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Chapter 19: Problem 1

Figure 19.11 The Rh antigen is found on Rh-positive red blood cells. An Rh- negative female can usually carry an Rh-positive fetus to term without difficulty. However, if she has a second Rh-positive fetus, her body may launch an immune attack that causes hemolytic disease of the newborn. Why do you think hemolytic disease is only a problem during the second or subsequent pregnancies?

Short Answer

Expert verified
Answer: Hemolytic disease occurs during the second or subsequent pregnancies of an Rh-negative female carrying an Rh-positive fetus because the mother's immune system becomes sensitized to the Rh antigen after the first exposure. In the first pregnancy, the mother's immune system has not yet produced significant levels of Rh antibodies. However, in the second or subsequent pregnancies, the mother's immune system has already produced Rh antibodies that can cross the placenta and attack the fetus's red blood cells, leading to hemolytic disease.

Step by step solution

01

Background on Rh Antigens and Blood Types

An individual's blood type involves the presence or absence of specific antigens on the surface of red blood cells. There are two main blood group systems: ABO and Rh. The Rh system is determined by the presence (Rh-positive) or absence (Rh-negative) of the Rh antigen on red blood cells.
02

First Pregnancy of Rh-negative Female with Rh-positive Fetus

During the first pregnancy of an Rh-negative female carrying an Rh-positive fetus, the mother's immune system is exposed to the Rh antigen for the first time. In this case, the Rh-negative mother usually carries the Rh-positive fetus to term without major complications, as her immune system has not yet produced significant levels of antibodies against the Rh antigen on the fetus's red blood cells.
03

Sensitization and Rh Antibodies

After the first exposure to the Rh antigen, the Rh-negative mother's immune system becomes sensitized, meaning that it will recognize the Rh antigen as a foreign substance in future exposures. Over time, the mother's immune system will produce antibodies (specifically, immunoglobulin G or IgG) against the Rh antigen.
04

Second and Subsequent Pregnancies with Rh-positive Fetuses

In subsequent pregnancies with Rh-positive fetuses, the Rh antibodies present in the Rh-negative mother's blood can cross the placenta and reach the fetus. These antibodies can attach to the Rh antigens on the fetus's red blood cells, leading to hemolysis (destruction of red blood cells). This causes hemolytic disease of the newborn (HDN), which can lead to severe anemia, jaundice, brain damage, and even death.
05

Reasons Behind Hemolytic Disease in Second or Subsequent Pregnancies

The main reason why hemolytic disease of the newborn typically occurs during the second or subsequent pregnancies is because the immune system's production of Rh antibodies takes time. In the first pregnancy, the mother's immune system needs to be exposed to the Rh antigen and learn to recognize it as a potential threat. Consequently, in the first pregnancy, the passage of Rh antibodies to the fetus is usually limited, resulting in no or minor complications. However, by the second or subsequent pregnancies, the mother's immune system has already been sensitized and has produced Rh antibodies that can cross the placenta and attack the fetus's red blood cells, leading to hemolytic disease.

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