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Antepartum Rh Immune Globulin
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Joanne Wible-Kant, M.D., * and Alan E. Beer, M.D.t
The introduction of anti-D immune globulin in 1968 has resulted in the near eradication of hemolytic disease of the newborn secondary to rhesus incompatibility .. The incidence of and the infant mortality from the disease have decreased dramatically owing to intensive programs for physician education, patient identification, postpartum, and most recently antepartum administration of anti-D to all women at risk. Because of the success of these programs it was thought that once the population of women sensitized prior to anti-D availability stopped reproducing, new cases of Rh isoimmunization would be eliminated completely. Unfortunately, this has not occurred, and during the past 10 years very little progress has been made in reducing the incidence of Rh sensitization further. Reasons for the continued occurrence of sensitization in the Rhnegative patient include the following (Table 1): 1. Patient was sensitized prior to the availability of anti-D prophylaxis. 2. Rh immune globulin was not given when indicated (after abortion, ectopic gestations, and so on). 3. Prophylaxis was given but failed to protect; this usually occurs with unexpected fetomaternal hemorrhages of greater than 15 ml of packed red blood cells or 30 ml whole blood. 4. The patient received a transfusion of Rh-positive blood at a previous time. 5. Rh antibodies appeared during a first pregnancy. 6. The patient was sensitized in utero as a consequence of receipt of D-positive cells from a twin or mother.
For women who were sensitized prior to the availability of anti-D and for Rh-negative women who inadvertently received Rh-positive transfusions there is very little that can be done; however, results emanating from clinical attempts to alter existing levels of sensitization in such individuals with oral administration of the antigen appear promising. 2.21 For recognizing and dealing with instances of transplacental hemorrhages that are not *Instructor, Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, Michigan tProfessor and Chairman, Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, Michigan
Clinics in Perinatology-Vol. 10, No.2, June 1983
343
on
""",,.nt,,,,,, Obstetrics
I
lin
Joanne Wible-Kant, M.D., * and Alan E. Beer, M.D.t
The introduction of anti-D immune globulin in 1968 has resulted in the near eradication of hemolytic disease of the newborn secondary to rhesus incompatibility .. The incidence of and the infant mortality from the disease have decreased dramatically owing to intensive programs for physician education, patient identification, postpartum, and most recently antepartum administration of anti-D to all women at risk. Because of the success of these programs it was thought that once the population of women sensitized prior to anti-D availability stopped reproducing, new cases of Rh isoimmunization would be eliminated completely. Unfortunately, this has not occurred, and during the past 10 years very little progress has been made in reducing the incidence of Rh sensitization further. Reasons for the continued occurrence of sensitization in the Rhnegative patient include the following (Table 1): 1. Patient was sensitized prior to the availability of anti-D prophylaxis. 2. Rh immune globulin was not given when indicated (after abortion, ectopic gestations, and so on). 3. Prophylaxis was given but failed to protect; this usually occurs with unexpected fetomaternal hemorrhages of greater than 15 ml of packed red blood cells or 30 ml whole blood. 4. The patient received a transfusion of Rh-positive blood at a previous time. 5. Rh antibodies appeared during a first pregnancy. 6. The patient was sensitized in utero as a consequence of receipt of D-positive cells from a twin or mother.
For women who were sensitized prior to the availability of anti-D and for Rh-negative women who inadvertently received Rh-positive transfusions there is very little that can be done; however, results emanating from clinical attempts to alter existing levels of sensitization in such individuals with oral administration of the antigen appear promising. 2.21 For recognizing and dealing with instances of transplacental hemorrhages that are not *Instructor, Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, Michigan tProfessor and Chairman, Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, Michigan
Clinics in Perinatology-Vol. 10, No.2, June 1983
343