Learning objectives:

• Discuss the pathophysiology of HDFN and which patients are most at risk for HDFN
• Describe the usual ABO groups involved in HDFN due to ABO antibodies and the difference between ABO HDFN and HDFN from other IgG antibodies
• Describe the critical titer of anti-D as it pertains to HDFN
• Detail the history of Rh immune globulin, its clinical utility, its mechanism of action, how it is dose and when it should be given to women at risk of HDFN due to anti-D
• Discuss the methodology and indications for the rosette test, the Kleihauer-Betke test and flow cytometry in assessing for fetomaternal hemorrhage
• Discuss whether women with weak D and partial D mutations are candidates for Rh immune globulin
• Explain why anti-K HDFN differs from all other types of HDFN and how one would monitor the at-risk patient
• Discuss when and how an antibody titration procedure is performed in a pregnant woman
• Describe the clinical presentation of HDFN
• Detail the antenatal management of pregnancies at risk for HDFN including the use of middle cerebral artery Doppler ultrasonography, fetal blood sampling, and intrauterine transfusion
• Describe the post-delivery management of neonates afflicted with HDFN including the use of neonatal intravenous immunoglobulin, phototherapy, and red cell exchange transfusion