When the mother is type O and the infant is type A blood. - page 2

Tell me what kind of problems you have seen when the mother has type O blood and the infant has type A. I know there is jaundice in SOME cases but how bad does it get and does it get worse with... Read More

  1. by   SteveNNP
    What happens is that either the "O" mother becomes sensitized to A/B antibodies through the environment or through some type of fetomaternal transfusion. Mom then produces IgG antibodies to the baby's blood type, which cross the placenta and attack the baby's RBCs. Only Type O mothers are thought to be capable of producing enough IgG antibodies to cause RBC hemolysis/jaundice in newborns. A/B type mothers produce mostly IgM and IgA, which do NOT cross the placenta.
    We had a baby recently whose mom was O+, and he was A+. He had a particularly bad reaction, and required 2- double volume exchange transfusions with O neg blood before his bili started falling.

    A Coombs test is sent on the baby's blood to detect if mom's anti AB IgG antibodies are present in his blood.

    Rh immunoincompatibilty is a completely different game.

    If an Rh negative mom gets pregnant with a Rh positive baby, she is given RhoGAM to destroy any fetal cells that may escape into her bloodstream and sensitize her to her baby's foreign blood type. Even if she does get sensitized, that baby will be ok, but the next Rh negative baby will have a hemolytic reaction when mom's antibodies cross the placenta and attack.
  2. by   Nicky30
    Great thread.

    I am O- and so is my daughter. She was under lights for 48hours due to jaundice (now that I am a student midwife I want to know more about neonatal jaundice). I had a precautionary Rhogam during that pregnancy as I had an amnio at 16 weeks.

    My son is O+ and they thought he was going to get jaudiced due to bruising from his rapid delivery. He never did. I got another dose of Rhogam at delivery.


  3. by   NurseNora
    In "the olden days" when I was a young nurse, we saw lots of Rh sensitized women. The babies were often induced early (before they died in utero) and required exchange transfusions after delivery. If you do family history research, you may find someone who had one child and many stillbirths, she was probably Rh negative married to an Rh positive man. If the man was heterozygous (one positive and one negative gene), he would be positive, but statistically one in 4 of his kids with a negative woman would be negative, and live.

    The positive babies of sensitized moms get very anemic because as the pregnancy progresses, some fetal cells get into maternal circulation and cause her to produce antibodies against the positive blood cells. These antibodies can cross the placenta and begin destroying the fetal cells. As the Hct gets lower and lower, the heart has to work harder trying to keep everything oxygenated. The baby becomes hydroptic and finally die unless something is done.

    When I worked in the Big City Medical Center, we used to do untrauterine transfusions for babies of sensitized moms. When the baby started getting sick, under ultrasonic guidance, a spinal needle would be inserted into the umbilical vein, the baby given a little pavulon to hold him still, and he would be transfused with packed cells until the Hct reached the desired level. This would be done as many times during the pregnancy as necessary until the baby was able to be delivered or died. It helped babies stay alive in utero until they were mature enough to stand a chance of survival in NICU.

    People with type O blood have no antigens, that's why they're the "Universal Donor". There are type A and type B antigens, if you have one, you're that type, if you have both, you're type AB. A Type O mother with a baby of another type can develop antibodies to that antigen and begin to produce antibodies against the baby's blood which can cause the same problems as Rh sensitization. I've never seen it be as severe as Rh sensitization, but it can cause problems. I don't recall ever doing a transfusion on a fetus with ABO incompatability; that's not to say that it hasn't been done.

    RhoGam works by giving a passive imminity to the Rh positive antigen so the mother's body never learns to make antibodies against it. When we first started using it, we just gave it at delivery. Now they give it once earlier in the pregnancy as well as at the end because of the tiny leaks between the two blood systems that naturally occur during the pregnancy. Once the mom's body has learned to make the antibody, the next time it encounters the same antigen, it makes antibodies faster and in larger quantities. That's why the first baby usually has little if any problem, but later babies have the major problems. Having the antibodies already there (that's basically what RhoGam is), means her body never has to learn to make them itself.

    Once again, I've run on and on. Sorry.
  4. by   CarrieH
    Quote from oramar
    Tell me what kind of problems you have seen when the mother has type O blood and the infant has type A. I know there is jaundice in SOME cases but how bad does it get and does it get worse with subsequent pregnancy? That is providing the subsequent infants are type A.
    I'm O+ and my son is A+. He had newborn jaundice, but didn't require bili lights. (My mom cheated and bought me a full spectrum light from home depot since it was winter and the windows were too drafty to sit by). He had a short period of time a normal skin color until he discovered sweet potatoes and butternut squash which turned him orange. :chuckle

    I didn't know anything about ABO incompatibility at the time (even though I worked for a pediatrician), but my daughter is O+ and wasn't jaundice at all.
  5. by   lindarn
    Quote from robynv
    i am O+ and my son is A+.
    He spent time in the NICU for many things due to his prematurity, but I read his records and one of the things listed was ABO incompatibiltiy. the nurses at the time said pretty much that sometimes these babies(Omom A baby) can get very jaundiced. I know my son spent much time under the bili lights. we called it his tanning booth.
    I am O+ and my daughter is A +. When she was born 18 years ago, she jaundiced within hours after being born. She had ABO in compatibility. She had + Coombs test that was run off of her cord blood. She was kept under the bili lamp for a few days, and was fine. I had a C- Section, so I was in the hospital while she underwent the bili lamp treatment.

    She is still fine, and a healthy 18 year old.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
  6. by   CEG
    Quote from racing-mom4
    And what about the Amish---some moms only go to midwives and may not get Rhogam.
    I know this is an old thread but as an FYI midwives give Rhogam. If they are in an area where they are not oracticing legally or able to prescribe I believe Mom just needs it within 72 hours of delivery so she could see anyone who can prescribe for it.
  7. by   jussocute
    I too am O+ and my daughter was A. She was jaundice when she was born and she remained in the hospital for three days. I was told it was because of our blood types.
  8. by   ElvishDNP
    It can be blood-type related, and a difference in blood type (esp if mom is O+) is definitely a setup for problems. But jaundice can occur when baby is same blood type as mom, and pleny of babies w/ different blood types never have jaundice issue.

    Just saying this for the record.