As medical management advances in this field, it is important that these patients be followed by high risk obstetricians/maternal-fetal medicine, and skilled neonatologists postpartum to ensure the most up to date and appropriate standard of care Antenatal * Routine prenatal labs drawn at the beginning of every pregnancy include a blood type and an antibody screen. Mothers who are Rh negative (A−, B−, AB−, or O− blood types) and have anti-D antibodies (found on the antibody screen) need to determine the fetus's Rh antigen. If the fetus is also Rh negative (A−, B−, AB−, or O− blood types) then the pregnancy can be managed like any other pregnancy. The anti-D antibodies are only dangerous to Rh positive fetuses (A+, B+, AB+, or O+ blood types). *The fetal Rh can be screened using non-invasive prenatal testing (NIPT). In the United States, BillionToOne, Inc. offers the Unity test. This test can screen for the fetus's Rh antigen (positive or negative) at the 10th week of gestation using a blood sample drawn from the mother. The Unity test uses NGS technology to look for Rh alleles (genes) in the cell free fetal DNA in the maternal bloodstream. In healthy pregnancies, at least 5% (fetal fraction) of the cell free DNA in the maternal bloodstream comes from the fetus (placenta cells shed DNA into the maternal bloodstream). This small fraction of cell free DNA from the fetus is enough to determine the fetus's Rh antigen. *Once a woman has been found to have made anti-D (or any clinically significant antibody against fetal red cells), she is followed as a high risk pregnancy with serial blood draws to determine the next steps * Once the titer of anti-D reaches a certain threshold (normally 8 to 16), serial Ultrasound and Doppler examinations are performed to detect signs of fetal anemia * Detection of increased blood flow velocities in the fetus are a surrogate marker for fetal anemia that may require more invasive intervention * If the flow velocity is found to be elevated a determination of the severity of anemia needs to ensue to determine if an intrauterine transfusion is necessary * This is normally done with a procedure called percutaneous umbilical cord blood sampling (PUBS or cordocentesis) * Intrauterine blood transfusion * Intraperitoneal transfusion—blood transfused into fetal abdomen * Intravascular transfusion—blood transfused into fetal umbilical vein—This is the method of choice since the late 1980s, and more effective than intraperitoneal transfusion. A sample of fetal blood can be taken from the umbilical vein prior to the transfusion. * Often, this is all done at the same PUBS procedure to avoid the needs for multiple invasive procedures with each transfusion Postnatal * Phototherapy for neonatal jaundice in mild<unk>  * Exchange transfusion if the neonate has moderate or severe<unk>  * Intravenous Immunoglobulin (IVIG) can be used to reduce the need for exchange transfusion and to shorten the length of phototherapy.
Rh disease
Rh deficiency syndrome
3-M syndrome
Fanconi anemia
3C syndrome
Leukocyte adhesion deficiency-1
X linked thrombocytopenia
NEMO deficiency syndrome