Why does Rhesus (Rh) incompatibility present a severe risk of hemolytic disease of the newborn primarily during a second or subsequent pregnancy rather than the first?
Answer and explanation
Correct answer: D. Maternal anti-D IgG and memory B cells develop following exposure to fetal Rh+ blood at delivery
An Rh-negative mother carrying an Rh-positive fetus is sensitized during delivery of the first child when feto-maternal hemorrhage occurs. The mother develops a primary immune response, producing memory B cells and anti-D IgG antibodies. In a subsequent Rh-positive pregnancy, maternal anti-D IgG antibodies cross the placenta via FcRn receptors and destroy fetal red blood cells (erythroblastosis fetalis). Administration of anti-D immunoglobulin (RhoGAM) prevents sensitization.
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