Anti-D (Rh₀) Immunoglobulin

How it works

Passively administered anti-D antibody binds and promotes clearance of RhD-positive fetal red cells from the maternal circulation before the mother can mount her own immune response, preventing formation of anti-D antibodies.

Prescribing in practice

• It must be given to non-sensitised RhD-negative women after any potential sensitising event and routinely in pregnancy; it is ineffective and not indicated once the woman has already formed her own anti-D antibodies, so confirm she is not already sensitised.
• The size of a large feto-maternal haemorrhage should be quantified (e.g. by Kleihauer testing) after delivery or major sensitising events so that additional doses can be given if needed.
• As a blood-derived product it should be given by the appropriate route promptly after the event and recorded carefully, with the usual precautions for anaphylaxis.

Monitoring

Confirm RhD status and antibody screen, and assess feto-maternal haemorrhage where indicated to ensure adequate cover.

Counselling the patient

• This injection protects future pregnancies by stopping your immune system reacting to a baby's blood group.
• It is given after events such as bleeding, certain procedures, miscarriage or delivery, as well as routinely during pregnancy.
• Keep a record of when you received it and report any rash, swelling or breathing difficulty after the injection.

Evidence & guidelines

Routine antenatal and postnatal anti-D prophylaxis for RhD-negative women is recommended by NICE and UK transfusion guidelines.