Noninvasive management of Rh partial null (D--) to supplement traditional management of Rh isoimmunization.
BACKGROUND
Rh partial null (D--) is a rare cause of Rh sensitization in an Rh-positive patient. Noninvasive management for this condition using middle cerebral artery Doppler studies was used to reduce invasive testing.


METHODS
An Rh D+ woman had an antibody titer of 1:512 to Rh-17, the Rh Cc/Ee protein. Rh typing revealed absence of any antigens at the Cc/Ee locus. Her husband was Rh D--, ccee. Middle cerebral artery Doppler studies and serial amniocenteses for Delta OD(450) were performed. When testing suggested severe fetal anemia, two intrauterine transfusions were performed.


CONCLUSIONS
Middle cerebral artery Doppler studies can be used to predict fetal anemia before the first transfusion. However, the cutoff to predict subsequent anemia in Rh D-- after transfusion remains to be defined.
Bush
Melissa C
MC
Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, New York 10029, USA. melissa.bush@mssm.edu
Gaddipati
Sreedhar
S
Berkowitz
Richard
R
D000328:Adult; D000740:Anemia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D001783:Blood Flow Velocity; D001805:Blood Transfusion, Intrauterine; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011247:Pregnancy; D012203:Rh Isoimmunization / Q000150:complications / Q000628:therapy*; D018608:Ultrasonography, Doppler