Some reflections on the Rhesus problem

Abstract

The problem presented by the Rhesus baby is not usually one of diagnosis - this should have been made by the obstetrician before the baby has been delivered. However, it is not uncommon for one to be faced with the problem of a baby who becomes jaundiced in the first 24-36 hrs. after delivery. In such cases, the baby is deemed to be suffering from haemolytic disease of the newborn until proved otherwise. Estimation of the Hb and serum bilirubin, the Coombs Test, blood group and Rhesus factor of the mother and the baby, examination of a blood film, together with direct cross-match of the baby's red cells will enable one to arrive at the correct diagnosis in the large majority of cases. Besides haemolysis due to Rh incompatibility one must bear in mind ABO incompatibility and other rarer group incompatibility, such as Kell, Duffy and a few others.