The Use of Anti-D Immunoglobulin for Rhesus D Prophylaxis
This is the third edition of this guideline, which was originally published in 1998 and revised in 2002 under the same title.
The development of anti-D antibodies usually occurs as a result of fetomaternal haemorrhage (FMH) in a rhesus D (RhD)-negative woman with an RhD-positive fetus. Post-delivery immunoprophylaxis using anti-D immunoglobulin (anti-D Ig) began in the UK in 1969. The programme has been an astounding success: deaths attributed to RhD alloimmunisation fell from 46/100 000 births before 1969 to 1.6/100 000 in 1990.
The recommendations in this edition of the guideline are taken from the updated review of the National Institute for Health and Clinical Excellence (NICE) technology appraisal guidance 1562 and from the Health Technology Assessment on routine antenatal anti-D prophylaxis (RAADP) for rhesus-negative women. Guidelines on RhD immunoprophylaxis were updated in 1976,4 19815 and 1991.6 However, RhD alloimmunisation continues to occur. There is clear evidence that the 1991 guidelines are not being fully applied. However, the most important cause of anti-D antibodies is now immunisation during pregnancy where there has been no overt sensitising event. Late immunisation, during the third trimester of a first pregnancy, is responsible for 18–27% of cases. Immunisation during a second or subsequent pregnancy probably accounts for a similar proportion of cases,although in this situation it is impossible to distinguish late sensitisation from failure of prophylaxis at the end of the preceding pregnancy. The recommendations in the 2002 RCOG Green-top Guideline of the same title were taken directly from the guidelines drawn up by a joint working group of the British BloodTransfusion Society and the RCOG. This guideline refers to the management of the non-sensitised RhD-negative woman.
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