title: Use of cffDNA to avoid administration of anti-D to pregnant women when the fetus is RhD-negative: implementation in the NHS.
abstract: OBJECTIVE
  To determine whether a policy of offering cffDNA testing to all RhD-negative women at about 16 weeks' gestation to avoid anti-D administration when the fetus is RhD-negative could be implemented successfully in the NHS without additional funding.
  
  
  METHODS
  Prospectively planned observational service implementation pilot and notes audit.
  
  
  METHODS
  Three maternity services in the South West of England.
  
  
  METHODS
  All RhD-negative women in a 6-month period.
  
  
  METHODS
  Prospective, intervention, cross-sectional observational study, using pre-intervention data as controls.
  
  
  METHODS
  Proportion of suitable women who offered and accepted the test. Accuracy of the cffDNA result as assessed by cord blood group result. Fall in anti-D doses administered.
  
  
  RESULTS
  529 samples were received; three were unsuitable. The results were reported as RhD-positive (n = 278), RhD-negative (n = 185) or inconclusive, treat as positive (n = 63). Cord blood results were available in 502 (95%) and the only incorrect result was one case of a false positive (cffDNA reported as positive, cord blood negative - and so given anti-D unnecessarily). The notes audit showed that women who declined this service were correctly managed and that anti-D was not given when the fetus was predicted to be RhD-negative. The total use of anti-D doses fell by about 29% which equated to about 35% of RhD-negative women not receiving anti-D in their pregnancy unnecessarily.
  
  
  CONCLUSIONS
  We recommend this service is extended to all UK NHS services.
authors.affiliation: Fetal Medicine Unit, St Michaels Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: P W
authors.initials: PW
authors.lastname: Soothill
authors.affiliation: NHS Blood and Transplant, International Blood Group Reference Laboratory, Filton, Bristol, UK.
authors.forename: K
authors.initials: K
authors.lastname: Finning
authors.affiliation: NHS Blood and Transplant, International Blood Group Reference Laboratory, Filton, Bristol, UK.
authors.forename: T
authors.initials: T
authors.lastname: Latham
authors.affiliation: Haematology, Southmead Hospital, Westbury-on-Trym, Bristol, UK.
authors.forename: T
authors.initials: T
authors.lastname: Wreford-Bush
authors.affiliation: Fetal Medicine Unit, St Michaels Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: J
authors.initials: J
authors.lastname: Ford
authors.affiliation: NHS Blood and Transplant, International Blood Group Reference Laboratory, Filton, Bristol, UK.
authors.forename: G
authors.initials: G
authors.lastname: Daniels
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000743:Anemia, Hemolytic / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D006291:Health Policy; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D007518:Isoantibodies / Q000008:administration & dosage*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011446:Prospective Studies; D012203:Rh Isoimmunization / Q000097:blood*; D012204:Rh-Hr Blood-Group System / Q000235:genetics*; D013222:State Medicine
chemical_list: D007155:Immunologic Factors; D007518:Isoantibodies; D012204:Rh-Hr Blood-Group System
keywords: Anti-D; RHD; RhD; cffDNA; non-invasive prenatal testing; rhesus disease