Lubušký M. Prevention of RhD alloimmunization in RhD negative women. Bimed. Pap. Med. Fac. Univ. Palacky Olomouc Czech Repub., 2010, 154 (1), p. 3-8.
ABSTRACT
Background. Despite the introduction of anti-D prophylaxis into clinical practice, RhD alloimmunization still
presents a problem to date. The actual incidence of RhD alloimmunization in pregnant women remains unknown in
most countries. Anti-D immunoglobulin is administered to RhD negative women at a fixed dose and in much greater
amounts than is actually necessary. On the other hand, it is not possible to diagnose cases where greater doses are
needed. To optimize the prevention of RhD alloimmunization in RhD negative women, it is important to diagnose
conditions that lead to fetomaternal hemorrhage (FMH), precisely determine the volume and subsequently administer
the appropriate dose of anti-D immunoglobulin. The possibility to accurately detect FMH and precisely determine its
volume would enable more effective and less costly prevention of RhD alloimmunization. Anti-D immunoglobulin could
be administered only in indicated cases and only in doses essentially necessary for prevention of RhD alloimmunization.
Methods and results. The Cochrane and UpToDate databases of systematic reviews, as well as national guidelines,
were reviewed.
Conclusions. Due to the medical significance and indispensable economic costs associated with prevention of RhD
alloimmunization, it would be appropriate to establish exact methodical guidelines. The text itself should be limited to a list of potentially sensitising events during which anti-D immunoglobulin should be administered to RhD negative women if anti-D antibodies are not already present. Following each potentially sensitising event, the minimal dose of anti-D immunoglobulin necessary for prevention of RhD alloimmunization should be determined. After 20 weeks of gestation, the volume of FMH should also be determined to specify the necessary dose of anti-D immunoglobulin.