Readers' Questions About Rh-negative Blood Types and Complications

Hello again. I apologize to all of you for my recent 'down-time' but the Chairman of our department decided to retire on very short notice and I have been put in the position of 'interim Chair' until we can get someone to replace him. I sincerely hope that will not be a long process. Been there, done that, don't want to do it again! Over the past week or so, I have accumulated MANY questions/comments from readers and my responses to several may be used as posts over the next few days to play catch up! Hope you don't mind. The three comments below pertain to Rh-negative status and complications related to Rh-sensitization. This seems to be an area of ongoing confusion among many of you, and for those of you who understand it completely already, I apologize again!

Anonymous Mon Jan 07, 07:47:00 PM 2008 said…

I am 33 years old and my husband and I are actively trying to conceive. Both my husband and I have been cleared of any complications by our fertility doctor. My concern is that I am B-negative and I was recently informed that in the event of a pregnancy, that I would need to get an antibody (Rh-immune globulin) given to me. This does not concern me, but what does is that when I was 15, I had an abortion at 16 weeks and was not given the antibody and I do not know if the father was Rh-negative or -positiive. Neither do I know if the baby was Rh-negative or -positive. I am now worried that my future pregnancies could be affected. How do I find out if I am sensitized?

Kenneth F. Trofatter, Jr., MD, PhD said...

To anonymous Jan 7: To find out if you were 'sensitized' to Rh-D or any other blood antigen, simply ask your doctor to perform a blood type and antibody screen. If the antibody screen is negative at this time you are probably in good shape, but you will be rescreened early in a pregnancy as part of the routine new OB labs. Odds are you are just fine. Incidentally, the Rh-immune globulin you will receive in pregnancy will help protect you from becoming sensitized in the event the baby is Rh-positive. Good luck to you and thanks for reading. Dr T
Fri Jan 11, 05:33:00 PM 2008


Ditchdoc Tue Jan 08, 01:44:00 AM 2008 said…

I have A+ blood and my husband has B+ blood but our 9 year old daughter has AB-. How is this? My grandfather was B-. Could the negative allele have come from him by succession?

Kenneth F. Trofatter, Jr., MD, PhD said...

To ditchdoc26 Jan 8: If your husband is indeed the baby's father, that simply means that both of you are heterozygous for the D allele - in other words, you each have one D gene and one gene without D and are then D/-. This happened because you each inherited one chromosome from each of your parents. On one chromosome you inherited the Rh-D gene and on the other you did not. That means when you have children, 1/4 will be D/D (Rh-positive; homozygous), 2/4 will be D/-; also Rh-positive but heterozygous like you and your husband - remember the D gene is expressed dominantly, two doses are not required to be Rh-positive), and 1/4 will be -/- (Rh-negative; you must have BOTH negatives to be Rh-negative). Hope that helps. Thanks for reading! Dr T
Fri Jan 11, 05:40:00 PM 2008


Amy & Damon Thu Jan 10, 06:55:00 PM 2008 said...

I am a 26 year old and I developed antibodies in my first pregnancy. The baby had to be induced but was full term. She had phototherapy for 5 days before being discharged.

My second child was monitored using the Doppler flow every 2 weeks. Then had his first fetal transfusion at 23 weeks and had to have one every 3 weeks. He was induced at 36 weeks weighing 3.35kg so in total he had 4 fetal transfusions. After he was born he had phototherapy for 5 days. Then needed another transfusion, at 2 weeks of age. Now he is 7 and a half months old and very healthy, normal and happy boy.

Now I am pregnant with my 3rd child (not planned but we are both happy) and scared what's going to happen? As I understand with each pregnancy it gets worse! I do have an appointment with a specialist in Maternal-Fetal Medicine in a few days but would love to know your opinion.

Yours sincerely
Amy

P.S I have no complaints about the Doppler method. Their was a very close call at 23 weeks as the doctors didn’t think the levels would rise so fast, but it all worked out I am just very greatful, we have such great technology and doctors!
I am very sad to hear about your baby passing away. It’s heart breaking and my biggest fear.

Kenneth F. Trofatter, Jr., MD, PhD said...

To Amy and Damon: Thank you for sharing your story. I am sure many readers will appreciate what you have been through because of your Rh-sensitization. Actually (hopefully!), it usually doesn't get much worse than it did the last time. The MFM doctor will probably recommend at the least starting the Doppler studies (peak systolic velocities in the middle cerebral artery) even earlier and they may recommend serial cord blood sampling, prepared to move directly to transfusion each time, because outcomes are a little less predictable in women who are sensitized and have had severely affected babies previously. As you know by now, there are risks each time that you have the cord blood sampling and a transfusion done, but in your case, all of that will probably be necessary again. Good luck to you and please let us know how things turn out. Regards. Dr T
Fri Jan 11, 05:44:00 PM 2008

Labels: rh-immune globulin, Rh-isoimmunization, Rh-negative blood type

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