Tasmanian Department of Health and Human Services
Royal Hobart Hospital
Clinical Guidelines
Note: The electronic version of this document is the version currently in use. Any printed version can not be assumed to be current.
Please remember to read our disclaimer.
Rh D IMMUNOGLOBULIN (Anti – D) ADMINISTRATION
GUIDELINE (WACS)
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Introduction
Objectives
Related Documents
Staff Scope
Routine Antenatal Care
Dosage
Indications for Administration
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MAT-1-0024
Alerts
Forms & Equipment
Preparation and
Administration Procedure
Refusal for Consent of
Treatment
References
Introductions
Rh D negative women are at risk of alloimmunisation resulting in the development of haemolytic antiD antibodies that are able to cross the placenta to such an extent that a Rh D positive foetus and
newborn are at risk of serious morbidity and mortality. The administration of passive anti-D at times of
actual and potential foeto-maternal haemorrhage (FMH) and routine antenatal prophylaxis has been
shown to reduce the rate of alloimmunisation.
Guidelines have been established for the recommended use of anti-D in pregnancy and post-partum
and are endorsed by the RANZCOG ARCBSNHMRC and ANZSBT
Objectives
To prevent Rhesus iso-immunisation in women who are Rh D negative with no preformed anti-D
antibodies in the following situations:
 After the birth of an Rh D positive infant.
 After termination or miscarriage at any stage of pregnancy
 After an event which may provoke a transplacental haemorrhage during pregnancy (e.g.
amniocentesis or chorionic villus sampling, ectopic pregnancy, antepartum haemorrhage,
external version or significant abdominal trauma).
 By antenatal prophylaxis to reduce the rate of unexpected antibody formation from
approximately 1.5% to 0.2% in Rh D negative women carrying an Rh D positive baby
despite appropriate use of postnatal prophylaxis.
Custodian: WACS
Authorised by: Haematology / Obstetric Depts
Document File Name: STAHS Clinical Guideline.doc
Effective Date: September 2014
Review Date: September 2017
Page 1 of 7
Tasmanian Department of Health and Human Services
Royal Hobart Hospital
Clinical Guidelines
Note: The electronic version of this document is the version currently in use. Any printed version can not be assumed to be current.
Please remember to read our disclaimer.
Rh D IMMUNOGLOBULIN (Anti – D) ADMINISTRATION
GUIDELINE (WACS)
MAT-1-0024
Related Documents
To be read in conjunction with:
Transfusion - THO South - Clinical Protocol
RHH COC 47 Blood Component Transfusion
RHH IC2-04 Sharps Handling and Disposal
RHH IC2-09 Blood and Body Substance – Spills Management
RHH Refusal of Procedure/Treatment form
Staff Scope
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Registered Nurse
Registered Midwife
Midwifery Students
Medical Officers
Transfusion Laboratory staff.
Routine Antenatal Care
Pathology
A blood sample should be taken from all pregnant women at their first antenatal visit to test for the
presence of red cell antibodies and to establish ABO and Rh D blood group. This group and antibody
screen should be repeated at the first antenatal visit in each pregnancy even for known Rh D
negative women because clinically significant antibodies to red cell antigens other than Rh D may
have developed since the previous pregnancy.
The antibody screen should then be repeated prior to the 28 week prophylactic dose of Rh D
Immunoglobulin.
A post natal Kleihauer-Betke test should be done on all Rh D negative women with Rh D positive
babies.NOTE: All babies born to women with an Rh D negative blood group must have cord blood
taken at birth (or if unavailable a blood sample from the baby must be taken) to determine the baby's
blood group.
Anti-D will be issued by the RHH Transfusion Laboratory on blood work from external laboratories but
the RHH laboratory makes a disclaimer that if it has not done the blood group – it takes no
responsibility for the results of other laboratories work.
A very small number of women are found to have antibodies which are likely to affect the baby (e.g.
Custodian: WACS
Authorised by: Haematology / Obstetric Depts
Document File Name: STAHS Clinical Guideline.doc
Effective Date: September 2014
Review Date: September 2017
Page 2 of 7
Tasmanian Department of Health and Human Services
Royal Hobart Hospital
Clinical Guidelines
Note: The electronic version of this document is the version currently in use. Any printed version can not be assumed to be current.
Please remember to read our disclaimer.
Rh D IMMUNOGLOBULIN (Anti – D) ADMINISTRATION
GUIDELINE (WACS)
MAT-1-0024
anti-D, anti-c, anti-K). More frequent samples need to be requested if these antibodies are present, or
if there is any other cause for concern regarding the baby’s well being.
Dosage
Strength
250 IU
Product
Rh D Immunoglobulin
INDICATION
1st trimester (less than 12 weeks) sensitizing events,
single pregnancy
625 IU
Rh D Immunoglobulin
1st trimester sensitizing events, multiple pregnancy
625 IU
Rh D Immunoglobulin
2nd & 3rd trimester sensitizing events
625 IU
Rh D Immunoglobulin
Routine prophylaxis at 28 weeks
625 IU
Rh D Immunoglobulin
Routine prophylaxis at 34 weeks
625 IU
Rh D Immunoglobulin
Post partum if baby Rh D positive
250-625 IU
Rh D Immunoglobulin
As determined by Kleihauer testing
Indications for Administration
A. SENSITISING EVENTS
1.1 First Trimester (up to and including Week 12 of gestation)
1.2 A dose of 250 IU (50 micrograms) Rh D Immunoglobulin should be offered to every Rh D
negative woman with no pre-existing anti-D antibodies to ensure adequate protection against
immunization for sensitizing events:
 Miscarriage
 Termination of pregnancy
 Ectopic pregnancy
 Ultrasound needle guided procedures e.g. chorionic villus sampling
 Antepartum haemorrhage
A dose of 250 IU Rh D Immunoglobulin is sufficient to prevent immunization by FMH of
2.5 ml red cells (i.e. 5ml whole blood)
Custodian: WACS
Authorised by: Haematology / Obstetric Depts
Document File Name: STAHS Clinical Guideline.doc
Effective Date: September 2014
Review Date: September 2017
Page 3 of 7
Tasmanian Department of Health and Human Services
Royal Hobart Hospital
Clinical Guidelines
Note: The electronic version of this document is the version currently in use. Any printed version can not be assumed to be current.
Please remember to read our disclaimer.
Rh D IMMUNOGLOBULIN (Anti – D) ADMINISTRATION
GUIDELINE (WACS)
MAT-1-0024
1.3 Multiple pregnancies require a dose of 625 IU
1.4 In the event of transfusion of Rh D positive blood products the recommended dose of Anti-D is
100 IU per 1 ml Rh D positive blood.
2 Second and Third Trimester Sensitising Events
2.1 A dose of 625 IU (125 micrograms) should be offered to every Rh D negative woman with no
preformed Anti-D antibodies to ensure adequate protection against immunization for the
following indications:
 Genetic studies (chorionic villous sampling, amniocentesis, cordocentesis)
 Abdominal trauma sufficient enough to cause FMH
 Each occasion of revealed or concealed antepartum haemorrhage. Where the patient
suffers unexplained uterine pain, the possibility of antepartum haemorrhage should be
considered, with a view to immunoprophylaxis.
 Recurrent bleeds.
B. Routine Antenatal Prophylaxis
At 28 and 34 weeks gestation universal prophylaxis with Rh D immunoglobulin administered to Rh D
negative women with no preformed anti-D antibodies, is regarded as best practice. The dose given
should be 625 IU (125 micrograms).
C. Post Natal Administration
All babies born to women with an Rh D negative blood group must have cord blood taken at birth (or
if unavailable a blood sample from the baby must be taken) to determine the baby's blood group.
1.1 All Rh D negative women delivering an Rh D positive infant will require Anti-D administration
within 72 hours of birth: 625 I U
1.2 All Rh D negative women with Rh D positive babies should have a Kleihauer-Betke test as soon
as possible following delivery, to determine the degree of feto-maternal haemorrhage. The test
results will determine whether an additional dose of Anti-D is required to inhibit formation of Rh
antibodies in the mother and prevent Rh disease in future Rh D positive children.
1.3 The Obstetric medical officer must review the pathology results of the Kleihauer-Betke test of all
Rh D negative women prior to discharge to ensure that additional Rh D immunoblogulin is
administered if required.
If patients are discharged prior to test results being available it is the responsibility of the
medical officer to follow up results and recall the patient if required.
1.4 Advice regarding additional doses can be obtained from the haematologist on call.
Custodian: WACS
Authorised by: Haematology / Obstetric Depts
Document File Name: STAHS Clinical Guideline.doc
Effective Date: September 2014
Review Date: September 2017
Page 4 of 7
Tasmanian Department of Health and Human Services
Royal Hobart Hospital
Clinical Guidelines
Note: The electronic version of this document is the version currently in use. Any printed version can not be assumed to be current.
Please remember to read our disclaimer.
Rh D IMMUNOGLOBULIN (Anti – D) ADMINISTRATION
GUIDELINE (WACS)
MAT-1-0024
Alerts
1. Day of Surgery Admissions requiring Anti-D [refer 1.1 and 2.1]: The Obstetric and/or
Gynaecology Medical Officer is responsible for the ordering of Anti-D for Rh D negative patients.
2. Rh D Positive Platelet Transfusion
2.1. Rh D negative patients should receive 250 IU prophylactic Anti-D when receiving Rh D
positive platelets if they are:
 Women of child bearing age
 Men less than 25 years of age
2.2. Anti–D should be given subcutaneously to patients with low platelet counts due to the risk of
haematoma.
2.3. For doses exceeding a volume of 5 ml, it is recommended to administer in divided doses at
different sites. Anti–D need only be given on a weekly basis
Forms and Equipment
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A Transfusion Medicine request form that includes indication for use and the gestation (in
weeks).
Human Anti-D Antibody Product Administration and patient consent form
Patient information brochure
Anti–D vial
5 ml syringe
Interlink Vial access
21 and 23G needle
Alco-wipes
Gloves
Preparation and Administration Procedure
1. Collect Anti-D from Pathology. A Transfusion Medicine Request form is required. Note if the
product appears turbid or contains any sediment do not use it. The product must be used
immediately after opening. Any unused solution should be discarded appropriately.
2. Patient Identification: check three points of identity with two registered nursing /midwifery staff
(See RHH COC 40 Patient Identification Policy and Procedure).
3. Checklist [refer to Human Anti-D Antibody Product Administration form]:
 Mothers blood group
 Baby’s blood group (post partum)
Custodian: WACS
Authorised by: Haematology / Obstetric Depts
Document File Name: STAHS Clinical Guideline.doc
Effective Date: September 2014
Review Date: September 2017
Page 5 of 7
Tasmanian Department of Health and Human Services
Royal Hobart Hospital
Clinical Guidelines
Note: The electronic version of this document is the version currently in use. Any printed version can not be assumed to be current.
Please remember to read our disclaimer.
Rh D IMMUNOGLOBULIN (Anti – D) ADMINISTRATION
GUIDELINE (WACS)



MAT-1-0024
Anti-D order by Medical Officer
Record batch number in patient medical records on Human Anti-D Antibody Product
Administration form
Patient consent section signed
4. Apply universal precautions (wear gloves)
5. Prepare skin with alcohol wipe
6. Administer slowly as deep intramuscular injection as per Product Information (see alerts)
7. Observe injection site
8. Document: dose, route, batch number and sign Human Anti-D Antibody Product Administration
form
Refusal for Consent of Treatment
Everyone has the right to decide whether or not to accept treatment before giving consent. It is
important for mothers to understand why they are being offered treatment and the risks and benefits
to them and their baby.
If there the paternal rhesus (D) status is positive, an option for checking the fetal blood group and
Rhesus status by the non-invasive prenatal testing may be discussed and offered to help with
counselling.
References
1. National Health and Medical Research Council (NHMRC): www.nhmrc.gov.au
2. Australian Society of Blood Transfusion Inc.(ASBT): www.anzsbt.org.au
3. Australian Red Cross Blood Service(ARCBS): www.transfusion.com.au
4. CSL Bioplasma: Rh(D) Immunoglobulin – VF, Product Information, 2007
5. Peninsula Health, Vic: Maternity Services Clinical procedure, Anti-RH(D) Immunoglogulin
Antenatal and Postnatal Administration,2006
Custodian: WACS
Authorised by: Haematology / Obstetric Depts
Document File Name: STAHS Clinical Guideline.doc
Effective Date: September 2014
Review Date: September 2017
Page 6 of 7
Tasmanian Department of Health and Human Services
Royal Hobart Hospital
Clinical Guidelines
Note: The electronic version of this document is the version currently in use. Any printed version can not be assumed to be current.
Please remember to read our disclaimer.
Rh D IMMUNOGLOBULIN (Anti – D) ADMINISTRATION
GUIDELINE (WACS)
MAT-1-0024
6. NWGH, Tas: Rh(D) Immunoglobulin (Anti-D), 2007
Custodian: WACS
Authorised by: Haematology / Obstetric Depts
Document File Name: STAHS Clinical Guideline.doc
Effective Date: September 2014
Review Date: September 2017
Page 7 of 7