Diagnosis
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| Type & screen performed when | during 1st trimester, include weak D test
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| Repeat screening when | 20-24 weeks
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| If AB screen is positive | must then identify & determine in clinically significant IgG AB
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| If IgG AB present | paternal phenotype to determine homo or heterozygous
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| IgG AB are | D, E, c, C, K
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| Titer clinically significant ABs | titer >32 is significant; 2 tube increase in titer from previous titier is significant; reagent red cells must be of same phenotype form one titer to the next
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| Titer clinically significant ABs cont | if initial titer >32, 2nd titer at 18-20 weeks; if titer still >32, then amnio or percutaneous umbilical cord sampling done between 20-24 weeks; 16 or less then repeat monthly at 18-20 weeks
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| Amniocentesis & Cordocentesis (PUBS) | performed no later than 24 weeks
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| Amniotic fluid | measurement of bilirubin conc. obtained spechtophoto & plotted over time; if conc. increases then hemolysis is worsening
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| PUBS | obtained by cannulating umbilical vein using ultrasound
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| PUBS cont | blood tested for Hgb, Hct, DAT, checked for NRBCs, allows for direct transfusion
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| Intrauterine transfusion | performed mostly by cordocentesis; risk of trauma to placenta may cause increase AB titiers because of antigenic challege to mother from FHM
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| Plasma exchange & Intravenous immune globulin | done during 2nd & 3rd trimester; used to delay severe HDN until fetus is large enough for IUT
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| Early delivery | not as necessary now with IUT
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