ABO & Rh

incompatibility

Adviser : Asc. Prof. Dr. Chavee Baosoung

Presentation By : Miss Pinanong
pimsuwan &
Incidence

ABO incompatibility 15%

Rh incompatibility
American 17.3%
Latin American 7.3 %
Asia 1.7 %
In American Hyperbilirubin due to ABO
incompatibility 54.1% per newborn 1,000
Incidence

According to the blood donation

center of the Thai Red Cross
Society Rh Negative 3 person per
1000
Chulalongkorn Hospital :
Hyperbilirubin due to ABO
incompatibility 5.13 % per
newborn 1,000
 Definition

ABO incompatibility
: A type of blood incompatibility in which recipients

Rh incompatibility
: The difference in Rh blood group
types between an Rh negative
mother and her Rh positive baby
 A type of blood

ABO system Rh system

https://study.com/academy/lesson/rh-blood-
group-rh-factor-erythoblasotis-fetalis.html
 ABO
system
Blood Group antigen antibody
A A Anti-B
B B Anti-A
AB AB -
O - Anti A,B
 ABO
system

In Thailand: group O 38% Caucasian: group A > B

group B 35%
group A 20%
group AB 7%

(Reid, & Lomas-Francis, 2004

 ABO
system
ABO Blood Transfusions of Possible
Parents MO
DadM
 ABO
system

Fetal gr. A 13.9 % occur ABO

incompatility with mother gr. O 81.81
% Fetal gr. B 17.7 % occur ABO
incompatility with mother gr. O 78.57
%

(Zama, Ati & Erhabor,20

 ABO
system
Mother gr. A occur ABO incompatility
3.8 %
Mother gr. B occur ABO incompatility
2.5 %
Mother gr. AB occur ABO incompatility
0%
(Zama, Ati & Erhabor,20
 Rh system

The Rh system consists of five antigens, D, C, C, E,

e, with antigen D, which is the most important and
promotes antibody production, followed by c> E>
C> e respectively.
 Rh system

Rh + : has antigen D in red blood

cells.
Rh - : does’t has antigen D in red blood cells
 Rh Transfusions of Possible
Parents
Case 1 Dad and Mom have Rh+ but have recessive gene
(Dd) So baby maybe Rh- 25%
 Rh Transfusions of Possible
Parents
Case 2 Dad or Mom has Rh+ and has recessive gene
(Dd), Rh- (dd) So baby maybe Rh- 50 %
 Rh Transfusions of Possible
Parents
Case 3 Dad and Mom has Rh- and has recessive gene
(dd), So baby maybe Rh- 100 %
 Pathophysiology

https://www.youtube.com/watch?v=ho3mJMdZCOo
Pathophysiology
Pathophysiology
Pathophysiology
 Fetomaternal hemorrhage as a reason
of Rh-
Risk of fetomaternal hemorrhage is
increased
 Abruption placenta
 Threatened abortion
 Toxemia And it occur during normal
 Ectopic pregnancy delivery
 Amniocentesis
 Intrauterine fetal
transfusion
Effect of newborn
 Effect of newborn

Hemolytic
disease of the
newborn
1.DFIU
2. Hydrops fetalis
3.hyperbilirubinemi
a
 Management

The aim of antenatal

management
 To predict which pregnancy is at risk
 To predict whether or not the fetus is severely
affected
 To correct anemia and reverse hydrops by
intrauterine transfusion
 To delivery the baby at the appropriate time
 Managemen
t
pregnancy at risk
 First ANC check blood group, antibody screening
 If indirect coombs test is positive, the father’s Rh
should be tested
 Serial maternal anti- D titers should be done every 2-4
wk
 If titer is less than 1/16 the fetus is not at risk
 If titer is more than 1/16 then severity of condition
 Management

Prediction of the severity of feta hemolysis : Laboratory examination

Management

rosette test

Antibody screening and antibody identifica

Antibody titer ultrasonography

middle cerebral artery Doppler

Management

Fetal genotyping

direct antiglobulin test

Elution test
Management
Management
 Prevention

 Screening of all pregnancy mothers to Rh D

antigen and antibody screening for Rh D
negative mothers
 Prophylactic anti D immunoglobulin to all Rh-
mothers after delivery if the fetus is Rh+ (at 28,
36 wk of pregnancy) and after abortion,
amniocentesis, abruption
Prevention

The standard dose of anti

D is 0.3 mg will eradicate
15 ml of fetal red blood
cells (routine for all Rh-
pregnancies) within 3 days
of delivery
 Prevention

http://www.bbguy.org/education/videos/rhigdosage/