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div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">HDN due to anti-RhE alloimmunization</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">anti-RhE</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Pediatrics" title="Pediatrics">Pediatrics</a> <span class="penicon autoconfirmed-show"><span class="mw-valign-text-top" typeof="mw:File/Frameless"><a href="https://www.wikidata.org/wiki/Q17002920?uselang=en#P1995" title="Edit this on Wikidata"><img alt="Edit this on Wikidata" src="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/10px-OOjs_UI_icon_edit-ltr-progressive.svg.png" decoding="async" width="10" height="10" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/15px-OOjs_UI_icon_edit-ltr-progressive.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png 2x" data-file-width="20" data-file-height="20" /></a></span></span></td></tr></tbody></table> <p><b>Hemolytic disease of the newborn</b> (<b>anti-RhE</b>) is caused by the anti-RhE antibody of the <a href="/wiki/Rh_blood_group_system" title="Rh blood group system">Rh blood group system</a>. The anti-RhE <a href="/wiki/Antibody" title="Antibody">antibody</a> can be naturally occurring, or arise following <a href="/wiki/Immune_system" title="Immune system">immune</a> sensitization after a <a href="/wiki/Blood_transfusion" title="Blood transfusion">blood transfusion</a> or pregnancy. </p><p>The anti-RhE antibody is quite common especially in the Rh genotype CDe/CDe; it usually only causes a mild hemolytic disease, but can cause a severe condition in the newborn. It can occur with other antibodies, usually the anti-Rhc antibody, which can also cause a severe hemolytic disease.<sup id="cite_ref-emedicine273995_1-0" class="reference"><a href="#cite_note-emedicine273995-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>One study done by Moran et al., found that titers are not reliable for anti-E. Their most severe case of <a href="/wiki/Hemolytic_disease_of_the_newborn" title="Hemolytic disease of the newborn">hemolytic disease of the newborn</a> occurred with titers 1:2. Moran states that it would be unwise routinely to dismiss anti-E as being of little clinical consequence.<sup id="cite_ref-pmid11117776_2-0" class="reference"><a href="#cite_note-pmid11117776-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Presentation">Presentation</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=1" title="Edit section: Presentation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Complications">Complications</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=2" title="Edit section: Complications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li>High at birth or rapidly rising <a href="/wiki/Bilirubin" title="Bilirubin">bilirubin</a><sup id="cite_ref-pmid17337672_3-0" class="reference"><a href="#cite_note-pmid17337672-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></li> <li>Prolonged <a href="/wiki/Hyperbilirubinemia" class="mw-redirect" title="Hyperbilirubinemia">hyperbilirubinemia</a><sup id="cite_ref-pmid17337672_3-1" class="reference"><a href="#cite_note-pmid17337672-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></li> <li>Bilirubin-induced neurological dysfunction<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Cerebral_palsy" title="Cerebral palsy">Cerebral palsy</a><sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Kernicterus" title="Kernicterus">Kernicterus</a><sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid2494315_7-0" class="reference"><a href="#cite_note-pmid2494315-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid14413526_8-0" class="reference"><a href="#cite_note-pmid14413526-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Thrombocytopenia" title="Thrombocytopenia">Thrombocytopenia</a><sup id="cite_ref-pmid2494315_7-1" class="reference"><a href="#cite_note-pmid2494315-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Hemolytic_anemia" title="Hemolytic anemia">Hemolytic anemia</a> – must <i>not</i> be treated with iron<sup id="cite_ref-pmid23802744_9-0" class="reference"><a href="#cite_note-pmid23802744-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup></li> <li>Late onset <a href="/wiki/Anemia" title="Anemia">anemia</a> – must <i>not</i> be treated with iron. Can persist up to 12 weeks after birth.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Mechanism">Mechanism</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=3" title="Edit section: Mechanism"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Hemolytic disease of the fetus and newborn (HDN) is a condition where the passage of maternal antibodies results in the hemolysis of fetal/neonatal red cells. The antibodies can be naturally occurring such as anti-A, and anti-B, or immune antibodies developed following a sensitizing event.<sup id="cite_ref-pmid21572705_12-0" class="reference"><a href="#cite_note-pmid21572705-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Isoimmunization occurs when the maternal immune system is sensitized to red blood cell surface antigens. The most common causes of isoimmunization are blood transfusion, and fetal-maternal hemorrhage.<sup id="cite_ref-pmid22439037_13-0" class="reference"><a href="#cite_note-pmid22439037-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> The hemolytic process can result in anemia, hyperbilirubinemia, neonatal thrombocytopenia, and neonatal neutropenia.<sup id="cite_ref-pmid2494315_7-2" class="reference"><a href="#cite_note-pmid2494315-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> With the use of RhD Immunoprophylaxis, (commonly called Rhogam), the incidence of anti-D has decreased dramatically and other alloantibodies are now a major cause of HDN.<sup id="cite_ref-pmid21572705_12-1" class="reference"><a href="#cite_note-pmid21572705-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Antibody_specific">Antibody specific</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=4" title="Edit section: Antibody specific"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>One study done by Moran et al., found that titers are not reliable for anti-E. Their most severe case of <a href="/wiki/Hemolytic_disease_of_the_newborn" title="Hemolytic disease of the newborn">hemolytic disease of the newborn</a> occurred with titers 1:2. Moran states that it would be unwise routinely to dismiss anti-E as being of little clinical consequence.<sup id="cite_ref-pmid11117776_2-1" class="reference"><a href="#cite_note-pmid11117776-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>In the case of anti-E, the woman should be checked around 28 weeks to see if she has developed anti-c as well.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2017)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="Testing">Testing</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=5" title="Edit section: Testing"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Testing for HDN involves blood work from both mother and father, and may also include assessment with amniocentesis and Middle Cerebral Artery scans.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Mother">Mother</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=6" title="Edit section: Mother"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Blood testing for the mother is called an indirect <a href="/wiki/Coombs_test" title="Coombs test">Coombs test</a> (ICT) or an indirect agglutination test (IAT). This test tells whether there are antibodies in the maternal plasma. If positive, the antibody is identified and given a titer. Critical titers are associated with significant risk of fetal anemia and hydrops.<sup id="cite_ref-emedicine273995_1-1" class="reference"><a href="#cite_note-emedicine273995-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Titers of 1:8 or higher is considered critical for Kell. Titers of 1:16 or higher are considered critical for all other antibodies. After critical titer is reached, care is based on MCA scans. If antibodies are low and have a sudden jump later in pregnancy, an MCA scan is warranted. If the titer undergoes a 4 fold increase, it should be considered significant regardless of if the critical value has been reached. Maternal titers are not useful in predicting fetal anemia after the first affected gestation and should not be used for the basis of care.<sup id="cite_ref-emedicne974349treatment_14-0" class="reference"><a href="#cite_note-emedicne974349treatment-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> Titers are tested monthly until 24 weeks, after which they are done every 2 weeks.<sup id="cite_ref-pmid22439037_13-1" class="reference"><a href="#cite_note-pmid22439037-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p><p>"In only 2 situations are patients not monitored identically to patients who are Rh sensitized. The first is that of alloimmunization to the c, E, or, C antigens. Some concern exists that hemolysis may occur in these patients with a lower than 1:16 titer. Thus, if the initial titer is 1:4 and stable but increases at 26 weeks' gestation to 1:8, assessment with MCA Doppler velocity at that point is reasonable. However, if the patient presents in the first trimester with a 1:8 titer that remains stable at 1:8 throughout the second trimester, continued serial antibody titers are appropriate. The second situation in which patients should not be treated identically to patients who are Rh D sensitized is that of Kell isoimmunization because several cases of severe fetal hemolysis with anti-Kell antibodies have occurred in the setting of low titers."<sup id="cite_ref-emedicine273995_1-2" class="reference"><a href="#cite_note-emedicine273995-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>In the case of a positive ICT, the woman must carry a medical alert card or bracelet for life because of the risk of a transfusion reaction.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Father">Father</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=7" title="Edit section: Father"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Blood is generally drawn from the father to help determine fetal antigen status.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> If he is homozygous for the antigen, there is a 100% chance of all offspring in the pairing to be positive for the antigen and at risk for HDN. If he is heterozygous, there is a 50% chance of offspring to be positive for the antigen.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> This test can help with knowledge for the current baby, as well as aid in the decision about future pregnancies. With RhD, the test is called the RhD genotype. With RhCE, and Kell antigen it is called an antigen phenotype.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Fetus">Fetus</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=8" title="Edit section: Fetus"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are three possible ways to test the fetal antigen status. Free cell DNA, <a href="/wiki/Amniocentesis" title="Amniocentesis">amniocentesis</a>, and <a href="/wiki/Chorionic_villus_sampling" title="Chorionic villus sampling">chorionic villus sampling</a> (CVS). Of the three, CVS is no longer used due to risk of worsening the maternal antibody response. Once antigen status has been determined, assessment may be done with MCA scans.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2017)">citation needed</span></a></i>]</sup> </p> <ul><li>Cell-free DNA can be run on certain antigens. Blood is taken from the mother, and using PCR, can detect the K, C, c, D, and E alleles of fetal DNA. This blood test is non-invasive to the fetus and is an easy way of checking antigen status and risk of HDN. Testing has proven very accurate and is routinely done in the UK at the International Blood Group Reference Laboratory in Bristol.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Sanequin laboratory in Amsterdam, Netherlands also performs this test. For US patients, blood may be sent to either of the labs. In the US, Sensigene is done by Sequenome to determine fetal D status. Sequenome does not accept insurance in the US, but US and Canadian patients have had insurance cover the testing done overseas.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2017)">citation needed</span></a></i>]</sup></li> <li>Amniocentesis is another recommended method for testing antigen status and risk for HDN. Fetal antigen status can be tested as early as 15 weeks by PCR of fetal cells.<sup id="cite_ref-pmid22439037_13-2" class="reference"><a href="#cite_note-pmid22439037-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup></li> <li>CVS is possible as well to test fetal antigen status but is not recommended. CVS carries a higher risk of fetal maternal hemorrhage and can raise antibody titers, potentially worsening the antibody effect.<sup id="cite_ref-pmid22439037_13-3" class="reference"><a href="#cite_note-pmid22439037-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="MCA_scans">MCA scans</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=9" title="Edit section: MCA scans"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Middle cerebral artery – peak systolic velocity is changing the way sensitized pregnancies are managed.<sup id="cite_ref-pmid10620643_18-0" class="reference"><a href="#cite_note-pmid10620643-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> This test is done noninvasively with ultrasound. By measuring the peak velocity of blood flow in the middle cerebral artery, a MoM (multiple of the median) score can be calculated. MoM of 1.5 or greater indicates severe anemia and should be treated with IUT.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid10620643_18-1" class="reference"><a href="#cite_note-pmid10620643-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Intervention">Intervention</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=10" title="Edit section: Intervention"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are several intervention options available in early, mid and late pregnancies.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2017)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Early_pregnancy">Early pregnancy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=11" title="Edit section: Early pregnancy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li>IVIG – IVIG stands for <a href="/wiki/Intravenous_immunoglobulin" class="mw-redirect" title="Intravenous immunoglobulin">intravenous immunoglobulin</a>. It is used in cases of previous loss, high maternal titers, known aggressive antibodies, and in cases where religion prevents blood transfusion. Ivig can be more effective than IUT alone.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Fetal mortality was reduced by 36% in the IVIG and IUT group than in the IUT alone group. IVIG and plasmapheresis together can reduce or eliminate the need for an IUT.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Plasmapheresis" title="Plasmapheresis">Plasmapheresis</a> – Plasmapheresis aims to decrease the maternal titer by direct plasma replacement.<sup id="cite_ref-pmid25722586_22-0" class="reference"><a href="#cite_note-pmid25722586-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Plasmapheresis and IVIG together can even be used on women with previously <a href="/wiki/Hydropic" class="mw-redirect" title="Hydropic">hydropic</a> fetuses and losses.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Mid_to_late_pregnancy">Mid to late pregnancy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=12" title="Edit section: Mid to late pregnancy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li>IUT – intrauterine transfusion (IUT) is done either by intraperitoneal transfusion (IPT) or intravenous transfusion (IVT).<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> IVT is preferred over IPT.<sup id="cite_ref-emedicine273995_1-3" class="reference"><a href="#cite_note-emedicine273995-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> IUTs are only done until 35 weeks. After that, the risk of an IUT is greater than the risk from post birth transfusion.<sup id="cite_ref-uptodate_IFTR_26-0" class="reference"><a href="#cite_note-uptodate_IFTR-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup></li> <li>Steroids – steroids are sometimes given to the mother before IUTs and early delivery to mature the fetal lungs.<sup id="cite_ref-uptodate_IFTR_26-1" class="reference"><a href="#cite_note-uptodate_IFTR-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-emedicne974349treatment_14-1" class="reference"><a href="#cite_note-emedicne974349treatment-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Phenobarbital" title="Phenobarbital">Phenobarbital</a> – Phenobarbital is sometimes given to the mother to help mature the fetal liver and reduce hyperbilirubinemia.<sup id="cite_ref-emedicne974349treatment_14-2" class="reference"><a href="#cite_note-emedicne974349treatment-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup></li> <li>Early delivery – delivery can occur anytime after the age of viability.<sup id="cite_ref-emedicine273995_1-4" class="reference"><a href="#cite_note-emedicine273995-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Emergency delivery due to failed IUT is possible, along with induction of labor at 35–38 weeks.<sup id="cite_ref-uptodate_IFTR_26-2" class="reference"><a href="#cite_note-uptodate_IFTR-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="After_birth">After birth</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=13" title="Edit section: After birth"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Testing_2">Testing</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=14" title="Edit section: Testing"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li>Coombs – after birth the baby will have a direct Coombs test run to confirm antibodies attached to the infant's red blood cells. This test is run from <a href="/wiki/Cord_blood" title="Cord blood">cord blood</a>.<sup id="cite_ref-pmid17337672_3-2" class="reference"><a href="#cite_note-pmid17337672-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></li></ul> <p>In some cases, the direct Coombs will be negative but severe, even fatal HDN can occur.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> An indirect Coombs needs to be run in cases of anti-C,<sup id="cite_ref-emedicne974349workup_30-0" class="reference"><a href="#cite_note-emedicne974349workup-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> anti-c,<sup id="cite_ref-emedicne974349workup_30-1" class="reference"><a href="#cite_note-emedicne974349workup-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> and anti-M. Anti-M also recommends antigen testing to rule out the presence of HDN.<sup id="cite_ref-pmid25722586_22-1" class="reference"><a href="#cite_note-pmid25722586-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Hgb – the infant's <a href="/wiki/Hemoglobin" title="Hemoglobin">hemoglobin</a> should be tested from cord blood.<sup id="cite_ref-pmid17337672_3-3" class="reference"><a href="#cite_note-pmid17337672-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Reticulocyte" title="Reticulocyte">Reticulocyte</a> count – Reticulocytes are elevated when the infant is producing more blood to combat anemia.<sup id="cite_ref-pmid17337672_3-4" class="reference"><a href="#cite_note-pmid17337672-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> A rise in the retic count can mean that an infant may not need additional transfusions.<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> Low retic is observed in infants treated with IUT and in those with HDN from anti-Kell<sup id="cite_ref-emedicne974349workup_30-2" class="reference"><a href="#cite_note-emedicne974349workup-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Neutrophil" title="Neutrophil">Neutrophils</a> – as <a href="/wiki/Neutropenia" title="Neutropenia">neutropenia</a> is one of the complications of HDN, the neutrophil count should be checked.<sup id="cite_ref-pmid2494315_7-3" class="reference"><a href="#cite_note-pmid2494315-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid14413526_8-1" class="reference"><a href="#cite_note-pmid14413526-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Thrombocyte" class="mw-redirect" title="Thrombocyte">Thrombocytes</a> – as thrombocytopenia is one of the complications of HDN, the thrombocyte count should be checked.<sup id="cite_ref-pmid2494315_7-4" class="reference"><a href="#cite_note-pmid2494315-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup></li> <li>Bilirubin should be tested from cord blood.<sup id="cite_ref-pmid17337672_3-5" class="reference"><a href="#cite_note-pmid17337672-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Ferritin" title="Ferritin">Ferritin</a> – because most infants affected by HDN have iron overload, a ferritin must be run before giving the infant any additional iron.<sup id="cite_ref-pmid23802744_9-1" class="reference"><a href="#cite_note-pmid23802744-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup></li> <li>Newborn screening tests – transfusion with donor blood during pregnancy or shortly after birth can affect the results of the newborn screening tests. It is recommended to wait and retest 10–12 months after last transfusion. In some cases, DNA testing from saliva can be used to rule out certain conditions.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=15" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Phototherapy" class="mw-redirect" title="Phototherapy">Phototherapy</a> – Phototherapy is used for cord bilirubin of 3 or higher. Some doctors use it at lower levels while awaiting lab results.<sup id="cite_ref-pmid15231951_32-0" class="reference"><a href="#cite_note-pmid15231951-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup></li> <li>IVIG – IVIG has been used to successfully treat many cases of HDN. It has been used not only on anti-D, but on anti-E as well.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> IVIG can be used to reduce the need for exchange transfusion and to shorten the length of phototherapy.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> The AAP recommends "In isoimmune hemolytic disease, administration of intravenousγ-globulin (0.5–1 g/kg over 2 hours) is recommended if the TSB is rising despite intensive phototherapy or the TSB level is within 2 to 3 mg/dL (34–51 μmol/L) of the exchange level. If necessary, this dose can be repeated in 12 hours (evidence quality B: benefits exceed harms). Intravenous γ-globulin has been shown to reduce the need for exchange transfusions in Rh and ABO hemolytic disease."<sup id="cite_ref-pmid15231951_32-1" class="reference"><a href="#cite_note-pmid15231951-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup></li> <li>Exchange transfusion – exchange transfusion is used when bilirubin reaches either the high or medium risk lines on the nonogram provided by the American Academy of Pediatrics (Figure 4).<sup id="cite_ref-pmid15231951_32-2" class="reference"><a href="#cite_note-pmid15231951-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> Cord bilirubin >4 is also indicative of the need for exchange transfusion.<sup id="cite_ref-emedicne974349followup_35-0" class="reference"><a href="#cite_note-emedicne974349followup-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Transfusion_reactions">Transfusion reactions</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=16" title="Edit section: Transfusion reactions"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Once a woman has antibodies, she is at high risk for a transfusion reaction.<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> For this reason, she must carry a medical alert card at all times and inform all doctors of her antibody status.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (July 2020)">citation needed</span></a></i>]</sup> </p><p>"Acute hemolytic transfusion reactions may be either immune-mediated or nonimmune-mediated. Immune-mediated hemolytic transfusion reactions caused by immunoglobulin M (IgM) anti-A, anti-B, or anti-A,B typically result in severe, potentially fatal complement-mediated intravascular hemolysis. Immune-mediated hemolytic reactions caused by IgG, Rh, Kell, Duffy, or other non-ABO antibodies typically result in extravascular sequestration, shortened survival of transfused red cells, and relatively mild clinical reactions. Acute hemolytic transfusion reactions due to immune hemolysis may occur in patients who have no antibodies detectable by routine laboratory procedures."<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> </p><p>Summary of transfusion reactions in the US:<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=17" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Coombs_test" title="Coombs test">Coombs test</a></li> <li><a href="/wiki/Hematology" title="Hematology">Hematology</a></li> <li><a href="/wiki/Hemolytic_anemia" title="Hemolytic anemia">Hemolytic anemia</a></li> <li><a href="/wiki/Hemolytic_disease_of_the_newborn" title="Hemolytic disease of the newborn">Hemolytic disease of the newborn</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=18" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-emedicine273995-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-emedicine273995_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-emedicine273995_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-emedicine273995_1-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-emedicine273995_1-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-emedicine273995_1-4"><sup><i><b>e</b></i></sup></a></span> <span class="reference-text"><i><a rel="nofollow" class="external text" href="https://emedicine.medscape.com/article/273995-overview">Erythrocyte Alloimmunization and Pregnancy</a></i> at <a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></span> </li> <li id="cite_note-pmid11117776-2"><span class="mw-cite-backlink">^ <a href="#cite_ref-pmid11117776_2-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-pmid11117776_2-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFMoranRobsonReid2000" class="citation journal cs1">Moran, P.; Robson, S. 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A; Roberts, I. 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(February 2017)">full citation needed</span></a></i>]</sup></span> </li> <li id="cite_note-pmid15231951-32"><span class="mw-cite-backlink">^ <a href="#cite_ref-pmid15231951_32-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-pmid15231951_32-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-pmid15231951_32-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFAmerican_Academy_of_Pediatrics_Subcommittee_on_Hyperbilirubinemia.2004" class="citation journal cs1">American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. (2004). <a rel="nofollow" class="external text" href="http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=15231951">"Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation"</a>. <i>Pediatrics</i>. <b>114</b> (1): 297–316. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1542%2Fpeds.114.1.297">10.1542/peds.114.1.297</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/15231951">15231951</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatrics&rft.atitle=Management+of+hyperbilirubinemia+in+the+newborn+infant+35+or+more+weeks+of+gestation&rft.volume=114&rft.issue=1&rft.pages=297-316&rft.date=2004&rft_id=info%3Adoi%2F10.1542%2Fpeds.114.1.297&rft_id=info%3Apmid%2F15231951&rft.au=American+Academy+of+Pediatrics+Subcommittee+on+Hyperbilirubinemia.&rft_id=http%3A%2F%2Fpediatrics.aappublications.org%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D15231951&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHemolytic+disease+of+the+newborn+%28anti-RhE%29" class="Z3988"></span></span> </li> <li id="cite_note-33"><span class="mw-cite-backlink"><b><a href="#cite_ref-33">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFOnesimoRizzoRuggieroValentini2010" class="citation journal cs1">Onesimo, R; Rizzo, D; Ruggiero, A; Valentini, P (2010). "Intravenous Immunoglobulin therapy for anti-E hemolytic disease in the newborn". <i>The Journal of Maternal-Fetal & Neonatal Medicine</i>. <b>23</b> (9): 1059–61. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.3109%2F14767050903544751">10.3109/14767050903544751</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/20092394">20092394</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:25144401">25144401</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Maternal-Fetal+%26+Neonatal+Medicine&rft.atitle=Intravenous+Immunoglobulin+therapy+for+anti-E+hemolytic+disease+in+the+newborn&rft.volume=23&rft.issue=9&rft.pages=1059-61&rft.date=2010&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A25144401%23id-name%3DS2CID&rft_id=info%3Apmid%2F20092394&rft_id=info%3Adoi%2F10.3109%2F14767050903544751&rft.aulast=Onesimo&rft.aufirst=R&rft.au=Rizzo%2C+D&rft.au=Ruggiero%2C+A&rft.au=Valentini%2C+P&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHemolytic+disease+of+the+newborn+%28anti-RhE%29" class="Z3988"></span></span> </li> <li id="cite_note-34"><span class="mw-cite-backlink"><b><a href="#cite_ref-34">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGottstein2003" class="citation journal cs1">Gottstein, R (2003). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1755998">"Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn"</a>. <i>Archives of Disease in Childhood: Fetal and Neonatal Edition</i>. <b>88</b> (1): F6–10. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1136%2Ffn.88.1.F6">10.1136/fn.88.1.F6</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1755998">1755998</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12496219">12496219</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Disease+in+Childhood%3A+Fetal+and+Neonatal+Edition&rft.atitle=Systematic+review+of+intravenous+immunoglobulin+in+haemolytic+disease+of+the+newborn&rft.volume=88&rft.issue=1&rft.pages=F6-10&rft.date=2003&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1755998%23id-name%3DPMC&rft_id=info%3Apmid%2F12496219&rft_id=info%3Adoi%2F10.1136%2Ffn.88.1.F6&rft.aulast=Gottstein&rft.aufirst=R&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1755998&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHemolytic+disease+of+the+newborn+%28anti-RhE%29" class="Z3988"></span></span> </li> <li id="cite_note-emedicne974349followup-35"><span class="mw-cite-backlink"><b><a href="#cite_ref-emedicne974349followup_35-0">^</a></b></span> <span class="reference-text"><i><a rel="nofollow" class="external text" href="https://emedicine.medscape.com/article/974349-followup">Hemolytic Disease of Newborn~followup</a></i> at <a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></span> </li> <li id="cite_note-36"><span class="mw-cite-backlink"><b><a href="#cite_ref-36">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFStrobel2008" class="citation journal cs1">Strobel, Erwin (2008). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076326">"Hemolytic Transfusion Reactions"</a>. <i>Transfusion Medicine and Hemotherapy</i>. <b>35</b> (5): 346–353. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1159%2F000154811">10.1159/000154811</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076326">3076326</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/21512623">21512623</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Transfusion+Medicine+and+Hemotherapy&rft.atitle=Hemolytic+Transfusion+Reactions&rft.volume=35&rft.issue=5&rft.pages=346-353&rft.date=2008&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3076326%23id-name%3DPMC&rft_id=info%3Apmid%2F21512623&rft_id=info%3Adoi%2F10.1159%2F000154811&rft.aulast=Strobel&rft.aufirst=Erwin&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3076326&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHemolytic+disease+of+the+newborn+%28anti-RhE%29" class="Z3988"></span></span> </li> <li id="cite_note-37"><span class="mw-cite-backlink"><b><a href="#cite_ref-37">^</a></b></span> <span class="reference-text"><i><a rel="nofollow" class="external text" href="https://emedicine.medscape.com/article/206885-overview">Transfusion Reactions</a></i> at <a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></span> </li> <li id="cite_note-38"><span class="mw-cite-backlink"><b><a href="#cite_ref-38">^</a></b></span> <span class="reference-text"><a rel="nofollow" class="external free" href="https://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ReportaProblem/TransfusionDonationFatalities/ucm302847.htm">https://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ReportaProblem/TransfusionDonationFatalities/ucm302847.htm</a><sup class="noprint Inline-Template" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citing_sources#What_information_to_include" title="Wikipedia:Citing sources"><span title="A complete citation is needed. (February 2017)">full citation needed</span></a></i>]</sup></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=19" title="Edit section: Further reading"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li>Antenatal & neonatal screening (second edition). Chapter 12: Rhesus and other haemolytic diseases, by E.A. Letsky, I. Leck, J.M. Bowman. 2000. Oxford University Press. <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/0-19-262826-7" title="Special:BookSources/0-19-262826-7">0-19-262826-7</a>.</li></ul> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemolytic_disease_of_the_newborn_(anti-RhE)&action=edit&section=20" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output 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href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/P55.8">P55.8</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=773.2">773.2</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" 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href="/wiki/Template_talk:Pediatric_conditions_originating_in_the_perinatal_period" title="Template talk:Pediatric conditions originating in the perinatal period"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Pediatric_conditions_originating_in_the_perinatal_period" title="Special:EditPage/Template:Pediatric conditions originating in the perinatal period"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Conditions_originating_in_the_perinatal_period_/_fetal_disease" style="font-size:114%;margin:0 4em">Conditions originating in the <a href="/wiki/Perinatal" class="mw-redirect" title="Perinatal">perinatal</a> period / <a href="/wiki/Fetal_disease" class="mw-redirect" title="Fetal disease">fetal disease</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Maternal factors <br /> complicating pregnancy,<br /> labour or delivery</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><span class="nobold"><i><a href="/wiki/Placental_disease" title="Placental disease">placenta</a></i></span></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Placenta_praevia" title="Placenta praevia">Placenta praevia</a></li> <li><a href="/wiki/Placental_insufficiency" title="Placental insufficiency">Placental insufficiency</a></li> <li><a href="/wiki/Twin-to-twin_transfusion_syndrome" title="Twin-to-twin transfusion syndrome">Twin-to-twin transfusion syndrome</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><span class="nobold"><i><a href="/wiki/Chorion" title="Chorion">chorion</a>/<a href="/wiki/Amnion" title="Amnion">amnion</a></i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Chorioamnionitis" title="Chorioamnionitis">Chorioamnionitis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><span class="nobold"><i><a href="/wiki/Umbilical_cord#Problems_and_abnormalities" title="Umbilical cord">umbilical cord</a></i></span></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Umbilical_cord_prolapse" title="Umbilical cord prolapse">Umbilical cord prolapse</a></li> <li><a href="/wiki/Nuchal_cord" title="Nuchal cord">Nuchal cord</a></li> <li><a href="/wiki/Single_umbilical_artery" title="Single umbilical artery">Single umbilical artery</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><span class="nobold"><i><a href="/wiki/Presentation_(obstetrics)" title="Presentation (obstetrics)">presentation</a></i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Breech_birth" title="Breech birth">Breech birth</a></li> <li><a href="/wiki/Asynclitic_birth" title="Asynclitic birth">Asynclitism</a></li> <li><a href="/wiki/Shoulder_presentation" title="Shoulder presentation">Shoulder presentation</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Growth</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Small_for_gestational_age" title="Small for gestational age">Small for gestational age</a> / <a href="/wiki/Large_for_gestational_age" title="Large for gestational age">Large for gestational age</a></li> <li><a href="/wiki/Preterm_birth" title="Preterm birth">Preterm birth</a> / <a href="/wiki/Postterm_pregnancy" title="Postterm pregnancy">Postterm pregnancy</a></li> <li><a href="/wiki/Intrauterine_growth_restriction" title="Intrauterine growth restriction">Intrauterine growth restriction</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Birth_trauma_(physical)" title="Birth trauma (physical)">Birth trauma</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Scalp" title="Scalp">scalp</a></i> <ul><li><a href="/wiki/Cephalohematoma" title="Cephalohematoma">Cephalohematoma</a></li> <li><a href="/wiki/Chignon_(medical_term)" title="Chignon (medical term)">Chignon</a></li> <li><a href="/wiki/Caput_succedaneum" title="Caput succedaneum">Caput succedaneum</a></li> <li><a href="/wiki/Subgaleal_hemorrhage" title="Subgaleal hemorrhage">Subgaleal hemorrhage</a></li></ul></li> <li><a href="/wiki/Brachial_plexus_injury" title="Brachial plexus injury">Brachial plexus injury</a> <ul><li><a href="/wiki/Erb%27s_palsy" title="Erb's palsy">Erb's palsy</a></li> <li><a href="/wiki/Klumpke_paralysis" title="Klumpke paralysis">Klumpke paralysis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Affected systems</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Respiratory_disease" title="Respiratory disease">Respiratory</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Intrauterine_hypoxia" title="Intrauterine hypoxia">Intrauterine hypoxia</a></li> <li><a href="/wiki/Infant_respiratory_distress_syndrome" title="Infant respiratory distress syndrome">Infant respiratory distress syndrome</a></li> <li><a href="/wiki/Transient_tachypnea_of_the_newborn" title="Transient tachypnea of the newborn">Transient tachypnea of the newborn</a></li> <li><a href="/wiki/Meconium_aspiration_syndrome" title="Meconium aspiration syndrome">Meconium aspiration syndrome</a></li> <li><i><a href="/wiki/Pleural_disease" title="Pleural disease">Pleural disease</a></i> <ul><li><a href="/wiki/Pneumothorax" title="Pneumothorax">Pneumothorax</a></li> <li><a href="/wiki/Pneumomediastinum" title="Pneumomediastinum">Pneumomediastinum</a></li></ul></li> <li><a href="/wiki/Wilson%E2%80%93Mikity_syndrome" title="Wilson–Mikity syndrome">Wilson–Mikity syndrome</a></li> <li><a href="/wiki/Bronchopulmonary_dysplasia" title="Bronchopulmonary dysplasia">Bronchopulmonary dysplasia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cardiovascular_disease" title="Cardiovascular disease">Cardiovascular</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pneumopericardium" title="Pneumopericardium">Pneumopericardium</a></li> <li><a href="/wiki/Persistent_fetal_circulation" title="Persistent fetal circulation">Persistent fetal circulation</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Bleeding" title="Bleeding">Bleeding</a> and<br /><a href="/wiki/Hematologic_disease" title="Hematologic disease">hematologic disease</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Vitamin_K_deficiency_bleeding" title="Vitamin K deficiency bleeding">Vitamin K deficiency bleeding</a></li></ul> <ul><li><a href="/wiki/Hemolytic_disease_of_the_newborn" title="Hemolytic disease of the newborn">HDN</a> <ul><li><a href="/wiki/Hemolytic_disease_of_the_newborn_(ABO)" title="Hemolytic disease of the newborn (ABO)">ABO</a></li> <li><a href="/wiki/Hemolytic_disease_of_the_newborn_(anti-Kell)" title="Hemolytic disease of the newborn (anti-Kell)">Anti-Kell</a></li> <li><a href="/wiki/Hemolytic_disease_of_the_newborn_(anti-Rhc)" title="Hemolytic disease of the newborn (anti-Rhc)">Rh c</a></li> <li><a href="/wiki/Rh_disease" title="Rh disease">Rh D</a></li> <li><a class="mw-selflink selflink">Rh E</a></li></ul></li> <li><a href="/wiki/Hydrops_fetalis" title="Hydrops fetalis">Hydrops fetalis</a></li> <li><a href="/wiki/Hyperbilirubinemia" class="mw-redirect" title="Hyperbilirubinemia">Hyperbilirubinemia</a> <ul><li><a href="/wiki/Kernicterus" title="Kernicterus">Kernicterus</a></li> <li><a href="/wiki/Neonatal_jaundice" title="Neonatal jaundice">Neonatal jaundice</a></li></ul></li></ul> <ul><li><a href="/wiki/Velamentous_cord_insertion" title="Velamentous cord insertion">Velamentous cord insertion</a></li> <li><a href="/wiki/Intraventricular_hemorrhage" title="Intraventricular hemorrhage">Intraventricular hemorrhage</a> <ul><li><a href="/wiki/Germinal_matrix_hemorrhage" title="Germinal matrix hemorrhage">Germinal matrix hemorrhage</a></li></ul></li> <li><a href="/wiki/Anemia_of_prematurity" title="Anemia of prematurity">Anemia of prematurity</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gastrointestinal_disease" title="Gastrointestinal disease">Gastrointestinal</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ileus" title="Ileus">Ileus</a></li> <li><a href="/wiki/Necrotizing_enterocolitis" title="Necrotizing enterocolitis">Necrotizing enterocolitis</a></li> <li><a href="/wiki/Meconium_peritonitis" title="Meconium peritonitis">Meconium peritonitis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Integumentary_system" title="Integumentary system">Integument</a> and<br /><a href="/wiki/Thermoregulation" title="Thermoregulation">thermoregulation</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Erythema_toxicum_neonatorum" title="Erythema toxicum neonatorum">Erythema toxicum</a></li> <li><a href="/wiki/Sclerema_neonatorum" title="Sclerema neonatorum">Sclerema neonatorum</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Nervous_system_disease" title="Nervous system disease">Nervous system</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Perinatal_asphyxia" title="Perinatal asphyxia">Perinatal asphyxia</a></li> <li><a href="/wiki/Periventricular_leukomalacia" title="Periventricular leukomalacia">Periventricular leukomalacia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Musculoskeletal_disorder" title="Musculoskeletal disorder">Musculoskeletal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gray_baby_syndrome" title="Gray baby syndrome">Gray baby syndrome</a></li> <li><i><a href="/wiki/Muscle_tone" title="Muscle tone">muscle tone</a></i> <ul><li><a href="/wiki/Hypertonia" title="Hypertonia">Congenital hypertonia</a></li> <li><a href="/wiki/Hypotonia" title="Hypotonia">Congenital hypotonia</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Infections</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Vertically_transmitted_infection" title="Vertically transmitted infection">Vertically transmitted infection</a></li> <li><a href="/wiki/Neonatal_infection" title="Neonatal infection">Neonatal infection</a> <ul><li><a href="/wiki/Congenital_rubella_syndrome" title="Congenital rubella syndrome">rubella</a></li> <li><a href="/wiki/Neonatal_herpes_simplex" class="mw-redirect" title="Neonatal herpes simplex">herpes simplex</a></li> <li><a href="/wiki/Mycoplasma_hominis_infection" title="Mycoplasma hominis infection">mycoplasma hominis</a></li> <li><a href="/wiki/Ureaplasma_urealyticum_infection" class="mw-redirect" title="Ureaplasma urealyticum infection">ureaplasma urealyticum</a></li></ul></li> <li><a href="/wiki/Omphalitis" class="mw-redirect" title="Omphalitis">Omphalitis</a></li> <li><a href="/wiki/Neonatal_sepsis" title="Neonatal sepsis">Neonatal sepsis</a> <ul><li><a href="/wiki/Group_B_streptococcal_infection" title="Group B streptococcal infection">Group B streptococcal infection</a></li></ul></li> <li><a href="/wiki/Neonatal_conjunctivitis" title="Neonatal conjunctivitis">Neonatal conjunctivitis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Miscarriage" title="Miscarriage">Miscarriage</a></li> <li><a href="/wiki/Perinatal_mortality" title="Perinatal mortality">Perinatal mortality</a> <ul><li><a href="/wiki/Stillbirth" title="Stillbirth">Stillbirth</a></li> <li><a href="/wiki/Infant_mortality" title="Infant mortality">Infant mortality</a></li></ul></li> <li><a href="/wiki/Neonatal_withdrawal" title="Neonatal withdrawal">Neonatal withdrawal</a></li> <li><a href="/wiki/Fetal_Alcohol_Spectrum_Disorder" class="mw-redirect" title="Fetal Alcohol Spectrum Disorder">Fetal Alcohol Spectrum Disorder</a></li></ul> </div></td></tr></tbody></table></div>    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