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Hemolytic disease of the newborn (HDN), with high potential for increased fetal loss is less common now, due to the universal screening for iso-sensitization and also because of appropriate use of antenatal anti-RhD antibody prophylaxis. There are other non-RhD antibodies that can cause HDN. In US, we occasionally encounter a highly sensitized fetus with significant morbidity and mortality. In utero RBC transfusions and Intravenous Immunoglobulin (IVIG) therapy for such an infant are effective to some extent, in the management of HDN. Partial exchange transfusions (immediately after the delivery) and double volume exchange transfusions are rarely but still, needed as rescue modes.