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Immunoglobulin (Rh Prophylaxis)

Anti-D (Rh₀) Immunoglobulin

Brand names: Rhesonativ, RHOPHYLAC, Partobulin SDF

Adult dose

Dose: Routine antenatal prophylaxis (RAADP): 1500 IU at 28 weeks; Postnatal (after delivery of Rh-positive infant to Rh-negative mother): ≥1500 IU within 72 hours. Following sensitising events: 250–500 IU IM depending on gestation; IV formulations: as per product SmPC
Route: Intramuscular (IM) or intravenous (IV — product-dependent)
Frequency: Per event/prophylactic schedule

Clinical pearls

  • Prevents haemolytic disease of the fetus/newborn (HDFN) by suppressing maternal anti-D sensitisation
  • NICE NG25 (2021): all non-sensitised Rh-negative pregnant women should be offered routine antenatal anti-D prophylaxis (RAADP) at 28 weeks
  • Also given after sensitising events: miscarriage (>12 weeks), termination, amniocentesis, external cephalic version, antepartum haemorrhage, abdominal trauma
  • Following delivery: Kleihauer test guides whether additional doses needed (large feto-maternal haemorrhage)
  • Cell-free fetal DNA (cffDNA) testing for fetal Rh status from 11 weeks avoids anti-D in Rh-positive fetuses
  • Human plasma-derived product — batch-tested and virus-inactivated; theoretical (very low) risk of transmissible agents

Contraindications

  • Rh-positive patients (not needed)
  • Known anti-D antibody in maternal serum (already sensitised — no benefit)
  • Hypersensitivity to immunoglobulins or excipients
  • IgA deficiency with anti-IgA antibodies (risk of anaphylaxis)

Side effects

  • Local injection site reactions
  • Pyrexia, chills
  • Anaphylaxis (rare)
  • Haemolytic anaemia in Rh-positive patients (if administered erroneously)

Interactions

  • Live vaccines (MMR, varicella) — anti-D may suppress response; postpone live vaccines for 3 months after anti-D
  • Does not interact with inactivated vaccines

Monitoring

  • Kleihauer-Betke test (or flow cytometry) post-delivery to quantify feto-maternal haemorrhage
  • Maternal blood group and antibody screen at booking and 28 weeks
  • Post-injection: anti-D levels confirmable by lab if needed

Reference: BNF; NICE NG25 (Ectopic pregnancy and miscarriage: anti-D, 2021); BCSH Guideline on anti-D prophylaxis (2014 updated); RCOG Green-top Guideline No. 22 (Anti-D immunoglobulin); https://bnf.nice.org.uk/drugs/anti-d-rh0-immunoglobulin/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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