Is fetal
            <i>RHD</i>
            typing in all RhD negative women cost effective?

Szczepura, Ala; Bonsel, Gouke J.; Krauth, Christian; Osipenko, Leeza; Haverkamp, Alexander

doi:10.1136/bmj.39556.499549.80

Cited by 8 publications

(3 citation statements)

References 4 publications

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“…Calculations on cost efficiency of the combined introduction of fetal RHD genotyping and antenatal anti‐D prophylaxis have been published . In Denmark and the Netherlands, fetal RHD genotyping is now routinely performed to target anti‐D Ig prophylaxis.…”

Section: Anti‐d Prophylaxismentioning

confidence: 99%

Haemolytic disease of the fetus and newborn

et al. 2015

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Haemolytic Disease of the Fetus and Newborn (HDFN) is caused by maternal alloimmunization against red blood cell antigens. In severe cases, HDFN may lead to fetal anaemia with a risk for fetal death and to severe forms of neonatal hyperbilirubinaemia with a risk for kernicterus. Most severe cases are caused by anti-D, despite the introduction of antental and postnatal anti-D immunoglobulin prophylaxis. In general, red blood cell antibody screening programmes are aimed to detect maternal alloimmunization early in pregnancy to facilitate the identification of high-risk cases to timely start antenatal and postnatal treatment. In this review, an overview of the clinical relevance of red cell alloantibodies in relation to occurrence of HDFN and recent views on prevention, screening and treatment options of HDFN are provided.

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Section: Anti‐d Prophylaxismentioning

confidence: 99%

Haemolytic disease of the fetus and newborn

et al. 2015

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“…If the fetus is RhD negative, it is unnecessary to administer IgG anti-D at 28 weeks gestation or perform RhD alloimmunization prevention in cases of potentially sensitising events (Table 1) [24][25][26][27] .…”

Section: Establishing Rhd Genotype Of the Fetusmentioning

confidence: 99%

PREVENTION OF RhD ALLOIMMUNIZATION IN RhD NEGATIVE WOMEN

Ľubušký¹

2010

BIOMED PAP

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Background. Despite the introduction of anti-D prophylaxis into clinical practice, RhD alloimmunization still presents a problem to date. The actual incidence of RhD alloimmunization in pregnant women remains unknown in most countries. Anti-D immunoglobulin is administered to RhD negative women at a fixed dose and in much greater amounts than is actually necessary. On the other hand, it is not possible to diagnose cases where greater doses are needed. To optimize the prevention of RhD alloimmunization in RhD negative women, it is important to diagnose conditions that lead to fetomaternal hemorrhage (FMH), precisely determine the volume and subsequently administer the appropriate dose of anti-D immunoglobulin. The possibility to accurately detect FMH and precisely determine its volume would enable more effective and less costly prevention of RhD alloimmunization. Anti-D immunoglobulin could be administered only in indicated cases and only in doses essentially necessary for prevention of RhD alloimmunization.Methods and results. The Cochrane and UpToDate databases of systematic reviews, as well as national guidelines, were reviewed.Conclusions. Due to the medical significance and indispensable economic costs associated with prevention of RhD alloimmunization, it would be appropriate to establish exact methodical guidelines. The text itself should be limited to a list of potentially sensitising events during which anti-D immunoglobulin should be administered to RhD negative women if anti-D antibodies are not already present. Following each potentially sensitising event, the minimal dose of anti-D immunoglobulin necessary for prevention of RhD alloimmunization should be determined. After 20 weeks of gestation, the volume of FMH should also be determined to specify the necessary dose of anti-D immunoglobulin.

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“…In cost‐efficiency studies, the number of false‐negative cases per year and population is the most emphasized figure because each HDFN case that would have been avoided by the current general antenatal Rh‐prophylaxis programme is associated with high costs for the health care system [31]. As false‐negative NIPD of RhD results has been shown to be rare events in recent studies, appropriate trials have to include a large number of cases (>1000) and are, thus, expensive.…”

Section: Targeted Administration Of Anti‐d Immunoglobulinmentioning

confidence: 99%

Prenatal rhesus testing

Legler

2010

ISBT Science Series

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Background Prenatal rhesus testing is currently not well standardized. The clinical guidelines and technologies differ between countries and regions. Aims To facilitate implementation of non-invasive prenatal diagnosis of the foetal Rh type (NIPD of Rh) from cell free foetal DNA in maternal plasma. To propel the implementation of targeted administration of anti-D immunoglobulin only to those women who carry a D-positive foetus. Materials and Methods A review of the English literature was performed. Results For foetal DNA extraction a variety of detailed protocols have been published which allow the prediction of the foetal Rh phenotype with an accuracy of above 99%. There are manual as well as automated systems on the market. Several thousand D-negative women have been tested in clinical trials for the foetal D status with real-time PCR. Primers and probes have been designed to be applicable in multi-ethnic populations despite the complex genetic background of the Rh blood group system. A control for foetal DNA has been published in some papers in order to provide an in-process control for cases where the foetus is D (C, c or E) negative. Discussion The scientific community reached a high level of accuracy which allows NIPD of Rh on a large scale. Conclusion NIPD of Rh is now available for all alloimmunized women. In most countries health politicians need to change guidelines now before targeted administration of anti-D immunoglobulin can be offered by obstetricians.

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Is fetal RHD typing in all RhD negative women cost effective?

Cited by 8 publications

References 4 publications

Haemolytic disease of the fetus and newborn

Haemolytic disease of the fetus and newborn

PREVENTION OF RhD ALLOIMMUNIZATION IN RhD NEGATIVE WOMEN

Prenatal rhesus testing

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