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Do not bind complement. For complement to be fixed (or the complement cascade activated), two
IgG immunoglobulins must attach to an RBC in close proximity. Rh antigens (to which the
antibody would attach) are not situated on the RBC surface this closely. Therefore, when an Rh
antibody coats the RBCs, intravascular, complement-mediated hemolysis does not occur.
RBC destruction resulting from Rh antibodies is primarily extravascular.
Rh antibodies formed by Rh-negative pregnant women do cross the placenta and may coat fetal
RBCs that carry the corresponding antigen. This results in the fetal cells testing positive by the
direct antiglobulin test.
D>c>E>C>e
Immunogenicity of common Rh antigens.
Exposure to less than 0.1 mL of Rh-positive RBCs can stimulate antibody production in an Rhnegative person. IgG1, IgG2, IgG3, and IgG4 subclasses of Rh antibodies have been reported. IgG1
and IgG3 are of the greatest clinical significance because the reticuloendothelial system rapidly
clears RBCs coated with IgG1 and IgG3 from the circulation.
Most commonly found Rh antibodies are considered clinically significant. Therefore, antigennegative blood must be provided to any patient with a history of Rh antibody sensitization, whether
the antibody is currently demonstrable or not.
Transfusion Reactions
Rh-mediated hemolytic transfusion reactions, whether caused by primary sensitization or secondary
immunization, usually result in extravascular destruction of immunoglobulin-coated RBCs. The
transfusion recipient may have an unexplained fever, a mild bilirubin elevation, and a decrease in
hemoglobin and haptoglobin.
The direct antihuman globulin test is usually positive, and the antibody screen may or may not
demonstrate circulating antibody.
Hemolytic Disease of the Newborn (HDN)
Levine and Stetson postulated that the antibody causing the transfusion reaction also crossed the
placenta and destroyed the RBCs of the fetus, causing its death. The offending antibody was
subsequently identified as anti-D.
HDN caused by Rh antibodies is often severe because the Rh antigens are well developed on fetal
cells, and Rh antibodies are primarily IgG, which readily cross the placenta.
Researcher: CUEVAS, Kathrina Joie A.
Reference:: Modern Blood Banking and Transfusion practices by Harmening