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Citation Information : Immunohematology. Volume 32, Issue 3, Pages 108-111, DOI: https://doi.org/10.21307/immunohematology-2019-055
License : (Transfer of Copyright)
Published Online: 09-October-2019
Despite the existence of long-standing, well-organized programs for Rh immune globulin (RhIG) prophylaxis, immune anti-D continues to be detected in the D– perinatal population. Between 2006 and 2008, 91 prenatal patients, found to have a previously unidentified anti-D, were followed up with a survey to their treating physician and with additional serologic testing where possible. The physician survey requested pregnancy and RhIG history information, including recent or distant potential alloimmunizing events, and the physicians were asked their opinion on the likely cause for the anti-D. Based on survey responses, updated RhIG information, and results of follow-up serology, anti-D was determined to be attributable to previously unreported RhIG in 44 of 91 (48.3%) cases and to active immunization (immune anti-D) in 36 of 91 cases (39.6%). A probable cause for alloimmunization was reported in 14 of 52 (26.9%) returned surveys. Anti-D alloimmunization continues to occur in our prenatal population despite a comprehensive approach to RhIG therapy. Observations from this prospective patient management strategy include the need for improved application of guidelines for RhIG administration and improved quality of information provided to laboratories assessing RhIG eligibility. A laboratory process for prospective follow-up when unexpected anti-D is detected in pregnancy is recommended.
1. Huchcroft S, Gunton P, Bowen T. Compliance with postpartum Rh isoimmunization prophylaxis in Alberta. Can Med Assoc J 1985;133:871–5.
2. Lloyd Jones M, Wray J, Wight, J, et al. A review of the clinical effectiveness of routine antenatal anti-D prophylaxis for rhesus-negative women who are pregnant. Br J Obstet Gynaecol 2004;111:892–902.
3. Bowman JM, Chown B, Lewis M, et al. Rh isoimmunization during pregnancy: antenatal prophylaxis. Can Med Assoc J 1978;118:623–7.
4. Bowman JM, Pollock JM. Antenatal prophylaxis of Rh isoimmunization: 28 weeks’-gestation service program. Can Med Assoc J 1978;118,:627–30.
5. De Silva M, Engelfriet CP, Reesink HW. International Forum: current status of immunoprophylaxis with anti-D immunoglobulin. Vox Sang 2003;85:328–37.
6. Bowman JM, Chown B, Lewis M, et al. Rh isoimmunization, Manitoba, 1963–1975. Can Med Assoc J 1977;116:282–4.
7. Tuohy JF, Sangalli M, Kim L. Red blood cell iso-immunization in the Wellington area of New Zealand: the case for antenatal prophylaxis. Aust NZ J Obstet Gynaecol 2004;44:458–9.
8. Hughes RG, Craig JIO, Murphy WG, et al. Causes and clinical consequences of Rhesus (D) haemolytic disease of the newborn: a study of the Scottish population, 1985–1990. Br J Obstet Gynaecol 1994;101:297–300.
9. McSweeney E, Kirkham J, Vinall P, et al. An audit of anti-D sensitization in Yorkshire. Br J Obstet Gynaecol 1998;105: 1091–4.
10. http://www.shotuk.org/reporting/anti-d-immunisationreporting/. Accessed August 11, 2016.