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Kenneth F. Trofatter, Jr., MD, PhDPregnancy and Childbirth
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Readers' Questions About Rh-negative Blood Types and Complications

Kenneth F. Trofatter, Jr., MD, PhD
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

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14 Comments:

  • At Sun Jan 13, 09:28:00 AM 2008, Anonymous Anonymous said…

    eZVI am rh- and allso one member of my immidate family is also. After one of my children were born i find out it is also RH-a male child how rare is this? Is it possable that one of my parents was not RH-?
    annomyous two

     
  • At Wed Jan 16, 07:47:00 PM 2008, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To anonymous Jan 13: One or BOTH of your parents could have been Rh-positive and heterozygous for the Rh-D gene! If you are Rh-negative and you have an Rh-negative child, then your partner must be either Rh-negative like you or be heterozygous for Rh-D (one chromosome with the Rh-D gene and one chromosome without it). If your partner is Rh-negative, then ALL your children will be Rh-negative; if your partner is heterozygous for the Rh-D gene, then half your children will be Rh-negative and half will be Rh-positive (and heterozygous). It only takes one dose of the Rh-D gene to make you look Rh-positive. I bet this is still confusing, but I hope this helps! Dr T

     
  • At Mon Feb 25, 02:49:00 AM 2008, Anonymous Tera said…

    Please respond asap. I am O neg and Rh neg. I have 2 children from a previous marriage (that are 12 and 13 yrs of age) and remarried and I am now about 6 mos post partum from a AB pos father. I did not receive the Rhogam shot postpartum and my 6 mos old is Rh positive. Recently I had a miscarriage. I am very concerned regarding future pregnancy (I plan on having one more child before I turn 40). I beleive that perhaps being 'sensitized' and not receving the Rhogam may have contributed to my miscarriage, and am very concerned on my future pregnancy attempt. I asked the nurse after delivering my daughter about receiving my Rhogam shot and was told it was not necessary? The nurse told me she would look into it but never returned I was transfered to another room after delivery and soon forgot to remind the nurses and doctors before leaving the hospital...please tell me how this will or could effect me...I desperately want another child yet the miscarrige has been very difficult on both me and my husband...it was in the ER when they came in to give me the Rhogam postmiscarriage that I realized that indeed an injection should have been given post delivery...my husbands email is jesselayinpipe101@yahoo.com (he is a plumber)...I have been up researching online and stumbled upon your website...I am not computer savy and fear I may not be able to find the site again for your response.
    Thank you for your time and consideration.
    Sincerly,
    Tera

     
  • At Wed Feb 27, 06:22:00 PM 2008, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Tera Feb 25: Tera, even if you are Rh-sensitized (and you probably are NOT) that would not have caused an early miscarriage. I wrote a series of blogs in March and April 2007 regarding miscarriage and recurrent early pregnancy loss. You might want to read them. Thanks for reading. Dr T

     
  • At Fri May 23, 08:37:00 AM 2008, Anonymous Anonymous said…

    I am now 19 weeks along and RH sensitized. I've had my titers checked 4 times, at 6ish weeks my titers jumped from 0 to 1:135 since then, the last 3 times we've checked them they've stayed constant at the 1:135. I also had an ultrasound done at 17 weeks- they said it was too early for the MCA doppler but did look for any signs of hydrops etc. and found nothing. Considering all this, would this lead you to believe my baby is RH- like me?

     
  • At Sat Jun 14, 09:17:00 AM 2008, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To anonymous May 23: Somehow I missed your post. I apologize. No, with that dramatic increase in antibody titer, I suspect the baby is Rh-positive and the appropriate screening follow-up will be by MCA Dopplers. Good luck and let us know how things turn out! Dr T

     
  • At Wed Jul 30, 01:29:00 PM 2008, Anonymous Anonymous said…

    I am a 30 year old woman, at 31 weeks pregnant. Second pregnancy, the first resulting in full term, healthy delivery, no problems.
    i have just been diagnosed today after 28 week bloods, as anti jkb titre 1;2 against heterozygous cells - jk type, jka+ and jkb-. with possible risk of hdn.
    my midwife has never come across this antibody before and doesnt have any information to give me. i am confused and scared. I cannot get an appointment to be seen by the obs ward for another fortnight! bloods are being done tomorrow to find out if the titre level has risen. for me though, i dont even understand what the condition is, what it means for me or my baby or what needs to be done. let alone what the titre system represents. my midwife is trying her best to find out more information but currently i am stressing out and feel i need to do something myself. i have scoured the internet and have just ended up more confused that before. any information or advice you can give me, would be so gratefully received. i do not want to leave this to chance and want as much back ground knowledge as possible.

    thanks and kind regards
    stacey howell

     
  • At Thu Aug 07, 05:32:00 PM 2008, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Stacey: Jka (or Kidd) antigen is one of those red blood cell substances that can lead to hemolytic disease of the fetus and newborn if you have antibodies to it AND if the baby actually carries the antigen. You have a very small amount (low titer) of these antibodies in your blood at this time and the baby is at VERY low risk of deveopling any complications over the next month until you have had a chance to see the consultant. Aside from serially checking the antibody titer, they will offer you the opportunity to have the baby screened noninvasively by performing Doppler flow studies (peak systolic velocities - PSV)by ultrasound on the baby's middle cerebral artery - this has become the standard of care for the initial screening for fetal anemia. Hang in there, you and your baby should be just fine. Let us know how things turn out! Dr T

     
  • At Fri Aug 22, 02:06:00 PM 2008, Anonymous Anonymous said…

    First Question: Would holding a baby up high before cutting the mother prevent a mixture of bloods? and, if a couple did so...how high and for how long...would an hour or two be good enough? If the blood is allowed to thicken wouldn't that help?
    Second question: Which blood type has the D gene? I was just wondering if the D gene is part of the problem with HIV. I am not convinced that HIV is a virus. If a person received protoglandin (not necessarily made from a human) and the D gene is possibly not human could their combined presence with synthetic hormones cause a shut down in the body of endorphins and by products like methyl suffocate the cells. Protoglandin was to make receptors unresponsive in the forming of a baby but what if RNA's and ana's cannot distinguish baby from their own replicas. Does the use of protoglandin shut down all receptors? Can the D gene kill a newborn? How many adults with HIV have or have not the D gene and the synthetics from the Pill and protoglandin? I am not explaining my mishmush am I. I as just wondering if the D gene could be re-educated. Is O negative the problem?

     
  • At Fri Aug 22, 02:50:00 PM 2008, Anonymous Anonymous said…

    I was involved with the making of the Rhogam shot. It was a team and I was present. I know how it was made. However, prior to this, I was researching HIV although it was not called HIV in 1966. I had met a police officer in 1966 in Montreal, Quebec. I knew he would die, I knew his whole family would die. He may or may not have been at a New York fair where scientist were explaining about serums. Vials were turned when bees attacked. And police officers were attacked by the bees eating from a serum which may have belonged to Einstein who may have had adopted me as a godchild. I thought he left me his papers because I questioned him about the serum. I was only about 4-6 years old. He had double vision and was dyslexic. And I said, "You are using the wrong bottle or vial." He may have been diabetic as he was hospitalized. From Montreal, we went looking for similair cases 1967-1972 in New York and a researcher had placed in a file that he thought he was dying from complications of dropping a research ?serum? on a scratch (he may not have said bee sting). A third case was a child with the same symptoms that was murdered and gossip had it that because they thought the white child was black a large group of college students hacked off her head and used it as a soccor ball and they all came down within time of something. Another case involved a researcher for the RH negative mother and he lied about his research. He may or may not have been present for the Rhogam serum. When a man and woman marry the c-gene (creator gene that makes the sperm & egg one male one female) designs the offspring. The sex is determined etc, sent over and another C-gene inspects it and makes changes as to colour etc and approves of the final product. That was the basis of Rhogam. I have concerns about the first serum that was lied about. I am not a scientist. I was just someone at the time that had money for research. I am a moron. I have concerns about the Rhesus monkey serum that "backfired". I don't remember. There are varibles. My concern is that HIV may not be a virus but a war between dna complicated by proglandin progesterone and shutting down the bodies abilities to procreate but rna, ana, cells need to procreate. The body mite not shut down just the baby making machine. The one fact that stood out with the HIV investigation between 1967-1975, is that most of the HIV patients were negative. There should have been a deeper investigation into why negative. It was not RH positive and most blacks have RH positive. It did not start in Africa. Was Einstein negative? He told me not to tell people my blood type. I was surprised when all four of my children were o negative. I said to my husband, "we can't both be RH positive." His grandmother was Aztec from Quatamala. Don't mind me...I am just thinking which negative? I had a brain accident between 1967-1970 and it's like I am back in 1967. I just wanted to share. Thanks. P.S. The woman that lost her baby probably lost it at four to five weeks with a fever. She should have antibiotics with her next pregnancy for about a month.

     
  • At Wed Sep 10, 04:55:00 PM 2008, Anonymous Anonymous said…

    Both of my parents are O POS. Why am I O-RH-NEG

     
  • At Tue Sep 23, 12:51:00 PM 2008, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To anonymous Sept 10: Both of your parents must be heterozygous for the Rh-D antigen - that means they each only have one dose of the D gene. When they make babies, they can end up with children who have two doses of D (Rh-positive), one dose of D (and therefore are Rh-positive also, just like they are - it oly takes one Rh-D gene to make you Rh-positive), or no Rh-D genes and are therefore Rh-negative just like you! Don't worry, they are probably BOTH your parents! Dr. T

     
  • At Fri Nov 14, 08:25:00 PM 2008, Blogger Gary Masters said…

    I have been donating plasma and had seen a poster saying they would give more money for Rh negative donars so I asked about it and it turns out that I was. I was glad of course being in college and more money is great, but I had no clue where the origins and what Rh negative truely does. In my short readings, only found out it helps with women whom are pregnant. Would you be kind to enlighten me?
    ~masters

     
  • At Fri Nov 28, 10:11:00 AM 2008, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Gary: Rh-negative blood is more rare than Rh-positive blood and it can be used in major blood group matched Rh-positive OR Rh-negative recipients - which makes it useful emergency situations when blood types may not be able to be completely sorted out. Dr T

     

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