Routine administration of Anti-D: the ethical case for offering pregnant women fetal RHDgenotyping and a review of policy and practice

Julie Kent,Anne-Maree Farrell,Peter Soothill

doi:10.1186/1471-2393-14-87

Abstract

BackgroundSince its introduction in the 1960s Anti-D immunoglobulin (Anti-D Ig) has been highly successful in reducing the incidence of haemolytic disease of the fetus and newborn (HDFN) and achieving improvements to maternal and fetal health. It has protected women from other invasive interventions during pregnancy and prevented deaths and damage amongst newborns and is a technology which has been adopted worldwide. Currently about one third of pregnant women with the blood group Rhesus D (RhD) negative in the UK (approximately 40,000 women per year in England and Wales), receive antenatal Anti-D Ig in pregnancy when they do not require it because they are carrying a RhD negative fetus. Since 1997, a test using cell free fetal DNA (cffDNA) in maternal blood has been developed to identify the genotype of the fetus and can be used to predict the fetal RhD blood group.DiscussionThis paper considers whether it is ethically acceptable to continue administering antenatal Anti-D Ig to all RhD negative women when fetal RHD genotyping using maternal blood could identify those women who do not need this product.SummaryThe antenatal administration of Anti-D Ig to a third of RhD negative pregnant women who carry a RhD negative fetus and therefore do not need it raises important ethical issues. If fetal RHD genotyping using maternal blood was offered to all RhD negative pregnant women it would assist them to make an informed choice about whether or not to have antenatal Anti-D Ig.

Highlights

Since its introduction in the 1960s Anti-D immunoglobulin (Anti-D Ig) has been highly successful in reducing the incidence of haemolytic disease of the fetus and newborn (HDFN) and achieving improvements to maternal and fetal health
If fetal RHD genotyping using maternal blood was offered to all Rhesus D (RhD) negative pregnant women it would assist them to make an informed choice about whether or not to have antenatal Anti-D Ig
The purpose of administering Anti-D Ig is to reduce the chance of sensitisation to RhD positive blood and so the potential risks of haemolytic disease of the fetus and newborn (HDFN)

Summary

Discussion

Administration of Anti-D Ig Since its introduction in the 1960s Anti-D Ig has been highly successful in reducing the incidence of HDFN and achieving improvements to maternal and fetal health. The ethical issues at stake here include weighing the relatively low risks of false negative results associated with fetal RHD genotyping using cffDNA and the costs of implementing mass testing, against the benefits of ceasing the practice of giving this group of pregnant women a human blood product they do not need. Authors’ information JK is Professor of Sociology of Health Technology and is researching the plasma industry and the use of blood products in maternity care as part of an ESRC funded project: Risk, safety and consent in blood services in the UK She is author of Regenerating Bodies: Tissue and Cell Therapies in the 21st Century (London: Routledge; 2012).

Background

11. Pregnant Women with Red Cell Antibodies