Hemolytic Disease of the Fetus and Newborn (HDFN)

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The page below is a sample from the LabCE course Overview Of Major Antigens of the Rh Blood Group System (retired 2/12/2020). Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Hemolytic Disease of the Fetus and Newborn (HDFN)

Rh antibodies are IgG immunoglobulins and, as such, are capable of crossing the placenta (chiefly IgG subclasses 1 and 3). Rh antigens are well developed early in fetal life. Therefore, the antibodies can coat the red cells of the developing fetus, and cause them to be removed prematurely from the circulation. If undetected/untreated, this can result in death of the fetus or to severe, life-threatening complications at birth - clinically termed hemolytic disease of the fetus and newborn (HDFN).
Until the advent of Rh immune globulin treatment in 1968, anti-D was the most frequent cause of HDFN. Given that D is the most antigenic of the Rh antigens, provision of Rh-negative blood to Rh-negative females of child-bearing age (generally considered to be below age 50) requires strict adherence along with provision of maternal Rh immune globulin treatment as ante-natal and postnatal prevention.
Other antigens of the Rh system (C, E, c) are also potent immunogens and antibodies directed against these antigens have been implicated in moderate to severe cases of HDFN. Anti-E and anti-c have been documented in cases of severe HDFN that required intervention and treatment. However, there is no immune globulin currently marketed to prevent maternal production of antibodies to other Rh antigens.
Harmening, DM,: Modern Blood Banking & Transfusion Practices, 6th ed. FA Davis, Philadelphia, PA, 2012, p 163, 428.
Blaney, KD and Howard, PR: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 3rd ed. Elsevier, St. Louis, MO, 2013, p 248.
Quinley, ED, Immunohematology Principles and Practice, 3rd ed. Lippincott, Williams, and Wilkins, Philadelphia, PA, 2011, p 145.