Anti-D Immunoglobulin during pregnancy and the postpartum period

What are the indications for administering Anti - D up to & including 12 weeks gestation (1st trimester) in an RhD negative woman?

• Termination of pregnancy medical from 10-12 weeks of gestation or

  surgical)

• Spontaneous miscarriage

• Ectopic pregnancy

• Chorionic villus sampling

• Molar pregnancy

• Uterine bleeding where this is repeated, heavy or associated with

  abdominal pain

What is the dose of Anti - D required for a single pregnancy up to & including 12 weeks gestation (1st trimester) in an RhD negative woman?

250 IU

A blood sample should normally be collected before administration of Anti-D to confirm that the mother has not been immunised and made their own anti-D.

True or False?

True

For a multiple pregnancy, the dose of Anti-D Immunoglobulin should be increased to 625 IU.

True or False?

True

Anti-D should be offered and administered within 72 hours of any event listed below:

• Termination of pregnancy medical from 10-12 weeks of gestation or

  surgical)

• Spontaneous miscarriage

• Ectopic pregnancy

• Chorionic villus sampling

• Molar pregnancy

• Uterine bleeding where this is repeated, heavy or associated with

  abdominal pain

True or False?

True

Kleihauer testing is not required before 20 weeks gestation

True or False?

True

What are the indications for administering Anti - D between 12 - 40+ gestation

(2nd and 3rd trimesters) in an RhD negative woman?

• Miscarriage or threatened miscarriage

• Antepartum haemorrhage

• Intrauterine death or stillbirth

• External cephalic version

• Chorionic villus sampling

• Ectopic pregnancy

• Molar pregnancy

• Termination of pregnancy (either medical or surgical)

• Abdominal trauma sufficient to cause FMH

• Amniocentesis, chorionic villus sampling, and intrauterine fetal blood sampling

• In utero therapeutic procedures (transfusion, surgery, insertion of shunts, laser)

What is the dose of Anti - D required between 12 - 40+ gestation

(2nd and 3rd trimesters) in an RhD negative woman?

625 IU

If Anti-D is not given within 72 hours, administration within 10 days may provide some benefit.

True or False?

True

A Kleihauer test is not indicated before 20 weeks of gestation. After 20 weeks gestation it is used to identify events where increased fetomaternal bleeding has occurred and an increased dose of Anti-D is indicated.

True or False?

True

If the Kleihauer test report recommends a dose greater than two (2) vials of Anti D Immunoglobulin, the dose must be discussed with a Transfusion Medicine Specialist. They will confirm the dose and determine if an IV preparation is more appropriate, including the correct rate of administration for an IV dose.

True or False?

True

If the fetal blood group shows anomalous results for RhD it should be regarded as RhD positive, until confirmed.

True or False?

True

Where bleeding continues after 12 weeks gestation, Anti-D Immunoglobulin should be given at up to two (2) weekly intervals.

True or False?

True

Routine Antenatal Anti-D Prophylaxis (RAADP):

Two-dose RAADP - Anti-D Immunoglobulin 625 IU at 28 and 34 weeks gestation

True or False?

True

Before administration of the 28 week dose a blood sample must be taken for a red cell antibody screen. There is no need to wait for the test result before administration of the Anti-D immunoglobulin.

True or False?

True

An antibody screen is not required before the 34-week dose as residual antibody will be present from the first dose.

True or False?

True

One - dose RAADP: There may be situations where only a single dose can be provided. In these situations, two (2) vials of Anti-D 625 IU are given at 30 weeks after a red cell antibody screen blood sample has been taken.

True or False?

True

If anti-D antibodies are detected in the sample taken before administration, you must contact a Transfusion Medicine Specialist to discuss management.

True or False?

True

Post-partum prophylaxis is still required for sensitising events after use of RAADP.

True or False?

True

Further red cell antibody screening is not indicated for women who have received routine prophylactic Anti-D, unless fetal anaemia is suspected.

True or False?

True

What is the dose of Anti - D required for post-partum prophylaxis in an RhD negative woman who has given birth to an RhD positive baby?

Anti-D Immunoglobulin 625 IU.

Additional dose(s) are indicated dependent on the red cell volume of the fetomaternal haemorrhage.