The investigation of infants with RhD-negative mothers: can we safely omit the umbilical cord blood direct antiglobulin test?
Historically, the investigation of a neonate at risk of Rhesus D antigen (RhD)-associated haemolytic disease has included a direct antiglobulin test on umbilical cord blood. However, the introduction of routine antenatal anti-RhD prophylaxis has led to a significant number of false positive results and recent studies suggest that a positive cord blood direct antiglobulin test is poorly predictive of subsequent hyperbilirubinaemia. The British Committee for Standards in Haematology guidelines now recommend that a direct antiglobulin test should no longer be performed routinely on umbilical cord blood in infants born to RhD-negative mothers. We review the recent changes in antenatal management of RhD-negative mothers and their impact on the neonatal presentation of RhD-associated haemolytic disease of the newborn that underpin this recommendation. We conclude that there is convincing evidence to support the guidelines. Finally, we consider how babies born to RhD-negative mothers should be investigated and consider alternative strategies to detect neonatal hyperbilirubinaemia.
James
R M
RM
1Epidemiology and Genetics Unit, Department of Health Sciences, York Hospital NHS Trust, York, UK. beki.james@egu.york.ac.uk
McGuire
W
W
Smith
D P
DP
D003298:Coombs Test / Q000592:standards*; D004899:Erythroblastosis, Fetal / Q000517:prevention & control*; D005260:Female; D005312:Fetal Blood; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000175:diagnosis; D007231:Infant, Newborn; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D012204:Rh-Hr Blood-Group System / Q000097:blood*; D018029:Rho(D) Immune Globulin / Q000627:therapeutic use; D019564:Unnecessary Procedures
D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin; C026410:Rho(D) antigen