Final year‎ > ‎

14.03.12 Anti-D prophylaxis

Screening
  • Kleihauer screening test should beperformed within 2 hours of delivery
  • Identifies RhD-negative women with a large FMH who require additional anti-D Ig
Timing
  • Anti-D Ig should be given as soon as possible after the potentially sensitising event but always within 72 hours
Miscarriage
  • Anti-D Ig should be given to all non-sensitised RhD-negative women who have a spontaneous complete or incomplete miscarriage at or after 12+0 weeks of gestation
  • Anti-D Ig is not required for spontaneous miscarriage before 12+0 weeks of gestation, provided there is no instrumentation of the uterus
  • Anti-D Ig should be given to non-sensitised RhD-negative women undergoing surgical evacuation of the uterus, regardless of gestation
  • Anti-D Ig should be considered for non-sensitised RhD-negative women undergoing medical evacuation of the uterus, regardless of gestation
Threatened miscarriage
  • Anti-D Ig should be given to all non-sensitised RhD-negative women with a threatened miscarriage after 12+0 weeks of gestation
  • In women in whom bleeding continues intermittently after 12+0 weeks of gestation, anti-D Ig should be given at 6-weekly intervals
  • Consider in non-sensitised RhD-negative women if there is heavy or repeated bleeding or associated abdominal pain as gestation approaches 12+0 weeks
Ectopic pregnancy
  • Anti-D Ig should be given to all non-sensitised RhD-negative women who have an ectopic pregnancy, regardless of management
Therapeutic termination of pregnancy
  • Anti-D Ig should be given to all non-sensitised RhD-negative women having a therapeutic termination of pregnancy, whether by surgical or medical methods
Prophylaxis following sensitising events before delivery
  • A minimum dose of 250 iu is recommended for prophylaxis following sensitising 
    events up to 19+6 weeks of gestation
  • For all events at or after 20+0 weeks of gestation, a minimum dose of 500 iu anti-D Ig should be given and a test to identify FMH greater than 4 ml red cells performed
  • Additional anti-D Ig should be given as required
  • In the event of recurrent vaginal bleeding after 20+0 weeks of gestation, anti-D Ig should be given at a minimum of 6-weekly intervals
Routine antenatal prophylaxis (RAADP)
  • RAADP should be offered to all non-sensitised RhD-negative women
  • RAADP is not required in women who are RhD sensitised
  • RAADP is a completely separate entity from the anti-D Ig required for potentially sensitising events
Postnatal prophylaxis
  • At least 500 IU of anti-D Ig must be given to every non-sensitised RhD-negative woman 
    within 72 hours following the delivery of an RhD-positive infant
  • A test to detect FMH greater than 4ml must also be undertaken so that additional anti-D Ig can be given as appropriate
  • If the pregnancy is non-viable and no sample can be obtained from the baby, anti-D Ig should be administered to a non-sensitised RhD-negative woman
Comments