Rh Incompatibility: The Case Study

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Table of Contents

Patient Presentation
Patient Symptoms
Disease Process
Clinical Factors
Lab Results
Immunohematology Testing and Intervention
Laboratory Results
References

Patient Presentation

A 24-year-old African American pregnant female patient with a history of two miscarriages presents to the hospital. The patient has given birth to one child and has experienced two miscarriages after the first delivery (Asif & Aldarweesh, 2020). The patient has never visited any hospital to seek medical attention in the previous pregnancies. Therefore, an ultrasound is conducted to examine the baby, view fluid build-up, and a blood sample is collected and sent to the blood bank for workup, and the patient is diagnosed with Rh incompatibility.

Patient Symptoms

The symptoms identified comprise destruction of the babys red blood cells and increased build-up of bilirubin in the bloodstream. The skin and white part of the eye of the baby have turned yellowish, lethargy, and low muscle tone (Asif & Aldarweesh, 2020). The amniotic fluid has changed color to yellow because of bilirubin. Other symptoms comprise heart failure, fast breathing, increased heart rate, lethargy, swelling of the babys skin, and kernicterus (Asif & Aldarweesh, 2020). Finally, the babys organs such as lungs, spleen, heart, liver, scalp, and stomach enlarge.

Disease Process

Rh incompatibility occurs when an Rh-negative woman conceives an Rh-positive baby. Hence, the mothers immune system responds by creating Rh antibodies (Asif & Aldarweesh, 2020). The developed antibodies make the body create an immune system against the baby, whom the mothers body considers as a foreign object. Various ways can cause the formation of these antibodies, such as when the fetal blood enters the mothers circulation or during blood transfusions. Other ways include problems such as miscarriages and ectopic pregnancies, the stomach getting injured, and bleeding during pregnancy (Asif & Aldarweesh, 2020). Therefore, Rh incompatibility can cause complications, especially if a woman becomes pregnant with another Rh-positive baby in the future. The immune system developed by the womans body mounts an attack against those Rh-positive red blood cells (Asif & Aldarweesh, 2020). Hence, this is why the doctor will always test the Rh factor of a pregnant woman early on in pregnancy.

Clinical Factors

Antibodies are proteins created by the mothers immune system to fight off substances foreign to the body, such as Rh-positive blood. If the patient has these antibodies, she has previously been exposed to Rh-positive blood, such as through mismatched blood transfusion, an abortion, miscarriage, or from a previous delivery (Taylor, 2022). As a result, the baby will be at a higher risk for incompatibility if the father is Rh-positive. Therefore, the patient must undergo screening tests to measure the level of antibodies in the body. A higher number of antibodies means that the baby will face a lot of health complications (Taylor, 2022). Rh factor is a protein on RBCs that determines if the blood of two people can mix, such as a mothers and that of a baby (Taylor, 2022). The Rh factor of the blood and that of an unborn child can be determined during pregnancy.

Lab Results

The patient is taken to the lab to be tested for the presence of the Rh factor. When carrying out the processes, blood is collected from the patient to test for the existence of cell-destroying antibodies within the mothers blood plasma (Taylor, 2022). The test shows a positive indirect Coombs test indicating the presence of Rh incompatibility. The lab results also indicate higher bilirubin levels in the infants blood, signifying the presence of Rh incompatibility (Taylor, 2022). An ultrasound test was also performed to view the baby for fluid build-up. A sampling of the fetuss blood through the umbilical cord was also performed to test for bilirubin, anemia, and other antibodies.

Immunohematology Testing and Intervention

Immunohematology tests are performed to facilitate safe blood transfusion and avoid undesired immune-related phenomena after transfusion during pregnancy. Interventions used to prevent Rh incompatibility can only be done by injecting the Rh immune globulins (Rhlg) (Westphalen, 2022). In addition, if at any point anemia develops, it would be necessary to carry out a blood transfusion of Rh-negative blood to the fetus. If the child is Rh-positive and thus incompatible with the mothers, blood ultrasound tests will be performed on the baby on a weekly basis to assess the babys condition (Westphalen, 2022). This is achieved using a small needle placed in the umbilical cord under the guidance of ultrasound (Westphalen, 2022). Such interventions are very effective and are associated with excellent outcomes.

Laboratory Results

The patient blood samples taken to the blood bank are tested for the type of Rh factors. Additionally, the blood is screened for the availability of any unexpected antibodies that might cause problems for the recipient (Westphalen, 2022). Laboratory results revealed that the mother was Rh-negative while the fetus was Rh-positive. Hence, the Rh factor of the father is suspected to be Rh-positive. Therefore, appropriate intervention needs to be taken to prevent the body from making antibodies to Rh-positive blood because they can destroy the babys blood cells (Westphalen, 2022). As a result, Rhogam is picked up by an OB nurse and administered to the patient.

References

Asif, M., & Aldarweesh, F. (2020). Educational Case: Partial D Phenotype and Role of RhoGAM. Academic Pathology, 7, 2374289520934088. Web.

Taylor, M. (2022). Rh Factor Blood Test What Is Rh and Why Is It Important?. What to Expect. Web.

Westphalen, D. (2022). RhoGAM Shot for Rh Incompatibility: Why You May Need It. Healthline. Web.

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