[Adverse effects and patient information].
Anti-D prophylaxis should be proposed to all RhD negative non-sensitized pregnant women, after delivering an information concerning both Rhesus disease and anti-D immunoglobulins. This information must be delivered as a written document and the patient's oral consent is required before administration of the anti-D immunoglobulins. Anti-D immunoglobulins currently used in France for prophylaxis are extracted from plasma of hyperimmunized paid donors. Even if all the conditions of viral safety are fulfilled in the preparation of anti-D immunoglobulins, they remain blood derived products. As such, prescription of anti-D immunoglobulins should follow legal rules concerning tracability and information. Refusal of rhesus prophylaxis can occur but should be transcribed and motivated in the patient's chart. Administration of anti-D immunoglobulins is usually well tolerated. Reactions to hemolysis of fetal Rhesus positive red cells can occur but remain rare and linked to important foeto-maternal hemorrhage. They can be easily prevented or treated by anti-inflammatory drugs. Patients can be vaccinated against rubella in the post-partum period even though they will receive a concomitant prophylaxis with Rh immunoglobulin. Persistence of passive anti-D in maternal circulation after injection lasts several weeks or months and could have various consequences. In the mother: it can interfere with diagnosis of active anti-D immunization. In most cases, it may be possible to differentiate passive and immune anti-D. When reliable information concerning date and dosage of antenatal anti-D prophylaxis are available. In the newborn: anti-D immunoglobulins can pass through the placenta and enter the fetal circulation, coat the D positive fetal red cells and give positive DAT. Positive DAT is reported in 5 to 15% of the newborns following rhesus prophylaxis in the third trimester but with no report of anemia or jaundice. In absence of ABO incompatibility, no additional investigation is needed in these newborns.
Centre National de Référence en Hémobiologie Périnatale (CNRHP), Hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris.
A
A
Cortey
Y
Y
Brossard
D004899:Erythroblastosis, Fetal / Q000517:prevention & control*; D005260:Female; D005602:France; D006801:Humans; D007116:Immunization, Passive; D007231:Infant, Newborn; D007258:Informed Consent; D007518:Isoantibodies / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use; D010353:Patient Education as Topic; D011247:Pregnancy; D012203:Rh Isoimmunization / Q000517:prevention & control*; D012204:Rh-Hr Blood-Group System / Q000276:immunology; D018029:Rho(D) Immune Globulin / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use; D012307:Risk Factors; D016896:Treatment Outcome
D007518:Isoantibodies; C061961:RHO(D) antibody; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin