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Results for “Rh Isoimmunization”

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At least 325 records · Page 18Linked to original sources
PubMed1995

Midtrimester Rh sensitization associated with circulating anticardiolipin antibodies and elevated maternal serum alpha-fetoprotein. A case report.

The incidence of antepartum Rh isoimmunization has been limited by third-trimester Rh immune globulin (RhIg) administration. Prophylactic failures are uncommon but can occur if sensitization takes place prior to the 28th week of gestation. We report a case of midtrimester Rh sensitization in an anticardiolipin antibody-positive primipara coincident with the discovery of an elevated maternal serum alpha-fetoprotein value, oligohydramnios and fetal growth retardation. This case suggests that fetal-maternal hemorrhage and subsequent sensitization may be facilitated by anticardiolipin antibody-induced placental damage. Prophylactic midtrimester RhIg administration might avoid sensitization in similar cases.

Adult↗
PubMed1989

A successful delivery of an extremely immature infant in Rh incompatibility after plasma exchange.

When Rh incompatible pregnancies occur, intrauterine fetal transfusion (IUT) and plasma exchange (PE) have made it possible to prolong the prenatal duration and to dramatically decrease the neonatal mortality. We administered a total of 10 PEs (from 20 weeks to 27 weeks of gestation) and one IUT (at 27 weeks and 1 day) for an Rh-isoimmunized gravida who already had a high maternal serum Rh antibody titer at the 14th gestational week, and delivered by Caesarian section (CS) an extremely immature infant of only 873 grams at 27 weeks and 4 days of gestation. The infant was hydropic with hyperbilirubinemia, therefore exchange transfusions were administered immediately after birth. The infant's weight reached the lowest point of 669 grams on the 13th day after birth, but began to increase thereafter. The baby weighted 3,052 grams on the 144th day and left the hospital without any complications.

Blood Transfusion, Intrauterine↗
PubMed1997

Intravenous immune globulin in the management of severe Rh D hemolytic disease.

Although intrauterine fetal transfusion has improved dramatically perinatal outcome in Rh D alloimmunization, in some cases the fetus is affected before transfusion is possible. Immune globulin (IVIG) administration is being increasingly used to successfully treat a variety of immune-mediated diseases, such as pregnancies affected by platelet alloimmunization. Although only a limited number of pregnancies have been reported, favorable outcomes with IVIG treatment of severe Rh disease have been described. We present a case report, review the published experience with IVIG treatment in severe, early-onset anti-D sensitization, and propose that IVIG may have an adjunctive role in the treatment of severe Rh isoimmunization.

Adult↗
PubMed1984

Rhesus isoimmunization in twin gestation.

The incidence of Rh isoimmunized twin gestation is extremely low. There are several perinatal risks inherent to twinning. Rhesus isoimmunization further increases hazards of such a compromised gestation. This paper reports three cases of rhesus isoimmunization in twin gestation, discusses the selective problems of such pregnancies, and reviews the pertinent literature.

Amniocentesis↗
PubMed1986

Detection and quantitation of fetomaternal hemorrhage.

Failure to administer additional doses of Rh immune globulin (RhIG) to patients with excessive fetomaternal hemorrhage (FMH) is one of the causes of continued Rh isoimmunization. We compared the fetal cell ratio (FCR) with the other laboratory methods currently used at our hospital to quantitate FMH, ie, fetal cell preparation (FCP), RhIG cross-match with maternal serum, and indirect Coombs' testing 24 to 48 hours after administration of RhIG. The incidence of excessive FMH as detected by the various methods was 3.6% (cross-match), 9.6% (Coombs'), 18% (FCP), and 66% (FCR). The methods currently used do not accurately quantify FMH. The FCR is the most sensitive test but it has a high false-positive rate and thus does not appear to be clinically useful. We suggest that repeating the indirect Coombs' test may provide a practical alternative for determining the need for additional doses of RhIG.

Adolescent↗
PubMed2005

Severe hemolytic disease of the newborn due to anti-Cw.

BACKGROUND: Pregnancies complicated by Rh isoimmunization have decreased significantly since the widespread use of Rh immune globulin. Uncommon red blood cell antigens have therefore become more clinically evident. We report a case of anti-Cw immunization that resulted in severe fetal anemia that required multiple transfusions. CASE: A 28-year-old multigravida presented to our service at 18 weeks of gestation with her fourth pregnancy. Her pregnancy was complicated by anti-Cw isoimmunization that resulted in severe fetal anemia requiring in utero fetal blood transfusions. CONCLUSION: While previous reports recommend only postpartum surveillance when Cw isoimmunization is present, we report a case resulting in severe fetal anemia.

Adult↗
PubMedDate not supplied

Care of the neonate with erythroblastosis fetalis.

Erythroblastosis fetalis, hemolytic disease of the newborn, occurs when an isoimmunized mother produces antibodies that cross the placenta and cause hemolysis of fetal red blood cells. This hemolysis can be accompanied by severe anemia, ascites, pleural and pericardial effusions, congestive heart failure, and neurological damage with resultant perinatal mortality. Rh isoimmunization in pregnancy still occurs in spite of the advent of Rh immune globulin. This article describes the complex management and nursing implications associated with caring for the neonate with erythroblastosis fetalis.

Anemia, Hemolytic↗
PubMed2003

Is Rh immune globulin needed in early first-trimester abortion? A review.

The prophylactic use of Rh immune globulin has been a medical success, protecting women who could be at risk from exposure to the Rh(D) antigen. Thus, it is not surprising that Rh(D) immunoprophylaxis has been extended from women with term pregnancies to all women with miscarriages, abortions, and ectopic pregnancies. In this article we review the existing medical literature to assess the risks of fetomaternal hemorrhage and Rh isoimmunization after complications of a first-trimester pregnancy, induced abortion, or ectopic pregnancy. The evidence to support the use of Rh immune globulin in the first trimester is sparse, but there is theoretic evidence of its necessity. Despite weak evidence to support its use, there is little risk.

Abortion, Induced↗
PubMed1995

Neonatal administration of high-dose intravenous immunoglobulin in rhesus hemolytic disease.

Our aim was to assess the effectiveness of neonatal treatment of Rh hemolytic disease with high-dose intravenous immunoglobulin (HDIVIG), in reducing neonatal hemolysis. A total of 40 neonates born to isoimmunized Rh negative women were studied. The population was randomized into 2 groups: Group 1 received IVIG 800 mg/kg/day for 3 days, plus phototherapy; and Group 2 received only phototherapy. No significant difference was observed between the groups in the severity of either the antenatal and neonatal disease, mode of delivery, mean birthweight, gestational age at delivery, proportion of preterm deliveries, 1 minute Apgar Score, days of phototherapy, and presence of neonatal cholestasis. Group 1 babies showed a significantly decreased duration of hospitalization, less hemolysis, and a less marked increase in bilirubin levels on the first day of life than Group 2 newborns. Therefore, Group 1 neonates received less treatment with transfusions (exchange-transfusions and/or simple blood treatment with transfusions) than those in Group 2. Our data suggest that the frequency of transfusional therapy can be reduced by combining conventional phototherapy with HDIVIG. Further studies are needed to determine the optimum timing and dosages of neonatal HDIVIG treatment.

Coombs Test↗
PubMed1975

Is Rh immunoglobulin indicated in patients having puerperal sterilization?

Prophylactic administration of Rh immunoglobulin to all Rh-negative women undergoing sterilization procedures has been advocated to prevent Rh isoimmunization, thus allowing transfusion of Rh-positive blood to those individuals in the future. However, results from a survey of 23 hospitals in the United States and 95 hospitals in the state of Iowa indicate that Rh-positive blood is rarely given to Rh-negative women in an emergency. Since 7 of 100 Rh-negative women are sensitized by their last pregnancy and the chance that any of those 7 women will ever receive Rh-positive blood is probably less than 2%, the advisability of routinely using Rh immunoglobulin in this situation is questioned.

Blood Group Incompatibility↗
PubMed1998

Safety profile of WinRho anti-D.

WinRho anti-D is manufactured with multiple processes to minimize the risk of transmitting blood-borne diseases such as viruses. These safety features include donor selection, plasma testing, solvent-detergent viral inactivation, and nanofiltration. To date, there has not been any case of viral transmission in association with use of WinRho anti-D. Adverse drug reactions are infrequent and generally mild; the most common are headache, fever, and chills. Some degree of hemolysis is inevitable due to the mechanism of action of WinRho anti-D, but this is predictable and transient. A few cases of intravascular hemolysis have been reported; hypersensitivity reactions are very rare. WinRho anti-D has been shown in both clinical trials and postmarketing surveillance to be safe and effective in the treatment of idiopathic thrombocytopenic purpura (ITP) and in the prevention of Rh isoimmunization.

Drug Hypersensitivity↗
PubMed1989

Foetal pulmonary maturation in pregnancies complicated by diabetes and Rh immunization.

In pregnancies complicated by diabetes, foetal lung maturation depends on a good control of maternal blood glucose values. In poorly controlled maternal diabetes, foetal hyperinsulinaemia may cause a delay in pulmonary maturation. There was no single case of respiratory distress syndrome (RDS) in 112 pregnant class B-F diabetic patients that we treated with high doses of insulin. Furthermore, in a controlled randomized trial of diet versus insulin treatment in class A diabetes we found no differences in perinatal mortality in patients with adequate metabolic control. In pregnancies complicated by Rh isoimmunization, determination of phosphatidylglycerol in amniotic fluid is a more reliable marker of foetal lung maturity than is the lecithin/sphingomyelin ratio. The marked decrease in perinatal mortality due to Rh incompatibility observed in recent years depends on several factors including administration of corticosteroids to the mother to prevent RDS, irrespective of whether amniotic fluid parameters indicate foetal lung maturity.

Blood Glucose↗
PubMed1995

Management of the Rh-sensitized mother.

The approval by the FDA of Rh immune globulin in 1968 led to a decrease in the incidence of Rh isoimmunization. As a result, fewer cases are seen by both the perinatologist and neonatologist. Prompt identification and early referral of the isoimmunized mother to a tertiary center will facilitate optimal management incorporating the latest techniques. In selected clinical situations, the less invasive technique of amniocentesis can be offered in place of fetal blood sampling for Rh D typing. In the anemic fetus requiring intrauterine transfusions, delivery is the goal once lung maturity is documented. As described elsewhere in the issue, recent improvements in neonatal care have facilitated management of complications not seen in the fetus but potentially critical in the neonate.

Anemia↗
PubMed2002

Hyporegenerative anemia associated with Rh hemolytic disease: treatment failure of recombinant erythropoietin.

A postnatal hyporegenerative anemia may complicate Rh hemolytic disease. Intramedullary hemolysis, bone marrow suppression, and erythropoietin deficiency have been implicated etiologically. Treatment with recombinant erythropoietin (r-EPO) has yielded encouraging preliminary results. The authors describe an infant with Rh isoimmunization who developed severe hyporegenerative anemia unresponsive to a 5-week course of r-EPO. Two additional doses at 12 weeks resulted in brisk reticulocytosis, coinciding with a 16-fold decline in the anti-Rh(D) antibody titer. Thus, treatment with r-EPO may be ineffective when anti-Rh(D) antibody titers are high. The authors also show that erythropoietin deficiency in hyporegenerative anemia is not as frequent and severe as originally thought.

Adult↗
PubMed1991

[Studies on manifestations of Rh-related hemolytic disease of the newborn in the years 1974-1989 in the Erfurt district].

In the course of 13 years (1977-1989) 223 of 223,121 liveborn infants in the district of Erfurt suffered from haemolytic disease due to Rh-isoimmunization, 0.1 per cent died. An initial drop of morbidity from 1.6 to 0.6 of 1000 newborns was followed by stagnation and further increase during the last years. More than 50% of the affected babies were delivered by women who had to be protected from sensibilization by immune prophylaxis. The cause for the immunization were deliveries (75%), miscarriages and interruptions (23%). The most important reason for the insufficient decrease of the Rh-morbidity is the failure of immune prophylaxis in the case of ABO-incongruence between mother and child. Our results support the demands for a general immune prophylaxis without taking into consideration the main blood groups and the number and result of the pregnancy. The quantity of severe erythroblastosis (7 stillborn and 5 hydropic liveborn) demonstrates the necessity to improve the prenatal management of these babies.

Abortion, Induced↗
PubMedDate not supplied

Coenzyme Q10 fetal plasma levels.

OBJECTIVE: This study aims at determining a cutoff value differentiating the fetal from the adult coenzyme Q10 (CoQ10) values and comparing substantial increases in CoQ10 plasma levels in fetuses with hypoxic hypoxia and nonimmune fetal hydrops. METHODS: We have selected 61 pregnancies and determined the CoQ10 levels in fetal and maternal samples obtained by cordocentesis. Our study included a control group and pregnancies with intrauterine growth retardation, Rh isoimmunization, nonimmune fetal hydrops, and fetal malformations. RESULTS: To differentiate the fetal from the adult values we have set 0.3 mg/ml as the cutoff value. The CoQ10 were higher only in fetuses with hypoxic hypoxia and nonimmune hydrops. CONCLUSION: Normal fetal CoQ10 plasma levels are lower than 0.3 mg/ml.

Coenzymes↗