Laboratory management of perinatal patients with apparently "new" anti-D.
Despite the existence of long-standing, well-organized programs for Rh immune globulin (RhIG) prophylaxis, immune anti-D continues to be detected in the D– perinatal population. Between 2006 and 2008, 91 prenatal patients, found to have a previously unidentified anti-D, were followed up with a survey to their treating physician and with additional serologic testing where possible. The physician survey requested pregnancy and RhIG history information, including recent or distant potential alloimmunizing events, and the physicians were asked their opinion on the likely cause for the anti-D. Based on survey responses, updated RhIG information, and results of follow-up serology, anti-D was determined to be attributable to previously unreported RhIG in 44 of 91 (48.3%) cases and to active immunization (immune anti-D) in 36 of 91 cases (39.6%). A probable cause for alloimmunization was reported in 14 of 52 (26.9%) returned surveys. Anti-D alloimmunization continues to occur in our prenatal population despite a comprehensive approach to RhIG therapy. Observations from this prospective patient management strategy include the need for improved application of guidelines for RhIG administration and improved quality of information provided to laboratories assessing RhIG eligibility. A laboratory process for prospective follow-up when unexpected anti-D is detected in pregnancy is recommended.
Medical Officer, Canadian Blood Services, 8249-114 Street, Edmonton, AB, Canada T6G 2R8.
Judith L
JL
Hannon
Associate Medical Director, Canadian Blood Services, Edmonton, AB, Canada.
Gwen
G
Clarke
D000328:Adult; D019468:Disease Management; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007755:Laboratories, Hospital / Q000458:organization & administration*; D008499:Medical Records; D018743:Perinatal Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D017584:Reproductive History; D012203:Rh Isoimmunization / Q000209:etiology / Q000517:prevention & control; D018029:Rho(D) Immune Globulin / Q000008:administration & dosage / Q000097:blood*; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000009:adverse effects
C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin