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Ask Dr. Craig!: Rhesus Incompatibility

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Dr. Craig is a BellaNaija columnist and one of the doctors who writes for BN Doctors’ Lounge {Get familiar here}. The idea behind ‘Ask Dr. Craig!‘ is for BN readers to get quick sharp answers to niggling medical issues that they have. This does not in anyway mean that readers should not go to their doctors. However, sometimes you just need a human face to give answers to those fast, burning medical concerns our readers have.

Send your questions for Dr. Craig to features(at)bellanaija(dot)com stating your full name and where you are writing from. (Your name will never be published) The editor reserves the right to edit submissions for content brevity and clarity. We regret that we cannot provide individual answers to questions sent in and cannot state at which exact date answers would be published.

***
Dear Dr. Craig

I read your article on Sickle Cell Disease and was very impressed by the simplicity and ease with which you detailed the options available to couples who both have the AS genotype. I and my boyfriend at the time (now fiancé) read it and decided to get our genotypes checked and found out that we are both AA. (Yay!)

However, we also ran a couple of other tests and while the nurse assured us that all the others were okay, she mentioned that our “Rh” blood groups were incompatible and that we should come back to see the doctor for explanation.

Rh??? I thought it was only AS and SS we had to be worried about!
Please what is this Rh blood group and I hope the options available are not as expensive or as heartbreaking as those that AS/AS couples face?

(p.s Please nobody should tell me I have to look for another man o, ehen. Because I don’t think I can live without my boo and there are no men left in Lagos anyway.)

My-boo-and-I-forever. Agungi, Lagos

—–

Dear Miss My-boo-and-I-forever,

First of all, congratulations on your engagement!
I’m happy to hear that you and your fiancé found the article on Sickle Cell useful and that you have both decided to spend the rest of your lives together.

So, there’s good news and there’s not-so-good news.

-The not-so-good news is that your nurse was right. There is such a thing as the Rh (Rhesus) blood group and couples who are incompatible stand a chance of having a child that is either stillborn or born severely ill.
-The good news is that preventing the complications that can occur as a result of Rhesus incompatibility are very simple and relatively very affordable.

Before we talk about the prevention of Rhesus disease of the newborn, let’s quickly look at what causes it in the first place.

The Immune System: Antigens and Antibodies
Our bodies have a sophisticated network of defence systems that protect us from infection and disease and one of the most important of these is our immune system. The immune system is a combination of cells and chemicals and signals and receptors that help to keep our body free from invasion and infection by parasites bacteria and viruses.
So how does the immune system work?

Our immune system is so effective because it can distinguish between cells that belong to us and cells that are foreign. The default setting in our bodies is to attack and destroy all foreign cells because the body automatically assumes that they are likely to be bacteria or viruses or parasites.
When a person is exposed to a bacteria virus or parasite for the first time, the body recognises the foreign cell and immediately dispatches fighter “spy” cells to ‘learn’ how to kill the invader. These spy cells look for particles on the surface of the invading cell that they can exploit as a gateway to destroy it. These particles are called Antigens. Once the spies identify a weakness in the invaders biochemistry, they signal the barracks (bone marrow) to begin a full scale production of targeted missiles specially designed to destroy the invader. These “missiles” are Antibodies. The bone marrow also begins an intense training of specialised commando killer cells specific for the identified invader (white blood cells known as Activated T-cell lymphocytes) who will assist in the ground offensive.

Once the threat is eliminated, the antibodies remain in the body on alert and if the same invader enters the body again, they will be ready to seek out and destroy it.
Antigens are not just present on germs and parasites. In fact practically every cell including human cells have antigenic particles on their surfaces too. The difference is that the body recognises your antigens and does not attack them.

The red blood cells in our bodies have a vast range of antigens on their surface and these antigens are classified according to different groups. The most common of these are the A, B, AB and O blood groups that most people are familiar with. These antigens are particularly important when it comes to blood transfusions because the foreign blood cells could trigger the patient’s immune response. This is why before a person receives blood the doctors run a grouping and crossmatch test to ensure that the patient’s body does not have antigens in their blood that will attack and destroy the donor’s blood.

The Rh blood grouping system is a way of classifying a different group of antigens that are present on the red blood cells of humans and these are called the Rhesus antigens. There are three rhesus antigens but the one that has the most clinical significance is the Rhesus D antigen.
If a person’s red blood cells have the Rh D antigen on its surface then they are positive (+) and if they don’t have it they are negative (-).
What this means is that if a person without the antigen (-), comes in contact with blood that carries the antigen (+), their body will identify those (+) cells as foreign and destroy them.

rhesus

If a woman who is Rh (-) marries a man who is Rh(+) and gets pregnant, there is a tendency that her baby would inherit the Rh(+) antigen from its father. When this happens, the mothers body will identify the baby’s blood as foreign cells because the Rh(+) antigen is not present in her own body. As soon as the baby’s cells come in contact with the mother via the placenta (or during the course of delivery) the mothers body dispatches the “spy” cells to identify the antigen on the baby’s cells and signals the bone marrow to produce antibodies to destroy them. The first pregnancy usually does not have any problems because the “missiles” and “commandos” are still in production and training, but as soon as the woman gets pregnant again with another Rh(+) baby, her immune system kicks in and begins to attack the “foreign” cells in her womb. Depending on how aggressive the immune response is, the mother’s body could completely kill off her own baby or at best the baby could be born severely ill.
This is what we mean by Rhesus incompatibility

Prevention of Rh Disease of the new born
Rh (-) women can marry Rh(+) men and have healthy babies but they must receive an injection to inactivate the Rh (+) cells as soon as any event occurs that may cause the baby’s blood to mix with the mothers blood before the immune response is activated. The scenarios that can make baby’s blood come in contact with mother’s blood are:
1. Miscarriage
2. Termination of pregnancy
3. Bleeding during pregnancy (Placenta Previa /Abruption of Placenta)
4. Any testing that involves taking a sample from the baby while still in the womb (i.e. Chorionic Villous Sampling (CVS) or Amniocentesis)
5. Vaginal delivery
6. Traumatic Caesarean section delivery

Prevention of the initiation of the immune response is critical because once it occurs the antibodies will remain in the woman’s body indefinitely and will attack all subsequent pregnancies that are Rh (+). Note that if a woman is Rh(+) there is no risk of Rhesus disease of the new born since her body already has Rh antigens and would not recognize it as foreign if her baby has it too

Treatment of Rh Disease of the new born
As with all things, prevention is better than cure.
The treatment for babies whose mother’s immune systems have launched an attack on their blood cells is intense and can easily be avoided.
Babies suffering from Rhesus Disease will need to have frequent blood transfusions while still in the mother’s womb. This is done by passing a needle into the baby’s heart through the mother’s womb under ultrasound guidance or through a vein in the umbilical cord. Depending on the severity, these transfusions may have to be repeated as often as every 7-10 days.
In severe cases, as soon as the baby reaches 34 weeks, the doctors may take the decision to deliver the baby prematurely and remove it from the continued attack of the mother’s immune system.

So you see, it is perfectly safe for you to go ahead and marry your fiancé but it is very important that you let your doctors know your full and complete past obstetric history so as to give them all the information necessary to adequately prepare for you when you choose to get pregnant.

I hope this helps put your mind at ease and I wish you and your “boo” all the best with everything.

***Disclaimer: This column is written for patient education. It is not intended to diagnose or prescribe treatment and does not replace the advice of your physician. It in no means attempts to cover the full medical scope of this condition.

Photo Credithttp://i44.tinypic.com/hs6s0g.jpg

 

David Olamide Craig is a Pastor, Physician, Sex Educator and Relationship counsellor. Follow him @RevDrCraig or visit www.surulerelove.com

48 Comments

  1. Ayaba

    October 8, 2014 at 12:34 pm

    Woooow!! This is how we know who has a mastery of their work. I had just a vague idea abt this Rhesus incompatibility thingy. But now, i have been totally educated. Well done Doc!!!
    #CommandoKillercells lol

  2. Nk

    October 8, 2014 at 12:35 pm

    Hi Dr Craig,

    i am AA O+ and my fiance is AA O-. Should we be worried?

    • Ayaba

      October 8, 2014 at 12:44 pm

      If i understood the Doc well, i think you would also need dat injection to prevent the body from produces those commando killer cells that will attack your baby(ies).

    • Ayaba

      October 8, 2014 at 12:51 pm

      If i understood the Doc very well, then you wld need that injection to prevent your body from producing those commando killer cells from attacking your baby(ies).

    • Aibee

      October 8, 2014 at 2:15 pm

      From my understanding of the Article, if you are a female and O+, and your fiancé is O-, there are no Rhesus D antigens on his red blood cells for your body to fight. So figuratively speaking, your blood cells would be indifferent to him and just siddon look. If you both are O+, the blood cells would register as family and wouldn’t fight. If you are O- and he is O+, your blood doesn’t have the Rhesus D antigens and so wouldn’t detect any invader.

      Abeg, Dr. Craig and other doctors here, come and help clarify this point. Thank you.

    • Ayaba

      October 8, 2014 at 2:51 pm

      OOOh Okay!!! i had to read further and i got this sentences ‘If you are an Rh-Positive (Rh+) woman, there is no concern for you regardless of your partners blood factor.’
      okaaay!! means i misunderstood. the way i understood it at first was like they must be thesame, the moment there is a +ve and -ve (regardless of gender), problems will occur during preg. But i now understand that if a woman is Rh+, she need not worry.
      Please let the doctors in this forum validate this.

    • Lau

      October 8, 2014 at 9:09 pm

      Dats exactly what he explained. Being rh- doesn’t mean ur body can’t detect the invader please. When u are rh- ur body will recognise any rh- foetus as a foreign agent (invader).

    • tee

      October 8, 2014 at 2:28 pm

      no worries dear, i’m AA O- and my husband is AA O+, all you need to do is make sure you dont miss your dose of rhogan injection which will protect your baby, i have 3 healthy kids and i took the Rhogan injection twice, once during pregnancy and 1 immediately i deliver my baby.

    • ziba

      October 9, 2014 at 8:45 am

      thankyou for saying ur neg and have 3 healthy kids wit a positive huby.. i am neg n hv positiv fiance..howver i knew abt rhesus factor n dat injection while in university but hv not come across pple who hv dis issue n took d injection….tanks for giving me more hope.

    • Akua Y

      October 8, 2014 at 2:42 pm

      No, Nk you dont need the injection since you are Rh+ regardless of whether your fiance is Rh+ or Rh- there will be no problem.
      However if it were the other way around and you were negative and your fiance was Rh+, you would need the injection after your first child or any of the scenarios he mentioned.

    • Dr. Craig

      October 8, 2014 at 4:38 pm

      Hi Nk,
      If you are O+ve it means you have nothing to be concerned about. Your body already has the Rhesus antigens and would not identify it as foreign if any of your children are Rh + too.

    • nk

      October 8, 2014 at 6:33 pm

      Thank You Dr Craig…..my mum actually hinted this yesterday when my fiance said he was O-. i guess it’s all clear now.
      God bless you!

  3. Ayaba

    October 8, 2014 at 12:38 pm

    Wooooow!!! this is how we can tell of a person who has a mastery of their work. I had just a vague idea of what Rhesus incompatibility was all about, but now i have been educated! totally and completely! Well done Doc!!!
    #CommandoKillerCells lol

    • Akua Y

      October 8, 2014 at 2:44 pm

      Nope, you still don’t understand the concept dear….

  4. makeupbyebi

    October 8, 2014 at 12:41 pm

    Thank you Dr. Craig 🙂

  5. Aibee

    October 8, 2014 at 12:49 pm

    Thank you BN, thank you Dr. Craig. I’d mentally planned to google this Rhesus Factor thing today so this Article couldn’t have come at a better time for me. LEt me read and digest it well and come back to comment.

    • Aibee

      October 8, 2014 at 2:17 pm

      Back! From what I’ve read here today, it’s better for a woman to be positive for the rhesus antigen. That way, her body doesn’t fight whatever antigen her husband brings to the table.

  6. Baby

    October 8, 2014 at 12:59 pm

    Meeeem dr Craig is hot eeeeeeh……..lol.

    • Fols

      October 8, 2014 at 1:23 pm

      Erm…do you mean mentally or physicaly?

    • Susu

      October 8, 2014 at 10:37 pm

      All…mentally, physically ati be be lo,

  7. FIRSTLADY

    October 8, 2014 at 1:05 pm

    Dr Craig God bless you abundantly for this information. you totally enlighten my knowledge and precautions cause am negative.Thank you

  8. Baby

    October 8, 2014 at 2:01 pm

    Lol….physically of course…but he sounds intelligent too

  9. ama

    October 8, 2014 at 2:18 pm

    Dr. Craig, your picture is distracting

    Please change it so people can listen to you better

    God bless Nigeria!

    #thanksforeducatingus

    • iyke

      October 8, 2014 at 2:27 pm

      That picture is the reason why am not even reading all these stuffs he’s saying.Who is smiling for sef? Am not in the mood for this face now…rain no gree person comot for house, you come dey show this face dey make me vex more.Biko wepu picture a now.
      #bodydeybiteme

    • iyke

      October 8, 2014 at 2:29 pm

      change picture like Isio make we see another look. I don tire for this look. Change picture abeg ….you no fine again for my eyes. lol

    • Pat

      October 8, 2014 at 8:27 pm

      LOL Ama u are too funny 🙂

    • Honey

      October 9, 2014 at 1:25 am

      Hahaha hahaha guuuurrrl u spoke my mind hunnaaay……i was like “aah ah…All I wana do is see Dr Craig all night, somebody find me Dr Craig” lmao

  10. tee

    October 8, 2014 at 2:35 pm

    I’m aa o- while my husband is aa o+, with rhogan injection, nothing happens to my babies (i have 3 kids now), the injection is a bit expensive but that shouldn’t be an issue if you want to deliver a live baby and not have still birth. it was new to me when my doctor was educating me on its importance and the need for me to get the drug, also the last dose of the drug is to protect the next baby and on my second baby i told the doctor i wasn’t planning on having a third baby but she insisted i take the injection, alas i got pregnant with a third baby years later. No one with the rhesus factor should compromise on getting the injection for peace of mind sake and sake of your unborn child.

  11. Nenye

    October 8, 2014 at 2:44 pm

    Wow never took the stuff seriously but God is a master planner, myself and my fiancee we are both AA genotype and bloodgroup O positive. not that i would have dropped him if its the other way round.the guy no dey two in this world.

  12. addy

    October 8, 2014 at 3:22 pm

    So you can be a doctor without going to med school? One can have a bachelor in medicine and surgery? I thought you go to med school for that?
    Interesting that Dr. craigs’s passion all starts with a “p”
    coilsandglory.com

    • Monsignoir

      October 8, 2014 at 3:54 pm

      Aunty Adddy
      MBBS is the same thing as Bachelor of Medicne and Bachelor of Surgery!!!
      That is what they graduate with when they go to “MED” school.

  13. ajay

    October 8, 2014 at 3:54 pm

    I thought there is an injection given to mums with the RH factor which makes it easy for them to be pregnant without the antigens attacking the baby? I am saying this because two of my sisters had to take the injection after the birth of each child and they were able to have 3 successful childbirths. Your suggestions are so bleak am worried.

  14. Liv

    October 8, 2014 at 4:01 pm

    What if you don’t know your husband’s rhesus? For unusual reasons? And the woman is (-)? Should she take the injection anyways?

    • tee

      October 9, 2014 at 3:28 pm

      i believe all hospitals that do child delivery MUST get you and your hubby’s blood group and genotype, its part of the ante natal process. its even the first step of registering for antenatal in any general and most private hospitals i’ve been to.

  15. Dorababe

    October 8, 2014 at 4:08 pm

    Hmmnn…Interesting! Now I understand why some women don’t why they lose their babies at birth…Knowledge they say is power, Am glad u shared this…Thanks Dr Craig!!!

  16. priscy

    October 8, 2014 at 5:07 pm

    Wow!!dis explanation is so simplified n wonderful,,,pls keep up the gud work,,am inspired

  17. mee-yow

    October 8, 2014 at 7:34 pm

    Didn’t really read the article cos I’m in medical school and I know what this is about..seems he explained it really well though. Just dropped by to say, Dr. Olamide Craig, you’se a cutie! K byeee

  18. fyre

    October 8, 2014 at 7:42 pm

    i think the injection is called “Rhogam” not “Rhogan” unless its called something different in other countries, it is given to a woman with Rh incompatibility at 28 weeks of pregnancy and within 72 hours after birth.

  19. deeva

    October 8, 2014 at 11:20 pm

    well done dr Craig for such a brilliant explanation. however, you didnt add that a woman may be sensitized if she had an abortion at some point in her life (maybe before she got married) and that will count as the first pregnancy and exposure to a rhesus positive fetus so that by the time she gets married, she may have a still birth baby and other complications of rhesus incompatibility. this reason is why people should always give correct and accurate past medical history to their doctors.
    secondly, you may be sensitized as a woman if you have previously been transfused with a rhesus positive blood. probably in an emergency where the person needed urgent blood transfusion. this would also count as the first contact/exposure to rhesus positive antigens and the antibodies would be formed already in the woman and so in pregnancy, if her husband is rhesus positive, there would be rhesus incompatibility and a still born child.

    • Morin

      October 9, 2014 at 7:52 am

      Doro Deeva
      He did mention termination of pregnancy and miscarriage as well as blood transfusion. Please read the article again.
      (PS. Don’t do this in your exam o. Its actually better to READ the question first before writing an answer)

  20. jumoke

    October 9, 2014 at 11:22 am

    thanks alot doc. this helped

  21. Kemmy

    October 9, 2014 at 3:29 pm

    What if the husband is rhesus – and the wife is + , then has a – foetus. Does the rules apply?

  22. Gracie

    October 10, 2014 at 10:53 am

    Good one Dr. This is informative and helpful to me particularly now that i am planning to settle down on the other hand i noticed that the Dr is still single. Bellanaijarian single/searching ladies launch out to the deep.

    • Tooke

      October 14, 2014 at 7:37 am

      Single Ke? This one went off the shelves a looong time ago. Trust me I would know. I stalked him for months only to find out that he’s engaged and quarter to marry 🙁
      Bella stop tormenting us oooooo!

  23. iwueke charles

    December 26, 2014 at 12:26 pm

    Dr Graig.i want to ask a question concerning this blood group of a thing,because I’m confused about it.my question goes this way.if a Rh+ man marry A Rh+ woman will there be a chances of problem occurs between to of them or their baby..

  24. henry

    January 20, 2016 at 11:43 pm

    Pls if me and my girl is AA in genotype and the blood group my b+ and her own is o+ can will get marry

  25. Rita

    May 6, 2016 at 7:56 am

    What if the women and man are both RH+?

  26. Maame Aduwaa

    October 31, 2016 at 2:37 pm

    My fiancé is B positive blood group .snd I have o positive blood group. Can have a child in future

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