Editorials

Anti-RhD prophylaxis for RhD negative pregnant women

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5437 (Published 04 September 2014) Cite this as: BMJ 2014;349:g5437
  1. Zarko Alfirevic, head of department of women’s and children’s health1,
  2. Therese Callaghan, consultant haematologist2
  1. 1Centre for Women’s Health Research, Institute of Translational Medicine, University of Liverpool, Liverpool L8 7SS, UK
  2. 2NHS Blood and Transplant, Speke, Liverpool L24 8RB, UK
  1. Correspondence to: Z Alfirevic zarko{at}liv.ac.uk

A simple antenatal blood test can target treatment only to those with RhD positive babies

When the father’s red cells are RhD positive and the mother is RhD negative, fetal blood cells will have paternally derived RhD antigen foreign to the mother. If a sufficient volume of fetal RhD positive blood enters maternal circulation, the mother will be sensitised. She will develop anti-RhD IgG antibodies that could endanger her fetus. These antibodies can cross the placenta and cause immune destruction of fetal cells, leading to fetal anaemia, fetal hydrops, and even death in extreme cases. As a rule, maternal rhesus sensitisation occurs during delivery of the placenta, putting any subsequent pregnancy at risk, but sensitisation can also happen during pregnancy.

Births of affected babies are fortunately a thing of the past thanks in part to the development of effective prophylaxis against rhesus disease, which began in the 1960s when Ronald Finn, Cyril Clarke, and colleagues did a series of well controlled studies in which they gave anti-D immunoglobulin concentrate to Liverpool policemen known locally as the “pregnant dads.” They then showed that …

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