Research Article| Volume 2, ISSUE 1, P107-122, March 1982

Download started.


Diagnosis, Prevention, and Therapy in Hemolytic Disease of the Newborn

  • H.F. Polesky
    Corresponding author: Minneapolis War Memorial Blood Bank, 2304 Park Avenue South, Minneapolis, Minnesota 55404
    Professor, Laboratory Medicine and Pathology, University of Minnesota; Director, Minneapolis War Memorial Blood Bank, Minneapolis, Minnesota
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.
      Protocols for prenatal testing to detect Rh immunized women and to identify candidates for Rh immune globulin, and for laboratory testing at or following delivery are presented. Therapeutic approaches in the immunized patient are evaluated.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Clinics in Laboratory Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Allen Jr., F.H.
        • Diamond L.K.
        Erythroblastosis Fetalis Including Exchange Transfusion Technique.
        Little, Brown, and Co., Boston1958
        • Allen Jr., F.H.
        • Diamond L.K.
        • Vaughan III, V.C.
        Erythroblastosis fetalis. VI. Prevention of kernicterus.
        Am. J. Dis. Child. 1950; 80: 779
        • Bergström H.
        • Nilsson L.-A.
        • Nilsson L.
        • et al.
        Demonstration of Rh antigens in a 38-day-old fetus.
        Am. J. Obstet. Gynecol. 1967; 99: 130
        • Bevis D.C.A.
        Composition of liquor amnii in haemolytic disease of the newborn.
        Lancet. 1950; 2: 443
        • Bierme S.J.
        • Blanc M.
        • Albal M.
        • et al.
        Oral Rh treatment for severely immunized mothers.
        Lancet. 1979; 1: 604
        • Bowman J.M.
        Clinical management of the immunized patient.
        in: Tregellas W.M. Wallas C.H. Prenatal and Perinatal Immunohematology. American Association of Blood Banks, Washington, D.C.1981: 61
        • Bowman J.M.
        Rh immunization during pregnancy: Antenatal prophylaxis.
        Can. Med. Assoc. J. 1978; 118: 623
        • Brown A.K.
        • McDonagl A.F.
        Phototherapy for Neonatal Hyperbilirubinemia: Efficacy.
        Chicago, Year Book Medical Publishers. 1979; 27: 341
        • Centers for Disease Control
        Current trends: Rh hemolytic disease.
        Morbid. Mortal. Week. Rep. 1981; 30: 13-15
        • Chan G.
        • Ilkiw R.
        • Schiff D.
        Clinical relevance of the plasma reserve albumin binding capacity for bilirubin (RABC) and “free” bilirubin concentration.
        Clin. Biochem. 1980; 6: 292
        • Chown B.
        • Duff A.M.
        • James J.
        • et al.
        Prevention of primary Rh immunization: First report of the Western Canadian trial, 1966–1968.
        Can. Med Assoc. J. 1969; 100: 1021
        • Davey M.G.
        • Zipursky A.
        McMaster conference on prevention of Rh immunization.
        Vox Sang. 1979; 36: 50
        • Defour D.R.
        • Monoghan W.P.
        ABO hemolytic disease of the newborn. A retrospective analysis of 254 cases.
        Am. J. Clin. Pathol. 1980; 73: 369
        • Eicher C.A.
        The Lui easy freeze elution test. A rapid method for eluting cord samples.
        J. South Centr. Assoc. Blood Bank. 1976; 19: 9
        • Finn R.
        • Clarke C.A.
        • Donohue W.T.A.
        • et al.
        Experimental studies on the prevention of Rh haemolytic disease.
        Br. Med. J. 1961; 1: 1486
        • Fraser I.D.
        • Bennett M.O.
        • Bothamley J.E.
        • et al.
        Intensive antenatal plasmapheresis in severe rhesus isoimmunization.
        Lancet. 1976; 1: 6
        • Freda V.J.
        • Gorman J.G.
        • Pollack W.
        • et al.
        Prevention of Rh hemolytic disease. Ten years clinical experience with RhoGAM immune globulin.
        in: Rh Antibody Mediated Immunosuppression. Ortho Research Institute of Medical Sciences, Raritan, New Jersey1975: 71
        • Gartner L.M.
        • Snyder R.N.
        • Chabon R.S.
        • et al.
        Kernicterus: High incidence in premature infants with low serum bilirubin concentrations.
        Pediatrics. 1970; 45: 906
        • Gluck L.
        • Kulovich M.V.
        • Borer R.C.
        • et al.
        Diagnosis of respiratory distress syndrome by amniocentesis.
        Am. J. Obstet. Gynecol. 1971; 109: 440
      1. Gorman, J. G., Freda, V. J., and Pollack, W.: Intramuscular injection of a new experimental gamma globulin preparation containing high levels of anti-Rh antibody as a means of preventing sensitization to Rh. Proc. Ninth Congress Int. Soc. Hematol., 1962, p. 545.

        • Hardy J.
        • Napier J.A.F.
        Red cell antibodies detected in antenatal tests on rhesus positive women in South and Mid Wales, 1948–1978.
        Br. J. Obstet. Gynaecol. 1981; 88: 91
        • Ibister J.P.
        • Ting A.
        • Seeto K.M.
        Development of Rh-specific maternal auto-antibodies following intensive plasmapheresis for Rh immunization during pregnancy.
        Vox Sang. 1977; 33: 353
        • Jennings L.R.
        Routine use of anti-Rh δ-globulin in Rh-negative newborns not recommended.
        J.A.M.A. 1978; 239: 235
        • Kleihauer E.
        • Braun H.
        • Betke K.
        Demonstration von fetalem hämoglobin in denerythrocytes eines blutausstrichs.
        Klin. Wochenschr. 1957; 33: 637
        • Knight R.C.
        Measuring IgG anti-A/B titers using dithiothreitol (DTT).
        J. Clin. Pathol. 1978; 31: 283
      2. Konugres, A., Polesky, H., and Walker, R.: Rh immune globulin and the Rh positive, D11 variant, mother. Transfusion, in press.

        • Lacey P.
        An unexpected case of severe hemolytic disease of the newborn due to anti-D.
        Transfusion. 1978; 18 (abstract): 642
        • Landsteiner K.
        • Miller Jr., C.P.
        Serological studies on the blood of the primates. II. The blood groups in anthropoid apes.
        J. Exp. Med. 1925; 42: 853
        • Landsteiner K.
        • Wiener A.S.
        An agglutinable factor in human blood recognized by immune sera for rhesus blood.
        Proc. Soc. Exp. Biol. 1940; 43: 223
        • Levine P.
        Serological factors as a possible cause of spontaneous abortions.
        J. Hered. 1943; 34: 71
        • Levine P.
        • Katzin E.M.
        • Burnham L.
        Isoimmunization in pregnancy, its possible bearing on the etiology of erythroblastosis fetalis.
        J.A.M.A. 1941; 116: 822
        • Levine P.
        • Stetson R.E.
        An unusual case of intragroup agglutination.
        J.A.M.A. 1939; 113: 126
        • Liley A.W.
        Liquor amnii analysis in management of pregnancy complicated by rhesus sensitization.
        Am. J. Obstet. Gynecol. 1961; 82: 1359
        • Liley A.W.
        Intrauterine transfusion of foetus in hemolytic disease.
        Br. Med. J. 1963; 2: 1107
        • Mollison P.L.
        Clinical aspects of Rh immunization.
        Am. J. Clin. Pathol. 1973; 60: 287
        • Mollison P.L.
        Blood Transfusion in Clinical Medicine.
        Edition 6. Blackwell, Oxford1979: 257
        • Mollison P.L.
        • Walker W.
        Controlled trials of the treatment of haemolytic disease of the newborn.
        Lancet. 1952; 1: 429
      3. Nevanlinna, H. R.: On factors affecting maternal Rh immunization. Acta Pathol. Microbiol. Scand., Suppl. 93, 1952.

        • Nossamann J.K.
        Laboratory evaluation of the immunized patient.
        in: Tregellas W.M. Wallas C.H. Prenatal and Perinatal Immunohematology. American Association of Blood Banks, Washington, D. C.1981: 48
        • Nusbacher J.
        • Bove J.R.
        Rh immunoprophylaxis. Is antepartum therapy desirable?.
        N. Engl. J. Med. 1980; 303: 935
        • Oberman H.
        Standards for Blood Banks and Transfusion Services.
        Edition 10. American Association of Blood Banks, Washington, D.C.1981: 34
        • Odell G.B.
        • Poland R.L.
        • Nostrea Jr., E.
        Neonatal hyperbilirubinemia.
        in: Klaus M.H. Fanaroff A. Care of the High Risk Neonate. W. B. Saunders Co., Philadelphia1973
        • Parkman R.
        • Mosier D.
        • Umansky I.
        • et al.
        Graft-versus-host disease after intrauterine and exchange transfusion for hemolytic disease of the newborn.
        N. Engl. J. Med. 1974; 290: 359
        • Polesky H.F.
        Blood group antibodies in prenatal sera.
        Minn. Med. 1967; 50: 601
        • Polesky H.F.
        • Sebring E.S.
        Evaluation of methods for detection and quantitation of fetal cells and their effect on RhlgG usage.
        Am. J. Clin. Pathol. 1981; 76: 525
        • Polesky H.F.
        • Sebring E.S.
        Detection of fetal maternal hemorrhage: An evaluation of serological tests related to Rho(D) immune globulin (human).
        Transfusion. 1971; 11: 162
        • Pollack W.
        • Ascari W.O.
        • Kochesky R.J.
        • et al.
        Studies on Rh prophylaxis. I. Relationship between doses of anti-Rh and size of antigenic stimulus.
        Transfusion. 1971; 11: 333
      4. Riley, J., Ness, P., and Taddie, S. J.: The detection and quantitation of fetal-maternal hemorrhage utilizing an enzyme linked antiglobulin test (ELAT). Transfusion, in press.

        • Robinson E.A.E.
        • Tovey L.A.D.
        Intensive plasma exchange in the management of severe Rh disease.
        Br. J. Haematol. 1980; 45: 621
        • Rubin H.
        Antibody elution from red blood cells.
        J. Clin. Pathol. 1963; 16: 70
        • Sabo B.H.
        Evaluation of the neonatal direct antiglobulin test: Notes on low-frequency antigens in hemolytic disease of the newborn.
        in: Bell C.A. A Seminar on Perinatal Blood Banking. American Association of Blood Banks, Washington, D.C.1978: 31
        • Scott J.R.
        • Beer A.E.
        • Guy L.R.
        • et al.
        Pathogenesis of Rh immunization in primigravidas. Fetomaternal versus maternofetal bleeding.
        Obstet. Gynecol. 1977; 49: 9
        • Sebring E.S.
        • Polesky H.F.
        Comparison of fetomaternal hemorrhage detection methods and Rh immune globulin usage.
        Am. J. Clin. Pathol. 1979; 72: 358
      5. Sebring, E. S., and Polesky, H. F.: Detection of fetal maternal hemorrhage in Rh immune globulin candidates: A rosetting technique using enzyme treated Rh2Rh2 indicator erythrocytes. Transfusion, in press.

        • Solway H.
        Rh immune globulin: A ton of prevention.
        Med. Lab. Observer. 1981; 13: 21
        • Starn K.
        • Davidsohn I.
        • Masiatis L.
        Experimental studies on Rh immunization.
        Am. J. Clin. Pathol. 1956; 26: 833
        • Stern K.
        • Goodman H.S.
        • Berger M.
        Experimental isoimmunization to hemoantigens in man.
        J. Immunol. 1961; 87: 189
        • Strand C.
        • Polesky H.F.
        Delayed anemia in erythroblastosis fetalis.
        Minn. Med. 1972; 55: 439
        • Tippett P.
        • Sanger R.
        Observations on subdivisions of the Rh antigen D.
        Vox Sang. 1962; 4: 9
        • Tovey G.H.
        Should anti-D immunoglobulin be given antenatally?.
        Lancet. 1980; 2: 466
        • Tovey L.A.D.
        • Taverner J.M.
        A case for the antenatal administration of anti-D immunoglobulin to primigravidae.
        Lancet. 1981; 1: 878
        • Tregellas W.M.
        Serological evaluation of the prenatal patient.
        in: Tregellas W.M. Wallas C.H. Prenatal and Perinatal Immunohematology. American Association of Blood Banks, Washington, D.C.1981: 1
        • Tsai M.Y.
        • Marshall J.G.
        Phosphatidylglycerol in 261 samples of amniotic fluid from normal and diabetic pregnancies as measured by one-dimensional thin-layer chromatography.
        Clin. Chem. 1979; 25: 682
        • Widmann F.
        Technical Manual of the American Association of Blood Banks.
        Edition 8. American Association of Blood Banks, Washington, D.C.1981: 177
        • Woodrow J.C.
        • Donohoe W.T.A.
        Rh-immunization by pregnancy: Results of a survey and their relevance to prophylactic therapy.
        Br. Med. J. 1968; 4: 139
        • Zimmerman D.R.
        Rh: The Intimate History of a Disease and Its Conquest.
        Macmillan, New York1973
        • Zipursky A.
        • Chintu C.
        • Brown E.
        • et al.
        The quantitation of spherocytes in ABO hemolytic disease.
        J. Pediatr. 1979; 94: 965