appropriate ABO group to remove the incompatible anti A, or anti B. When all this
antibody activity has been removed, her serum may then be tested against the father's
(7) When the mother is known to be immunized to any RBC antigen, cord
blood should be tested for: (1) hemoglobin and hematocrit, (2) serum bilirubin, (3) blood
smear evaluation, and (4) blood bank studies described in para
2-18b(1) of this section.
2-19. TREATMENT OF HEMOLYTIC DISEASE OF THE NEWBORN
a. Prenatal Treatment-Intrauterine Transfusion.
(1) Intrauterine transfusion carries a high risk of fetal mortality and,
therefore, must be performed only, after careful evaluation of the problem by trained
and experienced physicians. Red blood cells less than 5 days old may be used for
intrauterine transfusion. Many physicians prefer to use frozen deglycerolized red cells
because the risk of hepatitis and graft-vs-host disease may be reduced. The red cells
should be group O and compatible with the mother's serum. Once initiated, such
transfusions are usually repeated every 2 weeks until delivery.
(2) At birth, babies with RhOHDN who have had intrauterine transfusions
often type as Rh-negative (or weakly mixed field positive) and the results of a direct
antiglobulin test are negative (or weakly mixed field positive). These observations are a
result of the fact that, at birth, over 90 percent of the baby's blood may be that of the
donor. In rare patients with unusual high-frequency antibodies, it may be desirable to
collect blood from the mother and store the RBCs in the frozen state for either
Intrauterine or exchange transfusion.
b. Neonatal Treatment-Exchange Transfusion.
Objectives of exchange transfusion:
(a) To lower the serum biIirubin concentration in order to prevent
(b) To remove the baby's RBCs that have been coated with antibody,
and would be more rapidly destroyed.
To provide substitute compatible RBCs with adequate oxygen-
To reduce the amount of incompatible antibody in the baby.