Recurrent Rhesus alloimmunization with early-onset severe fetal anaemia in a low-resource setting: a case report

Fetal anaemia due to Rhesus alloimmunization remains a significant cause of perinatal mortality and morbidity in low- and middle-income countries (LMICs), where the unaffordability of anti-D immunoglobulin compromises the care of Rhesus-negative women. We report a case of a 37-year-old multiparous RhD-negative woman who presented at 18+2 weeks of gestation with a history of recurrent fetal losses attributed to recurrent Rhesus alloimmunization. Serial fetal cerebral blood flow assessments demonstrated progressively worsening anaemia, prompting two intrauterine transfusions. Despite intervention, intrauterine fetal demise still occurred. This case highlights the aggressive course of recurrent Rhesus alloimmunization and the challenges of management in a low-resource setting.