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Postpartum anti‐D: can we safely reduce the dose?
Author(s) -
Augustson Bradley M,
Fong Elizabeth A,
Grey Dianne E,
Davies Janine I,
Erber Wendy N
Publication year - 2006
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2006.tb00414.x
Subject(s) - medicine , audit , retrospective cohort study , obstetrics , gynecology , management , economics
Objective: To assess the potential for dose‐reduction of prophylactic anti‐D postpartum. Design: Retrospective audit of fetomaternal haemorrhage (FMH) quantitation by flow cytometry. Participants and setting: 5148 consecutive Rhesus D‐negative women aged 15–45 years who had FMH estimation by flow cytometry at a central laboratory in Western Australia in the 65 months between 1 August 1999 and 31 January 2005. Main outcome measures: Quantitation of FMH volume for adequate prophylactic anti‐D administration in a timely fashion. Results: 90.4% (4651/5148) of the women had an FMH volume of 1.0 mL or less of Rh D‐positive red cells, and 98.5% (5072/5148) had a volume of less than 2.5 mL. Only 0.4% of cases had an FMH volume of 6.0 mL or greater (range, 6.0–92.4 mL). Conclusions: This large retrospective audit shows that a currently available dose of 250 IU (50 mg) of anti‐D would have been sufficient for 98.5% of the 5148 Rh D‐negative women. On the basis of this evidence, a reduction in the recommended routine postpartum dose of anti‐D from 625 IU to 250 IU when flow cytometric quantitation for FMH is available should be considered. Adopting such a strategy would ensure the ongoing provision of a valuable human blood product currently in limited supply.