antibodies (
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Onesimo, Roberta; Rizzo, Daniela; Ruggiero, Antonio; Valentini, Piero (2010). "Intravenous Immunoglobulin therapy for anti-E hemolytic disease in the newborn".
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Cacciatore, A; Rapiti, S; Carrara, S; Cavaliere, A; Ermito, S; Dinatale, A; Imbruglia, L; Recupero, S; La Galia, T; Pappalardo, E. M.; Accardi, M. C. (2009).
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Coombs - after birth baby will have a direct coombs test run to confirm antibodies attached to the infant's red blood cells. This test is run from cord blood.
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Testing for HDN involves blood work from both mother and father, and may also include assessment with amniocentesis and Middle Cerebral Artery scans.
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In the case of a positive ICT, the woman must carry a medical alert card or bracelet for life because of the risk of a transfusion reaction.
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Mollison PL, Engelfriet CP and Contreras M. Blood Transfusion in Clinical Medicine. 1997. 10th edition. Blackwell Science, Oxford, UK.
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Ferritin - because most infants affected by HDN have iron overload, a ferritin must be run before giving the infant any additional iron.
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Phototherapy - Phototherapy is used for cord bilirubin of 3 or higher. Some doctors use it at lower levels while awaiting lab results.
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Shapiro, Steven M (2004). "Definition of the Clinical Spectrum of Kernicterus and Bilirubin-Induced Neurologic Dysfunction (BIND)".
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Anti-C and anti-c can both show a negative DAT but still have a severely affected infant. An indirect coombs must also be run.
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Phenobarbital - Phenobarbital is sometimes given to the mother to help mature the fetal liver and reduce hyperbilirubinemia.
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Mari, G. (2005). "Middle cerebral artery peak systolic velocity for the diagnosis of fetal anemia: The untold story".
2337: 216:, which is usually caused when a RhD negative mother is sensitised by her first pregnancy with a RhD positive fetus. 2461: 2451: 2342: 1732: 646:
Koenig, J. M.; Christensen, R. D. (1989). "Neutropenia and thrombocytopenia in infants with Rh hemolytic disease".
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Al-Alaiyan, S.; Al Omran, A. (1999). "Late hyporegenerative anemia in neonates with rhesus hemolytic disease".
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Thrombocytes - as thrombocytopenia is one of the complications of HDN, the thrombocyte count should be checked.
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Steroids - Steroids are sometimes given to the mother before IUTs and early delivery to mature the fetal lungs.
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In the case of anti-c, the woman should be checked around 28 weeks to see if she has developed anti-E as well.
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Lande, Lottie (1948). "Clinical signs and development of survivors of kernicterus due to Rh sensitization".
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than in the IUT alone group. IVIG and plasmapheresis together can reduce or eliminate the need for an IUT.
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Neutrophils - as Neutropenia is one of the complications of HDN, the neutrophil count should be checked.
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is the second most common cause of severe HDN. It occurs more commonly in women who are Rh D negative.
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https://www.aacc.org/publications/cln/articles/2015/march/molecular-typing-for-red-blood-cell-antigens
159: 2506: 2496: 2298: 2254: 1438:"Maternal anti-M induced hemolytic disease of newborn followed by prolonged anemia in newborn twins" 2691: 2674: 2524: 2380: 2290: 1992: 2609: 2565: 2542: 2432: 2209: 1795: 1663: 1590: 1415: 1372: 1328: 1240: 1170: 957: 845: 753: 549: 131: 1688: 1627:
https://www.mombaby.org/wp-content/uploads/2016/03/UNC-Isoimmunization-Detection-Prevention.pdf
2442: 2360: 2330: 2271: 2249: 2066: 1937: 1915: 1844: 1787: 1752: 1706: 1655: 1582: 1541: 1505: 1469: 1407: 1364: 1320: 1285: 1232: 1188: 1162: 1126: 1075: 949: 894: 837: 802: 745: 707: 663: 619: 584: 541: 506: 291: 102:) can range from a mild to a severe disease. It is the third most common cause of severe HDN. 82: 2684: 2511: 2171: 2112: 2076: 1905: 1895: 1834: 1826: 1779: 1744: 1647: 1572: 1533: 1497: 1459: 1449: 1399: 1356: 1312: 1275: 1224: 1154: 1116: 1106: 1065: 941: 884: 876: 829: 792: 784: 737: 697: 655: 611: 576: 533: 496: 488: 434: 194: 154: 309:, but the methods for IgG anti-Rhc antibodies have not been developed at the present time. 290:
It has been suggested that women of child-bearing age or young girls should not be given a
2641: 2427: 2319: 2239: 1028: 193:(RBC) Rhc antigens by her first pregnancy with a Rhc positive fetus. The mother can make 1862: 1006: 912: 2266: 2124: 1910: 1883: 1839: 1814: 1464: 1437: 1121: 1094: 1070: 1053: 982: 945: 889: 864: 797: 772: 501: 476: 190: 139: 1997: 1815:"Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn" 1733:"Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation" 659: 615: 2711: 2205: 2045: 1419: 1228: 1158: 317:
There are several intervention options available in early, mid and late pregnancies.
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Arora, Satyam; Doda, Veena; Maria, Arti; Kotwal, Urvershi; Goyal, Saurabh (2015).
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American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. (2004).
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of 1.5 or greater indicates severe anemia and should be treated with IUT.
2375: 833: 202: 1965: 169:- Must NOT be treated with iron. Can persist up to 12 weeks after birth. 2098: 1830: 219:
Sensitization to Rhc antigens can also be caused by blood transfusion.
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Transfusion Medicine and Hemostasis: Clinical and Laboratory Aspects
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Blair, Eve; Watson, Linda (2006). "Epidemiology of cerebral palsy".
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Hgb - the infant's hemoglobin should be tested from cord blood.
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and enter the fetal circulation. If the fetus is Rhc positive
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Haemorrhagic and haematological disorders of fetus and newborn
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BJOG: An International Journal of Obstetrics & Gynaecology
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Archives of Disease in Childhood: Fetal and Neonatal Edition
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Archives of Disease in Childhood: Fetal and Neonatal Edition
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Lalezari, P; Nussbaum, M; Gelman, S; Spaet, T. H. (1960).
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Basu, Sabita; Kaur, Ravneet; Kaur, Gagandeep (2011).
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The Journal of Maternal-Fetal & Neonatal Medicine
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In particular, it has problems with not using MEDMOS.
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This is similar as for 1608: 1606: 1604: 1877: 1875: 1726: 1724: 1722: 1431: 1429: 1256: 1254: 1047: 1045: 1043: 1041: 189:A Rhc negative mother can become sensitised by 927: 925: 723: 721: 679: 677: 470: 468: 466: 464: 462: 460: 2723:Disorders originating in the perinatal period 2025: 1526:American Journal of Obstetrics and Gynecology 641: 639: 637: 635: 633: 8: 108:hemolytic disease of the newborn (anti-Kell) 390:Bilirubin should be tested from cord blood. 2286: 2060: 2032: 2018: 2010: 1956: 1007:Erythrocyte Alloimmunization and Pregnancy 136:Bilirubin Induced Neurological Dysfunction 73: 1909: 1899: 1838: 1576: 1463: 1453: 1279: 1120: 1110: 1069: 888: 796: 701: 500: 59:Learn how and when to remove this message 1640:Ultrasound in Obstetrics and Gynecology 1305:Ultrasound in Obstetrics and Gynecology 569:Seminars in Fetal and Neonatal Medicine 456: 1711:: CS1 maint: archived copy as title ( 1704: 1029:Hemolytic Disease of Newborn~treatment 475:Murray, N. A; Roberts, I. A G (2007). 1863:Hemolytic Disease of Newborn~followup 201:, which are able to pass through the 7: 2304:Infant respiratory distress syndrome 1888:Asian Journal of Transfusion Science 1442:Asian Journal of Transfusion Science 1099:Transfusion Medicine and Hemotherapy 869:Transfusion Medicine and Hemotherapy 77:HDN due to anti-Rhc alloimmunization 1813:Gottstein, R; Cooke, R. W. (2003). 983:Hemolytic Disease of Newborn~workup 477:"Haemolytic disease of the newborn" 2309:Transient tachypnea of the newborn 946:10.1111/j.1365-3148.1995.tb00197.x 14: 2087:Twin-to-twin transfusion syndrome 1490:Transfusion and Apheresis Science 1095:"Hemolytic Transfusion Reactions" 865:"Hemolytic Transfusion Reactions" 2605:Vertically transmitted infection 1229:10.1111/j.1537-2995.2007.01437.x 1159:10.1111/j.1471-0528.2011.03028.x 440:Hemolytic disease of the newborn 294:with Rhc positive blood (or Kell 124:High at birth or rapidly rising 96:Hemolytic disease of the newborn 20: 2697:Fetal Alcohol Spectrum Disorder 2647:Group B streptococcal infection 2215:Intrauterine growth restriction 1268:New England Journal of Medicine 162:- MUST NOT be treated with iron 2040:Conditions originating in the 777:Paediatrics & Child Health 771:Mitchell, S; James, A (1999). 31:comply with Knowledge (XXG)'s 29:This article needs editing to 1: 2389:Vitamin K deficiency bleeding 1502:10.1016/j.transci.2006.07.002 1392:Journal of Clinical Apheresis 1349:Journal of Perinatal Medicine 822:Journal of Perinatal Medicine 660:10.1016/s0022-3476(89)80709-7 616:10.1016/S0022-3476(48)80225-8 2548:Periventricular leukomalacia 2366:Persistent fetal circulation 2314:Meconium aspiration syndrome 1058:Journal of Prenatal Medicine 2457:Intraventricular hemorrhage 1281:10.1056/NEJM200001063420102 703:10.1182/blood.V15.2.236.236 2749: 2462:Germinal matrix hemorrhage 2452:Velamentous cord insertion 2343:Bronchopulmonary dysplasia 1561:"Intrauterine Transfusion" 1538:10.1016/j.ajog.2006.10.890 581:10.1016/j.siny.2005.10.010 2733:Acquired hemolytic anemia 2492:Necrotizing enterocolitis 2201:Large for gestational age 2197:Small for gestational age 1784:10.3109/14767050903544751 1578:10.1007/s40556-016-0072-4 1565:Journal of Fetal Medicine 1361:10.1515/jpme.1997.25.1.85 648:The Journal of Pediatrics 604:The Journal of Pediatrics 1455:10.4103/0973-6247.150968 342:Intrauterine transfusion 2654:Neonatal conjunctivitis 2145:Single umbilical artery 2135:Umbilical cord prolapse 2082:Placental insufficiency 2055:complicating pregnancy, 1901:10.4103/0973-6247.75963 1093:Strobel, Erwin (2008). 863:Strobel, Erwin (2008). 526:Journal of Perinatology 493:10.1136/adc.2005.076794 106:is the most common and 2630:ureaplasma urealyticum 2338:Wilson–Mikity syndrome 2262:Brachial plexus injury 1749:10.1542/peds.114.1.297 305:) are used to prevent 303:Rho(D) immune globulin 2578:Congenital hypertonia 2469:Anemia of prematurity 2177:Shoulder presentation 1559:Deka, Dipika (2016). 913:Transfusion Reactions 538:10.1038/sj.jp.7211157 445:Rh blood group system 335:Mid to late pregnancy 174:Transfusion reactions 2728:Transfusion medicine 2583:Congenital hypotonia 2497:Meconium peritonitis 2299:Intrauterine hypoxia 2255:Subgaleal hemorrhage 934:Transfusion Medicine 834:10.1515/JPM.1999.014 2692:Neonatal withdrawal 2675:Perinatal mortality 2525:Sclerema neonatorum 2381:hematologic disease 789:10.1093/pch/4.3.201 41:improve the content 2625:mycoplasma hominis 2610:Neonatal infection 2566:Gray baby syndrome 2543:Perinatal asphyxia 2433:Hyperbilirubinemia 2210:Postterm pregnancy 2057:labour or delivery 1831:10.1136/fn.88.1.F6 654:(4 Pt 1): 625–31. 132:hyperbilirubinemia 2705: 2704: 2593: 2592: 2443:Neonatal jaundice 2361:Pneumopericardium 2331:Pneumomediastinum 2272:Klumpke paralysis 2250:Caput succedaneum 2185: 2184: 2053:Maternal factors 2007: 2006: 1404:10.1002/jca.20180 1193:978-0-12-397788-5 1112:10.1159/000154811 881:10.1159/000154811 742:10.1111/vox.12061 93: 92: 71:Medical condition 69: 68: 61: 2740: 2685:Infant mortality 2520:Erythema toxicum 2512:thermoregulation 2479:Gastrointestinal 2287: 2283:Affected systems 2160: 2128: 2113:Chorioamnionitis 2106: 2077:Placenta praevia 2070: 2061: 2034: 2027: 2020: 2011: 1957: 1924: 1923: 1913: 1903: 1879: 1870: 1859: 1853: 1852: 1842: 1810: 1804: 1803: 1767: 1761: 1760: 1728: 1717: 1716: 1710: 1702: 1700: 1699: 1693: 1687:. 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252:Father 237:Mother 185:Causes 167:anemia 2663:Other 2487:Ileus 2234:scalp 1998:773.2 1983:P55.8 1796:S2CID 1692:(PDF) 1685:(PDF) 1664:S2CID 1591:S2CID 1416:S2CID 1373:S2CID 1329:S2CID 1241:S2CID 1171:S2CID 958:S2CID 846:S2CID 754:S2CID 690:Blood 550:S2CID 261:Fetus 2421:Rh E 2416:Rh D 2411:Rh c 1993:9-CM 1938:ISBN 1916:PMID 1845:PMID 1788:PMID 1753:PMID 1713:link 1656:PMID 1583:PMID 1542:PMID 1506:PMID 1470:PMID 1408:PMID 1365:PMID 1321:PMID 1286:PMID 1233:PMID 1189:ISBN 1163:PMID 1127:PMID 1076:PMID 950:PMID 895:PMID 838:PMID 803:PMID 746:PMID 708:PMID 664:PMID 620:PMID 585:PMID 542:PMID 507:PMID 2509:and 2401:ABO 2396:HDN 2378:and 1989:ICD 1974:ICD 1906:PMC 1896:doi 1866:at 1835:PMC 1827:doi 1780:doi 1745:doi 1741:114 1648:doi 1573:doi 1534:doi 1530:196 1498:doi 1460:PMC 1450:doi 1400:doi 1357:doi 1313:doi 1276:doi 1272:342 1225:doi 1155:doi 1151:118 1117:PMC 1107:doi 1066:PMC 1032:at 1010:at 986:at 942:doi 916:at 885:PMC 877:doi 830:doi 793:PMC 785:doi 738:doi 734:105 698:doi 656:doi 652:114 612:doi 577:doi 534:doi 497:PMC 489:doi 195:IgG 2714:: 2208:/ 2199:/ 1996:: 1981:: 1978:10 1914:. 1904:. 1890:. 1886:. 1874:^ 1843:. 1833:. 1823:88 1821:. 1817:. 1794:. 1786:. 1776:23 1774:. 1751:. 1739:. 1735:. 1721:^ 1709:}} 1705:{{ 1662:. 1654:. 1644:28 1642:. 1603:^ 1589:. 1581:. 1569:27 1567:. 1563:. 1540:. 1528:. 1504:. 1494:35 1492:. 1468:. 1458:. 1444:. 1440:. 1428:^ 1414:. 1406:. 1396:23 1394:. 1371:. 1363:. 1353:25 1351:. 1327:. 1319:. 1309:25 1307:. 1284:. 1270:. 1266:. 1253:^ 1239:. 1231:. 1221:47 1219:. 1169:. 1161:. 1149:. 1125:. 1115:. 1103:35 1101:. 1097:. 1074:. 1060:. 1056:. 1040:^ 1018:^ 994:^ 970:^ 956:. 948:. 936:. 924:^ 893:. 883:. 873:35 871:. 867:. 844:. 836:. 826:27 824:. 801:. 791:. 779:. 775:. 752:. 744:. 732:. 720:^ 706:. 694:15 692:. 688:. 676:^ 662:. 650:. 632:^ 618:. 608:32 606:. 583:. 573:11 571:. 548:. 540:. 530:25 528:. 505:. 495:. 485:92 483:. 479:. 459:^ 2101:/ 2033:e 2026:t 2019:v 1991:- 1976:- 1966:D 1944:. 1922:. 1898:: 1892:5 1851:. 1829:: 1802:. 1782:: 1759:. 1747:: 1715:) 1701:. 1670:. 1650:: 1616:. 1597:. 1575:: 1548:. 1536:: 1512:. 1500:: 1476:. 1452:: 1446:9 1422:. 1402:: 1379:. 1359:: 1335:. 1315:: 1292:. 1278:: 1247:. 1227:: 1177:. 1157:: 1133:. 1109:: 1082:. 1062:3 964:. 944:: 938:5 901:. 879:: 852:. 832:: 809:. 787:: 781:4 760:. 740:: 714:. 700:: 670:. 658:: 626:. 614:: 591:. 579:: 556:. 536:: 513:. 491:: 296:1 98:( 62:) 56:( 51:) 47:( 43:. 35:.

Index

Manual of Style
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Specialty
Hematology
Rh disease
hemolytic disease of the newborn (anti-Kell)
bilirubin
hyperbilirubinemia
Cerebral Palsy
Kernicterus
Neutropenia
Thrombocytopenia
Hemolytic Anemia
anemia
red blood cell
IgG
antibodies
placenta
alloimmune
hemolysis
Rh disease
transfusion
Rho(D) immune globulin
Rh disease
Intrauterine transfusion
Hemolytic anemia
Hemolytic disease of the newborn
Rh blood group system

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