Irregular antibodies causing hemolytic disease of the newborn: a continuing problem.

The known antigens associathfed with hemolytic disease of the newborn, along with the grade of severity of the disease caused by each antigen, are presented in Table 11. The term "expectant" management means the obstetrician does not need to perform an amniocentesis and may deliver the patient at term. The obstetrician must notify the pediatrician about the delivery of te potentially sensitized infant so that proper nursery treatment of this infant can be initiated. Periodic screening of all antenatal patients for irregular antibodies can alert the physician to a potential problem with hemolytic disease of the newborn and allow the laboratory time to find acceptable donors for possible exchange transfusion. If the antibody is discovered before delivery, it is possible to obtain and store maternal blood to be utilized if a maternal transfusion is needed. When the antenatal patient with an irregular antibody is discovered, her partner should be tested for the antigen. If present, the physician can determine the severity of the disease than can be caused by this antibody from the data in Table 11 and manage the patient appropriately. The information presented should help the physician decide when further testing is needed and when unnecessary testing can be avoided.