An infant born to an Rh-sensitised mother has a cord blood haemoglobin of 9.5 g/dL and cord bilirubin of 6.2 mg/dL. Phototherapy is started. What additional intervention does this infant require?

• A Intravenous immunoglobulin alone
• B Exchange transfusion ✓
• C Repeat direct Coombs testing in 24 hours
• D Anti-D immunoglobulin to the newborn

Explanation

Exchange transfusion is indicated in haemolytic disease of the newborn when cord haemoglobin is below about 11 g/dL or cord bilirubin exceeds about 5 mg/dL, reflecting anaemia severe enough to have caused significant extramedullary erythropoiesis. IVIG is adjunctive in isoimmune haemolysis with rising bilirubin despite intensive phototherapy, not a substitute here. Anti-D to the newborn is meaningless since the damage is already done.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.