RH SYSTEM FOR BLOOD

TYPING

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 RH BLOOD GROUPS

• THEY ARE IMPORTANT IN BLOOD TRANSFUSION

• UNLIKE THE ABO SYSTEM, AGGLUTININS DO NOT DEVELOP SPONTANEOUSLY
• A PERSON SHOULD BE EXPOSED TO THE RH ANTIGEN FIRST, THEN THE ANTIBODIES
DEVELOP
• THERE ARE 6 RH ANTIGENS (RH FACTORS): C, D, E AND C, D, E AND EACH PERSON
HAS ONE OF EACH OF THE 3 PAIRS
• TYPE D ANTIGEN IS PREVALENT IN THE POPULATION
-IT IS ASSOCIATED WITH RH POSITIVE
- ABSENCE OF D ANTIGEN INDICATES RH NEGATIVE

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 THE RHESUS "D" SYSTEM

GENOTYPE PHENOTYPE

DA DA

RHESUS POSITIVE
DA D

D D RHESUS NEGATIVE

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 RH IMMUNE RESPONSE
• 1ST TIME EXPOSURE: RH+ BLOOD RBCS RH- BLOOD ANTI-RH
AGLUTININS DEVELOP  THRESHOLD AT APPROXIMATELY 2-4
MONTHS  AGGLUTINATION

• 2ND TIME EXPOSURE: IF THE INDIVIDUAL HAS BEEN EXPOSED TO THE

RH+ BLOOD, TRANSFUSION REACTION IS IMMEDIATE AND SEVERE

• ERYTHROBLASTOSIS FETALIS (HEMOLYTIC DISEASE OF THE

NEWBORN): BLOOD DISORDER IN A FETUS OF NEWBORN INFANT, IT IS
CHARACTERIZED BY AGGLUTINATION AND PHAGOCYTOSIS OF RBCS
- IN MOST CASES, THE MOTHER IS RH- AND THE FATHER IS RH+
-THE BABY INHERITS THE FATHER’S RH+ ANTIGEN
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- THE MOTHER DEVELOPS ANTI-RH AGGLUTININS  DIFFUSE
THROUGH THE PLACENTA  AGGLUTINATION
 The “Rh factor” is another major antigen on the RBC,
called D – is autosomal recessive
 DD and Dd: Rh+
 dd: Rh-
 If mom is Rh- and baby is Rh+, then small amount of
blood leaks into mom’s blood through placenta, and she
makes antibodies to D antigen; first Rh- pregnancy
usually ok, but not later Rh- ones (can be lethal to baby)
 If mom is Rh- then give “Rhogam” during pregnancy [(is
anti- Rh(D): Rh(D) Ig (immunoglobin)], an antibody
which will destroy any of the baby’s RBCs which leak
into mom’s blood during the pregnancy so she will not
mount an immune response to the D antigen
 If father is Rh+:
 If DD then all pregnancies will be Rh+
 If Dd then half of the pregnancies with this mom will be Rh- (no
Rh incompatibility problems)
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• AN RH- MOTHER DOES NOT DEVELOP SUFFICIENT ANTI-RH
ANTIBODIES TO HARM THE FIRST RH+ CHILD

• HOWEVER, THE 2ND CHILD MAY HAVE ERYTHROBLASTOSIS

FETALIS

- MOTHER’S ANTI-RH ANTIBODIES  FETUS  BLOOD 

AGGLUTINATION OF RBCS  HEMOLYSIS  HB 
BILIRUBIN  JAUNDICE

- INFANT’S LIVER AND SPLEEN ARE ENLARGED AND THEY

PRODUCE RBCS, THEY RELEASE NUCLEATED BLASTIC CELLS TO
THE BLOOD SYSTEM = ERYTHROBLASTOSIS FETALIS

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 HEAMOLYTIC DISEASE OF THE NEW BORN
• ERYTHROBLASTOSIS FETALIS IS A MEDICAL CONDITION THAT NEEDS
IMMEDIATE MEDICAL ATTENTION. IT IS ALSO KNOWN AS HAEMOLYTIC
ANEMIA.
• IT IS A RESULT OF BLOOD TYPE INCOMPATIBILITY OF THE MOTHER AND THE
BABY INSIDE HER WOMB, SPECIFICALLY THE FETAL BLOOD GROUP E RH0 (D)
ANTIGENS.
• THE RH FACTOR IS A TYPE OF INHERITED PROTEIN SITUATED ON THE SURFACE
OF THE RED BLOOD CELLS (RBCS). IF YOU HAVE THIS TYPE OF PROTEIN, IT IS
AN INDICATOR THAT YOU ARE RH POSITIVE. THOSE WHO DON’T HAVE ARE RH
NEGATIVE.
• RH INCOMPATIBILITY MAY ARISE IF THE WOMAN IS RH NEGATIVE AND A MAN
WHO IS RH NEGATIVE CONCEIVE A CHILD. THERE IS A HIGH POSSIBILITY THAT
THE FETUS IS RH POSITIVE. IN CASE OF RH INCOMPATIBILITY, THE FIRST
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PREGNANCY WILL NOT BE AFFECTED, BUT THE PROBLEM CAN ARISE IN THE
SUCCEEDING PREGNANCIES.
• THE RH FACTOR IS A TYPE OF INHERITED PROTEIN SITUATED ON THE
SURFACE OF THE RED BLOOD CELLS (RBCS). IF YOU THIS TYPE OF
PROTEIN, IT IS AN INDICATOR THAT YOU ARE RH POSITIVE. THOSE
WHO DON’T HAVE ARE RH NEGATIVE.
• RH INCOMPATIBILITY MAY ARISE IF THE WOMAN IS RH NEGATIVE AND
A MAN WHO IS RH NEGATIVE CONCEIVE A CHILD. THERE IS A HIGH
POSSIBILITY THAT THE FETUS IS RH POSITIVE. IN CASE OF RH
INCOMPATIBILITY, THE FIRST PREGNANCY WILL NOT BE AFFECTED, BUT
THE PROBLEM CAN ARISE IN THE SUCCEEDING PREGNANCIES.

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 MOTHER IS Rh-NEGATIVE

FOETAL RED CELLS

ENTER THE MATERNAL
CIRCULATION DURING
PARTURITION

DURING THE NEXT FEW MONTHS,

THE MOTHER MIGHT MAKE
ANTIBODIES AGAINST
THOSE OLIGOSACCHARIDES
(ON THOSE RBCs) THAT
SHE HERSELF DOES NOT MAKE,
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AND THEREFORE REGARDS AS FOREIGN
DURING THE NEXT PREGNANCY

MATERNAL IgG
ANTIBODIES
(AGAINST MEASLES,
MUMPS etc)
CROSS THE
PLACENTA

INCLUDING IgG
MADE AGAINST
THE PREVIOUS
BABY'S RED
BLOOD CELLS

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ERYTHROBLASTOSIS FOETALIS
or "HAEMOLYTIC DISEASE OF THE NEWBORN"
or "RHESUS BABY"

ANAEMIA and JAUNDICE

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DEATH CEREBRAL
PALSY
 WHAT ARE THE CAUSES OF
ERYTHROBLASTOSIS FETALIS?

1. RH INCOMPATIBILITY – THIS PROBLEM OCCURS IF THE MOTHER IS RH NEGATIVE

AND GETS PREGNANT BY RH POSITIVE FATHER. IT RESULTS TO RH DISEASE
WHEREIN THE BABY BECOMES RH POSITIVE.
2. ABO INCOMPATIBILITY – THIS OCCURS IF THE MOTHER AND THE BABY’S BLOOD
TYPES ARE INCOMPATIBLE.

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 WHEN IS RH INCOMPATIBILITY BECOMES A
PROBLEM?
• THE DANGER WITH RH INCOMPATIBILITY IS WHEN THE MOTHER’S BLOOD MIXES
WITH THE FETUS’ BLOOD DURING PREGNANCY. IT DOES NOT MATTER WHETHER
THE BLOOD THAT MIXES IS SMALL OR BIG. ONCE THE BLOODS MIXED, IT COULD
LEAD TO COMPLICATIONS TO THE OFFSPRING.
• THERE ARE VARIOUS CAUSES FOR MIXING OF BLOOD AND THESE ARE THE
FOLLOWING:
• BLEEDING DURING PREGNANCY
• ECTOPIC PREGNANCY
• MISCARRIAGE
• ABORTION
• THE PLACENTA IS DETACHED FROM THE UTERINE WALL DURING DELIVERY
• ROTATING A BREECH BABY MANUALLY
• BLUNT TRAUMA
• A FALL DURING PREGNANCY
• INVASIVE PRENATAL PROCEDURES SUCH AS CHORIONIC VILLUS SAMPLING AND
AMNIOCENTESIS (AMNIOTIC FLUID TEST).
• RH POSITIVE BLOOD NEEDLE CONTAMINATION
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• TRANSFUSION OF RH POSITIVE BLOOD DURING PREGNANCY
 HOW DOES ERYTHROBLASTOSIS FETALIS
DEVELOP
• THE PROBLEM WITH RH INCOMPATIBILITY IS THE POSSIBILITY OF EXPERIENCING RH
SENSITIZATION (AN IMMUNE RESPONSE).
• THE IMMUNE SYSTEM OF THE MOTHER WILL RECOGNIZE THAT THERE IS A FOREIGN THING
INSIDE THE BODY AND AS A DEFENSE MECHANISMS, THE IMMUNE SYSTEM WILL ATTACK THEM.
• ANTIBODIES WILL BE PRODUCED TO PREVENT EXPOSURE TO RH FACTOR, TO THE POINT THAT IT
WILL USE THE BLOOD SUPPLY OF THE FETUS. THIS IS WHERE THE REAL DANGER TAKES PLACE.
• USING THE BLOOD OF THE FETUS COULD DESTROY THE FETUS’ RED BLOOD CELLS, WHICH LEADS
TO THE CONDITION CALLED ERYTHROBLASTOSIS FETALIS.
• THERE WILL BE A RAPID RED BLOOD CELLS DESTRUCTION, WHICH COULD PUT THE LIFE OF THE
FETUS IN DANGER. IT COULD RESULT TO ILLNESS SUCH AS ENLARGEMENT OF THE LIVER AND
SPLEEN AS A RESULT OF THE FETUS’ ATTEMPT TO CREATE RED BLOOD CELLS.
• IN WORST CASE, IT COULD LEAD TO FETAL DEATH (SUCH DISEASE CONDITION IN THE NEWBORN
IS CALLED HYMOLYTIC DISEASE).
• THE NEWBORN’S BODY DOES NOT HAVE THE ABILITY TO EXCRETE AND BREAK DOWN RBCS. THE
NEWBORN’S BILIRUBIN LEVEL IS HIGH. THE BILIRUBIN IS A BY-PRODUCT OF RBCS BREAKDOWN.
• DUE TO HIGH BILIRUBIN LEVEL, THE NEWBORN IS JAUNDICE (YELLOWISH DISCOLORATION OF
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THE SKIN
 ERYTHROBLASTOSIS FETALIS SYMPTOMS
•The amniotic fluid appears yellow, which indicates a
high bilirubin. This can be assessed during
amniocentesis.

•Cardiomegaly (enlargement of the heart)

•Enlargement of the spleen and liver

•An ultrasound during pregnancy will reveal the

presence of fluid in the lungs, scalp, and abdomen.

•The newborn’s skin is pale.

•The newborn looks yellow, particularly the eyes and

umbilical cord.

•The yellowish discoloration is obvious at birth or a

few hours after delivery.
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•Breathing difficulty secondary to build-up of fluid in

various organs of the body.
 WHAT ARE THE POSSIBLE
COMPLICATIONS?

• FETUS COMPLICATIONS – THE BILIRUBIN LEVEL OF THE FETUS IS HIGH. THERE IS A

MILD TO SEVERE ANEMIA, ALONG WITH YELLOWISH DISCOLORATION OF THE
SKIN. IT COULD ALSO LEAD TO HYDROPS FETALIS (AN ACCUMULATION OF FLUID
IN THE FETAL TISSUES AND ORGANS LEADING TO HEART FAILURE). SUCH
CONDITION COULD LEAD TO STILLBORN (A BABY BORN WITHOUT SIGNS OF LIFE).
• NEWBORN COMPLICATIONS – HIGH BILIRUBIN LEVEL AT BIRTH. THE NEWBORN
LOOKS PALE AND YELLOWISH AT THE SAME TIME. THE LIVER IS ENLARGED. THERE IS
ALSO A POSSIBILITY OF KERNICTERUS (SEIZURE, DEAFNESS, BRAIN DAMAGE, OR
DEATH DUE TO EXCESSIVE BILIRUBIN LEVEL IN THE BLOOD).

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 TRANSFUSION REACTIONS

• JAUNDICE: HEMOLYSIS OF RBCS LEADS TO CIRCULATION OF FREE HB IN THE

BLOOD WHICH IS THEN CONVERTED TO  BILIRUBIN YELLOW PIGMENT

• MENTAL IMPAIRMENT: DAMAGE OF MOTOR AREAS OF THE BRAIN DUE TO

PRECIPITATION OF NEURONAL CELLS

• ACUTE KIDNEY FAILURE: HEMOLYZED CELLS RELEASE TOXIC SUBSTANCES 

RENAL VASOCONSTRICTION, CIRCULATORY SHOCK AND HB LEAKS INTO THE
GF PRECIPITATES AND BLOCK THE TUBULES DEATH

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 ORGAN AND TISSUE
TRANSPLANTATION
• IMMUNE REACTIONS OCCUR AND THEY ARE KNOWN AS GRAFT
REJECTION COMMONLY CAUSED BY HLA ANTIGENS
• HLA ANTIGENS ARE DIVERSE AND THEY ARE FOUND ON THE SURFACE OF
WBCS
• IT IS IMPOSSIBLE FOR TWO PEOPLE TO HAVE SAME HLA ANTIGENS
• PREVENTION OF GR IS ACCOMPLISHED BY USING DRUGS THAT SUPPRESS
THE IMMUNE SYSTEM
• HOWEVER, THE PERSON IS COMPLETELY UNPROTECTED FROM
INFECTIOUS DISEASES

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• WHAT IS THE CAUSE OF HDN?
• WHAT ARE THE BASIS OF BLOOD TYPE CLASSIFICATION RH BLOOD
TYPES?

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