Transcript The London Regional Transfusion Committee Anti-D This resource is to support the management of D negative pregnant women Ensure it is open in.

The London Regional Transfusion Committee
Anti-D
This resource is to support the management of D negative pregnant women
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This has been developed by the London Regional Transfusion Committee Transfusion Practitioner Group. For more information or to
get involved in other Patient Blood Management work contact your local Transfusion Practitioner or call the transfusion laboratory.
Introduction to Anti-D
• Anti-D prophylaxis reduces maternal sensitisation and
Haemolytic Disease of Foetus & Newborn in subsequent
pregnancies in D negative women
• Anti-D immunoglobulin (anti-D Ig) should be given for
prophylaxis routinely
• Anti-D Ig should be given for potentially sensitising events
“Correct Administration of Anti-D Saves Lives!”
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Anti-D Administration Pathway
Always confirm
• The woman’s identity
• The woman is D negative
• The woman does not have immune Anti-D
• The woman has given informed consent
Potentially
Sensitising
Event (PSE)
Routine Antenatal
Anti-D Prophylaxis
(RAADP)
Following Birth
Anti-D Detectable
On Booking
Potentially Sensitising Event (PSE)
• Administer Anti-D Ig as soon as possible and always
within 72 hours of the event
• If not administered due to exceptional circumstances
offer Anti-D up to 10 days after the PSE and report as an
incident
Potentially sensitising events
PV Bleeding; Abdominal Trauma; Miscarriage; Termination of Pregnancy;
Diagnosis of Intrauterine Death; Stillbirth; Invasive Antenatal Procedures;
Ectopic Pregnancy; External Cephalic; Delivery of D positive Baby
If less than
12 weeks
If 12 – 20 weeks
If more than
20 weeks
If less than 12 weeks
 Anti-D is NOT indicated unless;
• Therapeutic termination
• Molar or ectopic pregnancy
• Surgical intervention associated
with miscarriage
 Administer
at least 250IU
anti-D Ig within
72 hours of
PSE
• Painful vaginal bleeding
Document in patient’s notes
Potentially
Sensitising
Event (PSE)
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If 12 – 20 weeks
 Administer at least 250IU anti-D Ig within 72
hours of PSE
• A Kleihauer to measure Fetomaternal Haemorrhage is
NOT required
Document in patient’s notes
Potentially
Sensitising
Event (PSE)
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If more than 20 weeks
 Administer at least 500IU anti-D Ig within 72 hours of
PSE event.
 Take sample and send for Kleihuer test to measure
Fetomaternal Haemorrhage level:
 Check results to see if additional anti-D is required.
Speak to lab for further advice
Document in patient’s notes
Potentially
Sensitising
Event (PSE)
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Routine Antenatal Anti-D Prophylaxis
(RAADP)
• All D negative pregnant women with no immune anti-D
(check history) should be offered RAADP
• RAADP should be given regardless of any Anti-D Ig given
for a potentially sensitising event (PSE)
Check your local policy
For Single Dose
RAADP
Regime
For Two Dose
RAADP
Regime
For Single Dose RAADP Regime
Take blood sample at 28 weeks, before RAADP is given
 Administer 1,500IU anti-D Ig at 28-30 weeks
 Take further samples according to your local policy
Document in patient’s notes
Routine Antenatal
Anti-D Prophylaxis
(RAADP)
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For Two Dose RAADP Regime
28 weeks
 Take blood sample at 28 weeks, before RAADP is given
 Administer 500IU anti-D Ig at 28 weeks
 Take further samples according to your local policy
34 weeks
 Take blood sample at 34 weeks, before RAADP is given
 Administer 500IU anti-D Ig at 34 weeks
 Take further samples according to your local policy
Document in patient’s notes
Routine Antenatal
Anti-D Prophylaxis
(RAADP)
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Following Birth
 Send ‘mother and cord’ samples for testing
 Confirm baby is D positive
 Administer 500IU anti-D IG within 72 hours of delivery
 Take sample and send for Kleihuer test to measure
Fetomaternal Haemorrhage level:
 Check if additional Anti-D Ig is required – speak to lab for
further advice
Document in patient’s notes
If Cell Salvage
Used in
Caesarean Section
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If Cell Salvage Used in Caesarean Section
• If intra-operative cell salvage was used during a
caesarean section and cord group was confirmed as
D positive
 Administer 1,500IU anti-D IG following reinfusion of
salvaged red cells.
 Take a maternal sample 30-45 minutes after infusion
and check if further Anti-D Ig is needed
Document in patient’s notes
Following Birth
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Anti-D Detectable On Booking
• Where anti-D is detected in a booking blood sample
 Check obstetric and transfusion history with the woman
 Contact Labs to establish whether anti-D is immune or
passive
 Contact Consultant Obstetrician for advice
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