Rhesus disease may be mild, moderate or severe and this will affect what treatment is needed. In more severe cases, treatment may need to begin before the birth of the baby. Phototherapy and blood transfusions are the most common treatment options.
Around 50% of babies with rhesus disease will have a mild case that does not usually require much treatment. However, your baby will need to be monitored on a regular basis as in some babies the symptoms of anaemia may be delayed.
Around 25% of affected babies have moderate symptoms. Phototherapy is often needed and blood transfusions may be used to speed up the removal of bilirubin (a substance created when red blood cells break down) from the body.
Around 25% of babies with rhesus disease will have a severe case and the baby will often need neonatal intensive care (NIC). Intensive phototherapy will be needed and a blood transfusion will be required.
Rhesus disease does not affect the mother physically, but there may be preventative treatment offered during or after the mother’s first pregancy. Read more about preventing rhesus disease.
Phototherapy
Phototherapy is treatment with light and it has been used since the early 1970s. The newborn baby will be placed under a halogen or fluorescent lamp with their eyes covered.
Fibre-optic phototherapy devices that use a blanket containing optical fibres have also been developed. The baby lies on the blanket and the light travels through the optical fibres and shines onto their back. In both methods of phototherapy, the aim is to expose the baby’s skin to as much light as possible.
Phototherapy lowers the bilirubin levels in the baby’s blood by photo-oxidation. This process adds oxygen to change a substance (in this case, the bilirubin) using the energy from light. The bilirubin is converted into a substance that dissolves easily in water. This makes it easier for the baby’s liver to break down the bilirubin and remove it from the blood.
If rhesus disease is confirmed, phototherapy should be started soon after birth because the bilirubin levels in the blood can rise quickly. If enough phototherapy is used, there may be less need for a blood transfusion.
During phototherapy your baby should be kept hydrated, because more water is lost through their skin and more urine is produced as their body expels the bilirubin. Your baby may need to have intravenous hydration (where water is given into a vein) if they cannot drink enough themselves.
Blood transfusions
Your doctor will decide whether the level of bilirubin in the blood is high enough to need a transfusion. Depending on the severity of your baby’s jaundice or anaemia, your baby may need to have more than one blood transfusion.
During a blood transfusion, some of your baby’s blood will be removed and replaced with blood from a suitable matching donor (someone with the same blood group). A blood transfusion normally takes place through a tube inserted into a vein (intravenous catheter). This process has two benefits:
- It removes some of the bilirubin that is present in the baby’s blood.
- It removes the antigens that were passed from the mother into the baby.
Removing the antigens means that red blood cells will no longer be broken down. The replacement blood does not contain bilirubin and therefore the overall levels of bilirubin in the blood will decrease. It is also possible for the baby to have a transfusion of just red blood cells to top up those they already have.
Intrauterine blood transfusion
In more severe cases, your baby may develop rhesus disease while still in the womb and they may need to be given a blood transfusion before birth (intrauterine foetal blood transfusion (IUT). Even if the disease doesn't cause anaemia before birth, it is likely that your baby will be born a bit early.
Your baby may require more than one IUT, depending on how severely they are affected by rhesus disease. Transfusions can be repeated every two to four weeks until your baby is mature enough to be delivered (usually 34 weeks). An IUT may decrease the need for phototherapy after birth, but more blood transfusions could still be necessary.
Intravenous immunoglobulin
Intravenous immunoglobulin is also called IVIG. The immunoglobulin is a solution of antibodies (proteins produced by the immune system to fight against disease-carrying organisms) that is obtained from healthy donors. Intravenous means injected into a vein.
IVIG may be used alongside multiple sessions of phototherapy if the level of bilirubin in your baby’s blood is continuing to rise at a rapid hourly rate. The IVIG works by preventing the destruction of red blood cells, so that the level of bilirubin in your baby’s blood will stop rising.
IVIG significantly reduces the need for a blood transfusion, however, it does carry some small risks.
It is possible that your baby may have an allergic reaction to the IVIG, but it is difficult to calculate how likely this is or how severe the reaction will be. It is also possible for a virus to be transferred through the donated immunoglobulin, although the process to screen donors should prevent this.
Concerns over possible side effects, and the limited supply of IVIG, mean that IVIG is only used when the bilirubin level is rising rapidly, despite multiple phototherapy sessions.
IVIG has also been used during pregnancy, in particularly severe cases of rhesus disease. It can help delay the point during pregnancy at which IUTs become necessary.
