title: A review of maternal alloimmunisation to Rh D in Northern Ireland.
abstract: OBJECTIVE
  To estimate the current incidence of maternal sensitisation to Rhesus (Rh) D in Northern Ireland, examine adherence to recommendations for administration of anti-D immunoglobulin and identify potential causes for all cases of anti-D alloimmunisation sensitisation from January 2010 to September 2015.
  
  
  BACKGROUND
  Post-partum anti-D immunoglobulin administered to Rh D-negative women and routine antenatal anti-D prophylaxis have greatly reduced the incidence of haemolytic disease of the fetus and newborn due to immune anti-D. Despite these measures, anti-D alloimmunisation sensitisation continues to occur, albeit much less frequently than in the past.
  
  
  METHODS
  This was a retrospective review of new sensitisations to Rh D detected in antenatal records between January 2010 and September 2015 in Northern Ireland. A review of patient notes and laboratory data was carried out to examine adherence to standards and identify potential causes of sensitisation.
  
  
  RESULTS
  A total of 67 new sensitisations to Rh D were identified over a 69-month period, and the sensitisation rate for the full calendar years 2010-2014 was 0·310%. Only 4% of cases appear to have been preventable, with two cases involving failure to adhere to guidelines.
  
  
  CONCLUSIONS
  A total 96% of sensitisations occurred despite full compliance with guidelines. In a large proportion, sensitisation occurred following delivery (51%). A change in practice in Northern Ireland is under consideration to increase the dose of anti-D immunoglobulin given following delivery from 500 to 1500 U in an attempt to reduce these sensitisations.
authors.affiliation: Department of Haematology, Belfast City Hospital, Belfast, UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: McCauley
authors.affiliation: Transfusion Medicine, Northern Ireland Blood Transfusion Service, Belfast, UK.
authors.forename: K
authors.initials: K
authors.lastname: Morris
authors.affiliation: Transfusion Medicine, Northern Ireland Blood Transfusion Service, Belfast, UK.
authors.forename: K
authors.initials: K
authors.lastname: Maguire
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009660:Northern Ireland / Q000453:epidemiology; D049590:Postpartum Period; D011247:Pregnancy; D012189:Retrospective Studies; D012203:Rh Isoimmunization / Q000188:drug therapy / Q000453:epidemiology; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin / Q000008:administration & dosage*
chemical_list: D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin; C026410:Rho(D) antigen
keywords: Rhesus D; alloantibodies; maternal alloimmunisation; pregnancy