Transfus Med. 2026 Sep 4. doi: 10.1111/tme.70116. Online ahead of print.
ABSTRACT
The Rh-null phenotype is the rarest known red blood cell phenotype and is characterised by the complete absence of Rh antigens. During pregnancy, women with the Rh-null phenotype face unique challenges related to alloimmunisation against high-prevalence Rh antigens, haemolytic disease of the fetus and newborn, and the extremely limited availability of compatible blood for maternal or neonatal transfusion. We conducted a structured narrative review to identify published reports describing pregnancy-related or neonatal outcomes associated with the Rh-null phenotype, focusing on maternal antibody status, transfusion management, fetal monitoring, intrauterine intervention and maternal and neonatal outcomes. Eight reports published between 1983 and 2024 were identified. Anti-Rh29 was explicitly reported in three cases, whereas additional reports described panreactive antibody patterns consistent with antibodies directed against high-prevalence Rh antigens. Clinical outcomes ranged from mild neonatal haemolysis to severe fetal or neonatal disease. One pregnancy required intrauterine transfusion for severe fetal anaemia, and another neonate underwent repeated exchange transfusions because of severe haemolytic disease. Antenatal autologous blood donation was reported in one case as a proactive transfusion strategy. Pregnancy in women with the Rh-null phenotype requires advanced immunohaematologic investigation and specialised transfusion support. Early identification of Rh-null status, comprehensive antibody evaluation, coordinated maternal-fetal surveillance and proactive transfusion planning are central to management, ideally through multidisciplinary collaboration and access to rare donor resources.
PMID:42693881 | DOI:10.1111/tme.70116
