Recommendations for the use of anti‐D immunoglobulin for Rh prophylaxis

It has long been routine practice to transfuse RhDnegative females capable of childbearing only with RhD-negative blood. The development of anti-D antibodies therefore generally results from fetomaternal haemorrhage (FMH) occurring in RhD-negative women who carry an RhD-positive fetus. Post-delivery immunoprophylaxis using anti-D immunoglobulin (anti-D Ig) began in the UK in 1969 and, since then, the incidence of HDN due to anti-D has decreased dramatically. When Rh immunoprophylaxis was introduced in the UK, only postnatal treatment was recommended. This was reviewed in the Department of Health’s Green Booklet (Standing Medical Advisory Committee, 1976) which added the advice that anti-D should be used after all abortions. A further recommendation (Standing Medical Advisory Committee, 1981) identified other potentially sensitizing events during pregnancy for which prophylaxis was recommended. In 1991, the Immunoglobulin Working party of the UK Blood Transfusion Services reviewed and updated the recommendations (UK Blood Transfusion Services, 1991), including guidance on the use of anti-D Ig where Rh-positive blood was inadvertently transfused to an Rh-negative woman of childbearing age. The aim of these recommendations is to provide a further update and to include guidance regarding routine antenatal anti-D prophylaxis. 2. POTENTIALLY SENSITIZING EVENTS