313:
hemolytic disease, administration of intravenous Îł-globulin (0.5-1 g/kg over 2 hours) is recommended if the TSB is rising despite intensive phototherapy or the TSB level is within 2 to 3 mg/dL (34-51 ÎĽmol/L) of the exchange level . If necessary, this dose can be repeated in 12 hours (evidence quality B: benefits exceed harms). Intravenous Îł-globulin has been shown to reduce the need for exchange transfusions in Rh and ABO hemolytic disease."
239:
Coombs - after birth baby will have a direct coombs test run to confirm antibodies attached to the infant's red blood cells. This test is run from cord blood. In some cases, the direct coombs will be negative but severe, even fatal HDN can occur. An indirect coombs needs to be run in cases of anti-C,
312:
IVIG - Intravenous
Immunoglobulin therapy (IVIG) has been used to successfully treat many cases of HDN. It has been used not only on anti-D, but on anti-E as well. IVIG can be used to reduce the need for exchange transfusion and to shorten the length of phototherapy. The AAP recommends "In isoimmune
262:
Newborn
Screening Tests - Transfusion with donor blood during pregnancy or shortly after birth can affect the results of the Newborn Screening Tests. It is recommended to wait and retest 10–12 months after last transfusion. In some cases, DNA testing from saliva can be used to rule out certain
91:
populations about one fifth of all pregnancies have ABO incompatibility between the fetus and the mother, but only a very small minority develop symptomatic ABO HDN. The latter typically only occurs in mothers of blood group O, because they can produce enough IgG antibodies to cause hemolysis.
226:) do not screen for ABO HDN. If IgG anti-A or IgG anti-B antibodies are found in the pregnant woman's blood, they are not reported with the test results, because they do not correlate well with ABO HDN. Diagnosis is usually made by investigation of a newborn baby who has developed
246:
Reticulocyte count - Reticulocytes are elevated when the infant is producing more blood to combat anemia. A rise in the retic count can mean that an infant may not need additional transfusions. Low retic is observed in infants treated with IUT and in those with HDN from
154:
anti-A or IgG anti-B antibodies, which can pass through the placenta. Exposure to A-antigens and B-antigens, which are both widespread in nature, usually leads to the production of IgM anti-A and IgM anti-B antibodies but occasionally IgG antibodies are
316:
Exchange transfusion - Exchange transfusion is used when bilirubin reaches either the high or medium risk lines on the normogram provided by the
American Academy of Pediatrics (Figure 4). Cord bilirubin >4 is also indicative of the need for exchange
288:
break down. If the anemia is severe, it can be treated with a blood transfusion, however this is rarely needed. On the other hand, neonates have underdeveloped livers that are unable to process large amounts of bilirubin and a poorly developed
163:
Some mothers may be sensitized by fetal-maternal transfusion of ABO incompatible red blood and produce immune IgG antibodies against the antigen they do not have and their baby does. For example, when a mother of genotype OO
1334:
197:
IgG anti-A (or IgG anti-B) antibodies that enter the fetal circulation from the mother find A (or B) antigens on many different fetal cell types, leaving fewer antibodies available for binding onto fetal red blood
1267:
168:) carries a fetus of genotype AO (blood group A) she may produce IgG anti-A antibodies. The father will either have blood group A, with genotype AA or AO or, more rarely, have blood group AB, with genotype AB.
934:
Heddle, N. M.; Wentworth, P.; Anderson, D. R.; Emmerson, D.; Kelton, J. G.; Blajchman, M. A. (1995). "Three examples of Rh haemolytic disease of the newborn with a negative direct antiglobulin test".
396:
Wang, Michael; Hays, Taru; Ambruso, Dan R.; Silliman, Christopher C.; Dickey, William C. (2005). "Hemolytic disease of the newborn caused by a high titer anti-group B IgG from a group a mother".
2020:
1327:
777:
Rath, M. E. A.; Smits-Wintjens, V. E. H. J.; Oepkes, D.; Walther, F. J.; Lopriore, E. (2013). "Iron status in infants with alloimmune haemolytic disease in the first three months of life".
1320:
189:
In about a third of all ABO incompatible pregnancies maternal IgG anti-A or IgG anti-B antibodies pass through the placenta to the fetal circulation leading to a weakly positive
1139:
Onesimo, Roberta; Rizzo, Daniela; Ruggiero, Antonio; Valentini, Piero (2010). "Intravenous
Immunoglobulin therapy for anti-E hemolytic disease in the newborn".
2025:
357:
1708:
1050:
1723:
1713:
259:
Ferritin - because most infants affected by HDN have iron overload, a ferritin must be run before giving the infant any additional iron.
1081:
382:
309:
Phototherapy - Phototherapy is used for cord bilirubin of 3 or higher. Some doctors use it at lower levels while awaiting lab results.
575:
Shapiro, Steven M (2004). "Definition of the
Clinical Spectrum of Kernicterus and Bilirubin-Induced Neurologic Dysfunction (BIND)".
84:, about half of the cases of ABO HDN occur in a firstborn baby and ABO HDN does not become more severe after further pregnancies.
1606:
180:
as a great deal of effort and checking is done to ensure that blood is ABO compatible between the recipient and the donor.
2040:
1611:
1389:
87:
The ABO blood group system is the best known surface antigen system, expressed on a wide variety of human cells. For
1932:
1907:
1698:
1101:
695:
Koenig, J. M.; Christensen, R. D. (1989). "Neutropenia and thrombocytopenia in infants with Rh hemolytic disease".
193:
for the neonate's blood. However, ABO HDN is generally mild and short-lived and only occasionally severe because:
77:
95:
Although very uncommon, cases of ABO HDN have been reported in infants born to mothers with blood groups A and B.
1999:
1949:
1517:
1312:
869:
Al-Alaiyan, S.; Al Omran, A. (1999). "Late hyporegenerative anemia in neonates with rhesus hemolytic disease".
253:
Thrombocytes - as thrombocytopenia is one of the complications of HDN, the thrombocyte count should be checked.
361:
2030:
1691:
653:
Lande, Lottie (1948). "Clinical signs and development of survivors of kernicterus due to Rh sensitization".
209:
are not fully developed during gestation and so there are a smaller number of antigenic sites on fetal RBCs.
1927:
1850:
1668:
1616:
302:
1427:
1917:
1822:
1759:
297:
if left unchecked. If the bilirubin level is sufficiently high as to cause worry, it can be lowered via
250:
Neutrophils - as
Neutropenia is one of the complications of HDN, the neutrophil count should be checked.
1764:
1754:
1645:
1640:
1794:
1503:
1499:
1459:
1001:"Maternal anti-M induced hemolytic disease of newborn followed by prolonged anemia in newborn twins"
1860:
1781:
1099:
298:
1956:
1922:
1527:
1447:
1437:
1384:
290:
1057:
1837:
1655:
1564:
1547:
165:
53:
1300:
223:
1771:
1479:
441:"Significant ABO hemolytic disease of the newborn in a group B infant with a group A2 mother"
488:
Haque, K. M.; Rahman, M (2000). "An unusual case of ABO-haemolytic disease of the newborn".
2035:
1809:
1799:
1601:
1557:
240:
anti-c, and anti-M. Anti-M also recommends antigen testing to rule out the presence of HDN.
133:
Late onset anemia - Must NOT be treated with iron. Can persist up to 12 weeks after birth.
8:
1994:
1977:
1827:
1683:
1593:
1271:
1231:
1912:
1868:
1845:
1735:
1512:
1208:
1183:
1164:
1027:
1000:
982:
959:
947:
894:
846:
821:
802:
600:
552:
527:
470:
457:
440:
421:
190:
1276:
1184:"Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn"
1102:"Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation"
708:
666:
1745:
1663:
1633:
1574:
1552:
1369:
1213:
1156:
1121:
1075:
1032:
951:
886:
851:
794:
756:
712:
670:
635:
592:
557:
497:
462:
413:
376:
277:
177:
30:
1168:
963:
898:
806:
604:
474:
425:
1987:
1814:
1474:
1415:
1379:
1203:
1195:
1148:
1113:
1022:
1012:
943:
878:
841:
833:
786:
746:
704:
662:
627:
584:
547:
539:
452:
405:
332:
46:
1342:
999:
Arora, Satyam; Doda, Veena; Maria, Arti; Kotwal, Urvershi; Goyal, Saurabh (2015).
1944:
1730:
1622:
1542:
69:
751:
734:
1569:
631:
202:
88:
1152:
916:
293:
that is unable to block bilirubin from entering the brain. This can result in
2014:
1508:
1348:
1017:
543:
1628:
1469:
1217:
1160:
1125:
1117:
1100:
American
Academy of Pediatrics Subcommittee on Hyperbilirubinemia. (2004).
1036:
890:
855:
798:
760:
674:
639:
596:
561:
501:
466:
417:
1259:
955:
837:
716:
588:
1972:
1874:
1740:
1442:
1295:
882:
327:
294:
150:
and do not pass through the placenta, but some mothers "naturally" have
1982:
1939:
1880:
1718:
1199:
337:
285:
219:
81:
49:
790:
439:
Jeon, H; Calhoun, B; Pothiawala, M; Herschel, M; Baron, B. W. (2000).
409:
1885:
1344:
1236:
987:
281:
176:
It would be very rare for ABO sensitization to be due to therapeutic
65:
618:
Blair, Eve; Watson, Linda (2006). "Epidemiology of cerebral palsy".
1678:
227:
206:
57:
1401:
1405:
933:
776:
273:
243:
Hgb - the infant's hemoglobin should be tested from cord blood.
73:
2021:
Haemorrhagic and haematological disorders of fetus and newborn
1789:
1536:
1138:
438:
61:
1188:
Archives of
Disease in Childhood: Fetal and Neonatal Edition
532:
Archives of
Disease in Childhood: Fetal and Neonatal Edition
732:
733:
Lalezari, P; Nussbaum, M; Gelman, S; Spaet, T. H. (1960).
151:
147:
977:
975:
973:
822:"Severe late anemia of hemolytic disease of the newborn"
395:
735:"Neonatal neutropenia due to maternal isoimmunization"
1141:
The
Journal of Maternal-Fetal & Neonatal Medicine
970:
1249:
998:
868:
694:
2012:
923:. National Center for Biotechnology Information.
276:due to destruction of fetal red blood cells and
130:Hemolytic Anemia - MUST NOT be treated with iron
1095:
1093:
1091:
910:
908:
772:
770:
728:
726:
521:
519:
517:
515:
513:
511:
2026:Disorders originating in the perinatal period
1328:
819:
690:
688:
686:
684:
525:
1088:
905:
767:
723:
490:Bangladesh Medical Research Council Bulletin
914:
617:
508:
487:
389:
256:Bilirubin should be tested from cord blood.
1335:
1321:
681:
115:Bilirubin Induced Neurological Dysfunction
1207:
1181:
1026:
1016:
845:
750:
551:
456:
146:Anti-A and anti-B antibodies are usually
109:High at birth or rapidly rising bilirubin
620:Seminars in Fetal and Neonatal Medicine
574:
2013:
1080:: CS1 maint: archived copy as title (
526:Murray, N. A; Roberts, I. A G (2007).
381:: CS1 maint: archived copy as title (
1316:
1232:Hemolytic Disease of Newborn~followup
652:
1607:Infant respiratory distress syndrome
1005:Asian Journal of Transfusion Science
481:
43:ABO hemolytic disease of the newborn
983:Hemolytic Disease of Newborn~workup
528:"Haemolytic disease of the newborn"
432:
280:due to the rise in blood levels of
13:
1612:Transient tachypnea of the newborn
948:10.1111/j.1365-3148.1995.tb00197.x
921:Blood Groups and Red Cell Antigens
917:"Hemolytic disease of the newborn"
458:10.21307/immunohematology-2019-587
14:
2052:
1390:Twin-to-twin transfusion syndrome
1245:
64:circulation where they can cause
45:(also known as ABO HDN) maternal
1908:Vertically transmitted infection
272:The antibodies in ABO HDN cause
222:antibody screening blood tests (
103:
2000:Fetal Alcohol Spectrum Disorder
1950:Group B streptococcal infection
1518:Intrauterine growth restriction
1224:
1175:
1132:
1043:
992:
927:
862:
813:
230:during the first week of life.
184:
98:
1343:Conditions originating in the
826:Paediatrics & Child Health
820:Mitchell, S; James, A (1999).
646:
611:
568:
350:
1:
1692:Vitamin K deficiency bleeding
871:Journal of Perinatal Medicine
709:10.1016/s0022-3476(89)80709-7
667:10.1016/S0022-3476(48)80225-8
343:
1851:Periventricular leukomalacia
1669:Persistent fetal circulation
1617:Meconium aspiration syndrome
398:Pediatric Blood & Cancer
301:in the first instance or an
267:
213:
112:Prolonged hyperbilirubinemia
7:
1760:Intraventricular hemorrhage
752:10.1182/blood.V15.2.236.236
321:
10:
2057:
1765:Germinal matrix hemorrhage
1755:Velamentous cord insertion
1646:Bronchopulmonary dysplasia
632:10.1016/j.siny.2005.10.010
160:Fetal-maternal transfusion
2041:Acquired hemolytic anemia
1965:
1900:
1859:
1836:
1808:
1795:Necrotizing enterocolitis
1780:
1677:
1654:
1592:
1585:
1526:
1504:Large for gestational age
1500:Small for gestational age
1492:
1456:
1424:
1398:
1366:
1355:
1286:
1253:
1153:10.3109/14767050903544751
697:The Journal of Pediatrics
655:The Journal of Pediatrics
137:
52:with specificity for the
29:
24:
1018:10.4103/0973-6247.150968
72:which can lead to fetal
1957:Neonatal conjunctivitis
1448:Single umbilical artery
1438:Umbilical cord prolapse
1385:Placental insufficiency
1358:complicating pregnancy,
577:Journal of Perinatology
544:10.1136/adc.2005.076794
16:Maternal IgG antibodies
1933:ureaplasma urealyticum
1641:Wilson–Mikity syndrome
1565:Brachial plexus injury
1118:10.1542/peds.114.1.297
305:if severely elevated.
143:Environmental exposure
54:ABO blood group system
1881:Congenital hypertonia
1772:Anemia of prematurity
1480:Shoulder presentation
1182:Gottstein, R (2003).
589:10.1038/sj.jp.7211157
35:Hematology/pediatrics
2031:Transfusion medicine
1886:Congenital hypotonia
1800:Meconium peritonitis
1602:Intrauterine hypoxia
1558:Subgaleal hemorrhage
936:Transfusion Medicine
915:Bethesda DL (2005).
883:10.1515/JPM.1999.014
303:exchange transfusion
224:indirect Coombs test
1995:Neonatal withdrawal
1978:Perinatal mortality
1828:Sclerema neonatorum
1684:hematologic disease
838:10.1093/pch/4.3.201
291:blood–brain barrier
1928:mycoplasma hominis
1913:Neonatal infection
1869:Gray baby syndrome
1846:Perinatal asphyxia
1736:Hyperbilirubinemia
1513:Postterm pregnancy
1360:labour or delivery
1287:External resources
1200:10.1136/fn.88.1.F6
703:(4 Pt 1): 625–31.
191:direct Coombs test
2008:
2007:
1896:
1895:
1746:Neonatal jaundice
1664:Pneumopericardium
1634:Pneumomediastinum
1575:Klumpke paralysis
1553:Caput succedaneum
1488:
1487:
1356:Maternal factors
1310:
1309:
791:10.1111/vox.12061
410:10.1002/pbc.20503
178:blood transfusion
173:Blood transfusion
80:. In contrast to
56:pass through the
39:
38:
19:Medical condition
2048:
1988:Infant mortality
1823:Erythema toxicum
1815:thermoregulation
1782:Gastrointestinal
1590:
1589:
1586:Affected systems
1463:
1431:
1416:Chorioamnionitis
1409:
1380:Placenta praevia
1373:
1364:
1363:
1337:
1330:
1323:
1314:
1313:
1251:
1250:
1239:
1228:
1222:
1221:
1211:
1179:
1173:
1172:
1136:
1130:
1129:
1097:
1086:
1085:
1079:
1071:
1069:
1068:
1062:
1056:. Archived from
1055:
1047:
1041:
1040:
1030:
1020:
996:
990:
979:
968:
967:
931:
925:
924:
912:
903:
902:
866:
860:
859:
849:
817:
811:
810:
774:
765:
764:
754:
730:
721:
720:
692:
679:
678:
650:
644:
643:
615:
609:
608:
572:
566:
565:
555:
523:
506:
505:
485:
479:
478:
460:
445:Immunohematology
436:
430:
429:
393:
387:
386:
380:
372:
370:
369:
360:. Archived from
354:
333:Hemolytic anemia
284:a by-product of
205:surface A and B
127:Thrombocytopenia
22:
21:
2056:
2055:
2051:
2050:
2049:
2047:
2046:
2045:
2011:
2010:
2009:
2004:
1961:
1945:Neonatal sepsis
1892:
1861:Musculoskeletal
1855:
1832:
1813:
1804:
1776:
1731:Hydrops fetalis
1682:
1673:
1650:
1623:Pleural disease
1581:
1543:Cephalohematoma
1522:
1484:
1457:
1452:
1425:
1420:
1399:
1394:
1367:
1359:
1357:
1351:
1341:
1311:
1306:
1305:
1282:
1281:
1262:
1248:
1243:
1242:
1229:
1225:
1180:
1176:
1137:
1133:
1098:
1089:
1073:
1072:
1066:
1064:
1060:
1053:
1051:"Archived copy"
1049:
1048:
1044:
997:
993:
980:
971:
932:
928:
913:
906:
867:
863:
818:
814:
775:
768:
731:
724:
693:
682:
651:
647:
616:
612:
573:
569:
524:
509:
486:
482:
437:
433:
394:
390:
374:
373:
367:
365:
358:"Archived copy"
356:
355:
351:
346:
324:
270:
216:
187:
140:
106:
101:
70:red blood cells
20:
17:
12:
11:
5:
2054:
2044:
2043:
2038:
2033:
2028:
2023:
2006:
2005:
2003:
2002:
1997:
1992:
1991:
1990:
1985:
1975:
1969:
1967:
1963:
1962:
1960:
1959:
1954:
1953:
1952:
1942:
1937:
1936:
1935:
1930:
1925:
1923:herpes simplex
1920:
1910:
1904:
1902:
1898:
1897:
1894:
1893:
1891:
1890:
1889:
1888:
1883:
1871:
1865:
1863:
1857:
1856:
1854:
1853:
1848:
1842:
1840:
1838:Nervous system
1834:
1833:
1831:
1830:
1825:
1819:
1817:
1806:
1805:
1803:
1802:
1797:
1792:
1786:
1784:
1778:
1777:
1775:
1774:
1769:
1768:
1767:
1757:
1751:
1750:
1749:
1748:
1743:
1733:
1728:
1727:
1726:
1721:
1716:
1711:
1706:
1695:
1694:
1688:
1686:
1675:
1674:
1672:
1671:
1666:
1660:
1658:
1656:Cardiovascular
1652:
1651:
1649:
1648:
1643:
1638:
1637:
1636:
1631:
1619:
1614:
1609:
1604:
1598:
1596:
1587:
1583:
1582:
1580:
1579:
1578:
1577:
1572:
1562:
1561:
1560:
1555:
1550:
1545:
1532:
1530:
1524:
1523:
1521:
1520:
1515:
1506:
1496:
1494:
1490:
1489:
1486:
1485:
1483:
1482:
1477:
1472:
1466:
1464:
1454:
1453:
1451:
1450:
1445:
1440:
1434:
1432:
1428:umbilical cord
1422:
1421:
1419:
1418:
1412:
1410:
1396:
1395:
1393:
1392:
1387:
1382:
1376:
1374:
1361:
1353:
1352:
1340:
1339:
1332:
1325:
1317:
1308:
1307:
1304:
1303:
1291:
1290:
1288:
1284:
1283:
1280:
1279:
1263:
1258:
1257:
1255:
1254:Classification
1247:
1246:External links
1244:
1241:
1240:
1223:
1174:
1147:(9): 1059–61.
1131:
1112:(1): 297–316.
1087:
1042:
991:
969:
926:
904:
861:
812:
766:
722:
680:
661:(6): 693–705.
645:
610:
567:
507:
480:
431:
388:
348:
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345:
342:
341:
340:
335:
330:
323:
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134:
131:
128:
125:
122:
119:
118:Cerebral Palsy
116:
113:
110:
105:
102:
100:
97:
37:
36:
33:
27:
26:
18:
15:
9:
6:
4:
3:
2:
2053:
2042:
2039:
2037:
2034:
2032:
2029:
2027:
2024:
2022:
2019:
2018:
2016:
2001:
1998:
1996:
1993:
1989:
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1981:
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1929:
1926:
1924:
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1919:
1916:
1915:
1914:
1911:
1909:
1906:
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1063:on 2021-03-09
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785:(4): 328–33.
784:
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779:Vox Sanguinis
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745:(2): 236–43.
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364:on 2005-03-01
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1629:Pneumothorax
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1528:Birth trauma
1470:Breech birth
1460:presentation
1458:
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1226:
1194:(1): F6–10.
1191:
1187:
1177:
1144:
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1134:
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1065:. Retrieved
1058:the original
1045:
1008:
1004:
994:
981:
942:(2): 113–6.
939:
935:
929:
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877:(2): 112–5.
874:
870:
864:
832:(3): 201–3.
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742:
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623:
619:
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580:
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538:(2): F83–8.
535:
531:
493:
489:
483:
451:(3): 105–8.
448:
444:
434:
404:(6): 861–2.
401:
397:
391:
366:. Retrieved
362:the original
352:
317:transfusion.
299:phototherapy
271:
233:
232:
217:
188:
185:Risk factors
99:Presentation
94:
86:
42:
40:
2036:Neonatology
1973:Miscarriage
1875:muscle tone
1741:Kernicterus
1594:Respiratory
1570:Erb's palsy
1475:Asynclitism
1443:Nuchal cord
1296:MedlinePlus
583:(1): 54–9.
496:(2): 61–4.
328:Coombs test
295:kernicterus
263:conditions.
124:Neutropenia
121:Kernicterus
2015:Categories
1983:Stillbirth
1940:Omphalitis
1901:Infections
1810:Integument
1106:Pediatrics
1067:2017-02-15
368:2007-12-09
344:References
338:Hematology
286:hemoglobin
82:Rh disease
50:antibodies
1709:Anti-Kell
1347:period /
1345:perinatal
1237:eMedicine
988:eMedicine
282:bilirubin
268:Treatment
247:anti-Kell
220:antenatal
214:Diagnosis
155:produced.
89:Caucasian
68:of fetal
66:hemolysis
31:Specialty
1679:Bleeding
1370:placenta
1218:12496219
1169:25144401
1161:20092394
1126:15231951
1076:cite web
1037:25722586
964:21936425
899:32155893
891:10379500
856:20212966
807:24789324
799:23802744
761:14413526
675:18866937
640:16338186
605:19663259
597:15578034
562:17337672
502:11508073
475:38090703
467:15373613
426:44546304
418:16007582
377:cite web
322:See also
278:jaundice
228:jaundice
218:Routine
207:antigens
58:placenta
1918:rubella
1548:Chignon
1402:chorion
1209:1755998
1028:4339947
956:7655573
847:2828194
717:2494315
553:2675453
234:Testing
60:to the
25:ABO HDN
1493:Growth
1406:amnion
1301:001298
1216:
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1167:
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560:
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500:
473:
465:
424:
416:
274:anemia
201:Fetal
198:cells.
138:Causes
74:anemia
1966:Other
1790:Ileus
1537:scalp
1277:773.1
1165:S2CID
1061:(PDF)
1054:(PDF)
960:S2CID
895:S2CID
803:S2CID
739:Blood
601:S2CID
471:S2CID
422:S2CID
62:fetal
1724:Rh E
1719:Rh D
1714:Rh c
1272:9-CM
1214:PMID
1157:PMID
1122:PMID
1082:link
1033:PMID
952:PMID
887:PMID
852:PMID
795:PMID
757:PMID
713:PMID
671:PMID
636:PMID
593:PMID
558:PMID
498:PMID
463:PMID
414:PMID
383:link
76:and
1812:and
1704:ABO
1699:HDN
1681:and
1268:ICD
1235:at
1204:PMC
1196:doi
1149:doi
1114:doi
1110:114
1023:PMC
1013:doi
986:at
944:doi
879:doi
842:PMC
834:doi
787:doi
783:105
747:doi
705:doi
701:114
663:doi
628:doi
585:doi
548:PMC
540:doi
453:doi
406:doi
203:RBC
152:IgG
148:IgM
78:HDN
47:IgG
41:In
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