RhD Antenatal Prophylaxis - The Pathology Laboratory Perspective

Abstract

Stage 1 of routine antenatal RhD immunoglobulin prophylaxis was recommended in late 2002, for RhD negative women having their first child. This was as a result of a 1999 National Health Medical Research Council [NHMRC] recommendation as best practice to further reduce the incidence of HDN due to anti-D. Revised guidelines were released in 2003 by the National Blood Authority with NHMRC endorsement. It is likely that stage 2 [for all pregnancies in RhD negative women] will be in place by early 2005. The introduction of antenatal prophylaxis has raised a number of issues for pathology laboratories: a) frequency of antenatal testing within this new program b) laboratory protocols where the presence of RhD immunoglobulin is confirmed or suspected c) reporting formats in such circumstances d) inventory and supply issues including product traceability e) testing of maternal and cord samples at delivery in women who have received antenatal prophylaxis The Australian & New Zealand Society of Blood Transfusion released revised antenatal testing guidelines in early 2004 to assist laboratories in dealing with some of these issues. Collaboration with ARCBS, CSL and RANZCOG has also resulted in useful information being made available covering other aspects of this new initiative. The presentation will explore some of the above issues leading to more general discussion during the symposium.