RhD Prophylaxis in Australia: 1966 and Beyond

Abstract

In the late 1960s clinical trials showed that the incidence of Rh D immunisation of Rh negative women could be dramatically reduced by the administration of Rh D immunoglobulin (Ig) after delivery. In 1968 Australia became the first country to be self sufficient in Rh D Ig with the introduction of the Rh programme. Despite appropriate use of Rh D Ig 1–2% of Rh negative women still became immunised. Studies subsequently showed that immunisation rates could be further reduced by prophylactic administration of Rh D Ig during pregnancy. Routine antenatal prophylaxis has been practiced in Canada and USA for more than 20 years. The first NHMRC Clinical Practice Guidelines on the use of Rh D Ig were issued in 1999. These acknowledged that routine antenatal prophylaxis was best practice, however could not be recommended due to supply constraints. Subsequent initiatives included the licensing of the 250 IU dose of Rh D Ig, expansion of plasma collection and importation of product. Staged introduction of routine antenatal prophylaxis began in late 2002 with introduction of prophylaxis for primigravidae. Stage 2, which provides antenatal prophylaxis for all Rh D negative women, is to be implemented by 1 January 2005. Stage 3 will see cessation of the need for use of imported product. A Joint Consultative Committee of involved specialties is helping to ensure consultation and communication for the implementation process. The possibility of developing a laboratory Rh D Ig which could be produced in unlimited quantities, in a standardised formulation with no reliance on human derived sources has been entertained for many years. Results of trials of possible options have been intermittently published. However, it is likely that the ‘liquid gold’ anti D plasma donated by our amazing volunteers will be needed for many years to come.