Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Rh Incompatibility


Related Terms

  • Hemolytic Disease of the Newborn
  • Rh-induced Hemolytic Disease of the Newborn
  • Rhesus Isoimmunization

Differential Diagnosis

  • Another blood incompatibility disorder (rare)

Specialists

  • Gynecologist
  • Obstetrician/Gynecologist

Comorbid Conditions

Factors Influencing Duration

In rare cases of transfusion-related incompatibility, the possible complication of kidney dysfunction may influence length of disability.

Medical Codes

ICD-9-CM:
656.10 - Fetal and Placental Problems Affecting Management of Mother, Other, Rhesus Isoimmunization; Anti-D [Rh] Antibodies; Rh Incompatibility, Unspecified as to Episode of Care or Not Applicable
656.11 - Fetal and Placental Problems Affecting Management of Mother, Other, Rhesus Isoimmunization; Anti-D [Rh] Antibodies; Rh Incompatibility, Delivered, with or without Mention of Antepartum Condition
656.13 - Fetal and Placental Problems Affecting Management of Mother, Other, Rhesus Isoimmunization; Anti-D [Rh] antibodies; Rh Incompatibility, Antepartum Condition or Complication

Overview

Rh incompatibility refers to a difference between the Rh factor of a pregnant woman and that of her developing fetus, causing anti-Rh antibodies to develop and resulting in a serious, sometimes life-threatening reaction in the fetus. Rh refers to a group of protein molecules on the surface of the red blood cells that are unique to each person. Within this blood group, Rh0(D) is the protein that usually causes incompatibility problems. If red blood cells have Rh0(D) molecules, the blood is Rh-positive; if they do not, the blood is Rh-negative.

Problems develop when the mother has Rh-negative blood and the fetus has Rh-positive blood (inherited from a father who has Rh-positive blood). Should red blood cells from the fetal circulation leak into the maternal circulation, particularly late in pregnancy or during delivery, her system will not tolerate the presence of these Rh-positive cells. This causes her immune system to treat the Rh-positive fetal cells as if they were a foreign protein or substance and make antibodies against them. These anti-Rh-positive antibodies move through the placenta into the fetus, causing the red blood cells of the fetus to rupture (hemolyze).

The ruptured red blood cells create an increase in the waste product bilirubin (hyperbilirubinemia), which can be toxic to the infant's brain (kernicterus). A more serious concern is a life-threatening condition in which the red blood cell destruction results in severe anemia, heart failure, and generalized edema. This can occur in the fetus before birth (erythroblastosis fetalis) or in the infant immediately following birth (erythroblastosis neonatorum).

During a first pregnancy, the fetus or newborn rarely has problems because no significant contact occurs between the fetus's and mother's blood until delivery. However, certain events during the first Rh-incompatible pregnancy can cause mixing of the fetal and maternal blood and increase the risk of Rh-incompatibility problems in subsequent pregnancies. These events may include leakage between the blood of the fetus and the mother (antepartum fetal-to-maternal transfusion), spontaneous abortion (miscarriage), tubal (ectopic) pregnancy, intentional abortion, premature separation of the placenta (abruptio placentae), abdominal trauma, chorionic villus sampling, amniocentesis, fetal blood sampling (precutaneous umbilical blood sampling, or PUBS), turning a breech presentation (external cephalic version), and manual removal of the placenta.

Incidence and Prevalence: About 15% to 20% of the white population and 5% to 10% of the black population are Rh-negative, while fewer than 5% of Chinese and Native Americans have Rh-negative blood (Salem). Screening for these blood type incompatibilities is part of standard prenatal care. Preventative immunization of those at risk has been so effective that only 11 or every 10,000 Rh-positive babies born by Rh-negative women develop side effects related to incompatibility (Wagle). For those who do not receive prophylactic treatment, the risk of fetal-neonatal Rh incompatibility is much higher. Even then, only about 17% of Rh-negative women who are exposed to Rh-positive red blood cells actually develop antibodies to the Rh protein.

Source: Medical Disability Advisor



Causation and Known Risk Factors

With each subsequent Rh-incompatible pregnancy, the mother becomes more sensitized to Rh-positive blood, produces antibodies earlier, and creates greater risk for the fetus or infant. Aside from pregnancy, rare cases of Rh incompatibility have been reported in individuals who have received a transfusion of incompatible blood.

Source: Medical Disability Advisor



Diagnosis

History: Rh incompatibility rarely causes symptoms in the pregnant woman, although it may cause symptoms in the fetus or infant that range from very mild to death of the newborn. A pregnant woman usually gives a history of a previous pregnancy, miscarriage, and/or abortion.

Physical exam: There are no signs or symptoms in the mother who has Rh-negative blood. Therefore, the physical exam is usually normal for pregnancy.

Tests: A woman's blood group is identified at her first prenatal visit. Individuals with Rh-negative blood are tested for the presence of Rh antibodies at this and subsequent visits (usually at 28 weeks gestation). Additional tests may include indirect Coombs test and antibody titer. The fetal blood type and blood count may be tested by taking a sample by PUBS. An amniocentesis may be performed to obtain fluid for assessing the degree of fetal hemolysis and determining fetal bilirubin level.

After birth, a Kleihauer-Betke test may be done to measure the number of fetal cells in the maternal circulatory system. Tests done on the newborn include a hematocrit, mean corpuscular volume, ABO blood typing, Rh group, serum bilirubin level, and direct Coombs test.

Source: Medical Disability Advisor



Treatment

Treatment is initially aimed at preventing any reaction to blood type incompatibility. An Rh-negative woman in her first pregnancy (desensitized) is given an injection of Rh(D) immune globulin (RhoGAM) at 28 weeks. This injection inactivates any of the baby's blood cells that enter the mother before she becomes sensitized to them. At birth, if the infant is Rh-positive, the mother is given RhoGAM again.

RhoGAM is also given to women after a miscarriage, abortion, amniocentesis, or any other procedure that might result in exposure of the mother to fetal blood cells. It is also given if antepartum (before the delivery) hemorrhage occurs.

If the pregnant woman is sensitized from a previous pregnancy, ultrasound and periodic analysis of amniotic fluid are done to monitor the status of the fetus. If necessary, the fetus is given an intrauterine transfusion to correct anemia. If the fetus is severely affected, labor may be induced and the baby promptly delivered.

In the rare case where incompatible blood is transfused (Rh-positive blood given to Rh-negative recipient), the transfusion is promptly stopped. The individual is monitored for worsening signs and symptoms (including fever, chills, and backache). Generally, symptoms subside once the transfusion is stopped.

Source: Medical Disability Advisor



Prognosis

Preventatively treating Rh-negative mothers with RhoGAM effectively prevents Rh incompatibility in most cases. In those women who do not receive preventative treatment, in subsequent pregnancies the fetus may be severely compromised. The fetus may need a blood transfusion in the uterus before birth or may be born with anemia, which can cause jaundice and breathing problems for the newborn. The fetus may also die in the womb.

Source: Medical Disability Advisor



Complications

Complications include rupture of red blood cells (hemolysis) in the fetus or newborn, elevated blood bilirubin (hyperbilirubinemia), erythroblastosis fetalis, erythroblastosis neonatorum, kernicterus, and hydrops (edema). Reactions following transfusion with incompatible blood may be complicated by acute kidney failure.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Generally, there are no work restrictions or accommodations for the mother upon return to work. However, for those who received an intrauterine transfusion, strenuous activity and heavy lifting may be temporarily restricted.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does the mother have Rh-negative blood? Is the fetus Rh-positive?
  • Has individual received a transfusion with incompatible blood?
  • Does individual have a history of previous pregnancy? Miscarriage? Abortion?
  • Has the mother been screened for Rh incompatibility?
  • Was it necessary to obtain a fetal blood sample (PUBS)?
  • Was an amniocentesis done?
  • After birth, was a Kleihauer-Betke test, hematocrit, mean corpuscular volume, ABO blood typing, Rh group, serum bilirubin level, and direct Coombs test done?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Is this a first pregnancy?
  • Has individual been given RhoGAM at 28 weeks of pregnancy? Did she receive it again at birth if the infant is Rh-positive?
  • Was RhoGAM also given to the woman after a miscarriage, abortion, tubal pregnancy, or amniocentesis?
  • Was it also given if antepartum hemorrhage occurred?
  • Is the pregnant female sensitized from a previous pregnancy?
  • Have ultrasound and periodic analysis of amniotic fluid been done?
  • Was it necessary to give the fetus an intrauterine transfusion?
  • Did it become necessary to induce labor?
  • If the reaction was due to a transfusion, was it immediately stopped?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that could affect ability to recover?
  • Was individual monitored for signs of kidney dysfunction?

Source: Medical Disability Advisor



References

Cited

Salem, Leon. "Rh Incompatibility." eMedicine. Eds. Assaad J. Sayah, et al. 11 Dec. 2001. Medscape. 4 Jan. 2005 <http://emedicine.com/emerg/topic507.htm>.

Wagle, Sameer, and Prashant G. Deshpande. "Hemolytic Disease of Newborn." eMedicine. Eds. Itani Oussama, et al. 14 Mar. 2003. Medscape. 4 Jan. 2005 <http://emedicine.com/ped/topic959.htm>.

Source: Medical Disability Advisor






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