A. Identification of blood group and antibody screening
A blood sample for blood group (ABO and Rh D) and antibody screen (2 x blue EDTA tubes) should be obtained at the booking or point of contact appointment.
Caution: if a woman books later in the pregnancy, they still require samples for the above. The results will be inputted into the woman’s electronic record. The woman should be informed of her blood group as soon as is practical.
Note: Prophylactic anti-D Ig given to prevent sensitisation is indistinguishable from immune anti-D antibody. If a woman has received any prophylactic anti-D Ig during her pregnancy the date, time, dose and reason (RAADP or PSE) should be stated on the group and screen sample request form. (This information should be available in the anti-D section of the Badger record). This will help with the laboratory interpretation as to whether any anti-D antibody identified is likely to be maternal immune antibody or passive anti-D Ig recently administered to reduce the risk of sensitisation. In some instances this differentiation between immune and passive anti-D may not be immediately possible and the woman would need monitoring over time to distinguish between the two. In certain cases the additional testing would be required (anti D quantitation performed in Glasgow SNBTS lab) and the blood bank in Raigmore has established ways to identify these cases.
B. Women who are Rh D positive
Women, who are Rh D positive and have no red cell antibodies, should have a further blood sample taken for routine antibody screen (1 x blue EDTA tube) at 28 weeks gestation at the same time of routine sampling for full blood count estimation.
Women who are Rh D positive and have red cell antibodies should receive care in line with the Scottish National Guidelines: Scottish-Red-Cell-Antibodies-in-Pregnant-Women-Guidance-Feb-2020-FINAL.pdf (nhs.scot)
C. Women who are Rh D negative
Women who have a Rh D negative blood group and who have not formed anti-D antibodies will be sent a letter and Rh D card from the hospital transfusion laboratory. The midwife should discuss the blood group and anti-D prophylaxis with the woman at the earliest opportunity.
If a woman with Rh D negative blood develops red cell antibodies other than anti-D antibodies at any time during her pregnancy, she should receive care in line with the Scottish National Guidelines: Scottish-Red-Cell-Antibodies-in-Pregnant-Women-Guidance-Feb-2020-FINAL.pdf (nhs.scot)
Rh D negative woman who have red cell antibodies other than anti-D, should be offered anti-D immunoglobulin prophylaxis to prevent formation of anti-D antibodies.
Caution: Rh D negative women who had developed immune anti-D antibodies should not be given anti-D immunoglobulin. If there is any doubt whether the anti-D being detected is immune or prophylactic in nature, this should be discussed with a transfusion specialist for advice on further management and follow up.
D. RhD Variants
Most people are either positive (D Positive) or negative (D Negative) for the D antigen However, a small proportion of people have a variant D antigen. The blood transfusion laboratory will carry out further testing on these individuals to determine the type of D variant.
Clinical Interpretation of D variant Investigations:
- Variants identified as Weak D Types 1, 2 and 3: Considered to be and reported as D Positive. These patients are NOT eligible for prophylactic anti-D.
- All other variants: Considered to be and reported as D negative. These patients ARE eligible for prophylactic anti-D.
These D variants will be recorded in the Woman’s SCI Store record.
E. Anti-D immunoglobulin prophylaxis following a potentially sensitising event during pregnancy
Any woman who experiences a potentially sensitising event (PSE) during pregnancy should be offered prophylactic anti-D immunoglobulin (Ig).
In order to be effective, prophylactic anti-D Ig should be administered as soon as possible and always within 72 hours of a PSE. The Raigmore Hospital Blood Bank performs FMH for the whole of the NHS Highland region Monday- Sunday. If you are concerned that your patient will not receive anti-D within 72 hours of the PSE then please contact the Raigmore Hospital Blood Bank to discuss your patients care with the laboratory and SNBTS Transfusion Consultant.
If it is not possible to administer prophylactic anti-D Ig within 72 hours, it may still be effective when administered within 10 days. (The decision to administer anti-D Ig in this instance should be made by an obstetrician following consultation with a haematologist/transfusion specialist).
Prophylactic anti-D Ig offered following a PSE during pregnancy should be administered regardless of routine antenatal anti-D prophylaxis.