Hemolytic disease of the fetus and newborn (HDFN) remains an important cause of perinatal morbidity and mortality. HDFN is caused by maternal alloimmunization to red blood cell (RBC) antigens. This article describes and highlights issues in the care of pregnant women with RBC alloimmunization. This includes monitoring for, and management of fetal anemia caused by maternal red cell alloantibodies, but also considerations for transfusion support for the woman in the event of major bleeding. Many aspects of care for women with RBC alloantibodies are not covered within specific guidelines, particularly with respect to best practice for antenatal management of women with prior significant obstetric morbidity or mortality due to HDFN, and we outline our approach in these cases. The use of noninvasive monitoring for fetal anemia through measurement of the middle cerebral artery peak systolic velocity has led to a paradigm shift in antenatal care for women with high-risk antibodies, and medical therapies hold promise for women with the most severe disease.
Skip Nav Destination
TRANSFUSION MEDICINE|
May 15, 2025
How I manage pregnant patients who are alloimmunized to RBC antigens Available to Purchase
Helen Frances Savoia,
Helen Frances Savoia
1Department of Clinical Haematology, The Royal Children's Hospital, Parkville, VIC, Australia
2Department of Clinical Haematology The Royal Women’s Hospital Parkville, VIC, Australia
Search for other works by this author on:
Anna Parakh,
Anna Parakh
2Department of Clinical Haematology The Royal Women’s Hospital Parkville, VIC, Australia
Search for other works by this author on:
Stefan Charles Kane
Stefan Charles Kane
3Department of Maternal Fetal Medicine, The Royal Women's Hospital, Parkville, VIC, Australia
4Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Parkville, VIC, Australia
Search for other works by this author on:
Blood (2025) 145 (20): 2275–2282.
Article history
Submitted:
March 15, 2024
Accepted:
May 7, 2024
First Edition:
May 14, 2024
Connected Content
A related article has been published:
How I treat challenging transfusion cases in sickle cell disease
A related article has been published:
How I manage major hemorrhage
A related article has been published:
How I diagnose and treat cardiorespiratory complications of transfusion
A related article has been published:
How I use noninvasive prenatal testing for red blood cell and platelet antigens
A related article has been published:
How I treat patients who are refractory to platelet transfusions
A related article has been published:
Introduction to a How I Treat series on transfusion medicine
Citation
Helen Frances Savoia, Anna Parakh, Stefan Charles Kane; How I manage pregnant patients who are alloimmunized to RBC antigens. Blood 2025; 145 (20): 2275–2282. doi: https://doi.org/10.1182/blood.2023022894
Download citation file:
My Account
Sign In
May 15 2025
Advertisement intended for health care professionals
Cited By
Advertisement intended for health care professionals
This feature is available to Subscribers Only
Sign In or Create an Account Close Modal