An audit of anti‐D sensitisation in Yorkshire

Abstract

Objective To determine the likely factors that contribute to RhD sensitisation. Design Retrospective study of all new cases of RhD sensitisation occurring between 1988 and 1991.Setting Leeds Blood Centre, National Blood Service, Yorkshire. Population One hundred and forty-seven cases of RhD sensitisation from 15 obstetric units within the Yorkshire region, of which 129 (312 pregnancies) could be assessed. after delivery, RhD immunisation occurred in approximately 1% of RhD negative women. There are a number of explanations for the continued development of RhD sensitisation, including failure of administration of anti-D immunoglobulin, failure of protection despite administration of anti-D immunoglobulin, and unrecognised sensitising events, such as occult fetomaternal haemorrhage during the third trimester of pregnancy. We conducted a retrospective study to determine the likely factors that contributed to RhD sensitisation in a consecutive series of 147 cases that occurred during the period 1988 to 1991. Ethics committee approval was obtained before undertaking this study. METHODSAt the outset the criteria to be measured were identified, including: 1. the identification of potential immunising events outlined in local and National 0

RhD prophylaxis failure in Rio de Janeiro, Brazil

“…The high rate of births and abortions in which RhD prophylaxis was not given differed from similar studies conducted in developed countries [3,4], where failure to administer postnatal prophylaxis is rare, and antenatal alloimmunization seems to be the most important reason for new cases of maternal sensitization. However, the inherent limitations of retrospective studies make it difficult to assess with certainty the proper cause and precise time that sensitization occurred.…”

Prevención de la isoinmunización materna al RhD, con gamma-globulina anti-D

“…36,37 • Es aceptable la evidencia (nivel II-2, recomendación B), que apoya el rastreo de anticuerpos (Coombs indirecto) en las semanas 24 a 28 de gestación. 19,28 • Aunque hay ventaja inicial (recomendación B), no son concluyentes los estudios sobre la práctica uniforme en el empleo prenatal de la γ-globulina anti-D. 12,14,18,31,33 • Es aceptable la evidencia que recomienda el rastreo luego del aborto inducido (nivel III, recomendación B) y de la amniocentesis (nivel II-2, recomendación B), ante la probabilidad de hemorragia fetomaterna. 5,38,39 • Es pobre la evidencia que recomienda la inclusión o exclusión del rastreo de anticuerpos, ante la aspiración de vellosidades coriales.…”

“…Sin embargo, se tienen informaciones de que en población caucásica la probabilidad de isoinmunización materna con fetos Rh incompatibles ocurre entre 9 y 22% de las mujeres en riesgo. 3,11,12 A pesar de los serios problemas de subregistro que existe en los informes hospitalarios, 13 se sabe que la prevalencia de isoinmunización al RhD ha declinado significativamente, a partir de la introducción de nuevas modalidades de tratamiento en la década de los setenta. Así, entre 1970 y 1979, en mujeres sajonas, la tasa cruda de isoinmunización disminuyó de 9.1-10.3 a 1.4 casos por 1 000 nacimientos.…”

Use of anti-D immunoglobulin in the treatment of threatened miscarriage in the accident and emergency department

“…2 However, sensitisation still occurs in several patients, often resulting from failed or delayed administration of anti-D immunoglobulin after a potentially sensitising event. [3][4][5] When Rh D immunoprophylaxis was initially introduced in the UK only postnatal treatment was recommended. In 1976 the department of health further advocated the use of anti-D immunoglobulin to cover all abortions, irrespective of gestational age.…”