Diagnosis and management of non-anti-D red cell antibodies in pregnancy

Abstract

Key content: • Anti-D prophylaxis has reduced the incidence of haemolytic disease of the newborn. • A variety of non-anti-D red cell antibodies can cause a degree of neonatal haemolysis. • The frequency of antibody testing should be individualised. • Management of non-anti-D alloimmunisation should be aimed at minimising perinatal morbidity. Learning objectives: • To understand the causes and risk factors for maternal non-anti-D antibodies. • To learn when to initiate invasive testing in the antenatal period. • To know when to deliver the baby to maximise perinatal outcome. • To learn about which antibodies can cause fetal hydrops and intrauterine haemolysis. Ethical issues: • When is it necessary to perform paternal blood tests to determine red cell antibody status? • When should the mother be delivered in cases where the red cell antibody detected has a weak association with neonatal haemolysis? Keywords amniocentesis / fetal blood sampling / fetal genotype / intrauterine infusion / middle cerebral artery peak systolic velocity (MCA-PSV)