Anti-D Administration - | Health



Canberra Hospital and Health ServicesClinical ProcedureAnti-D AdministrationContents TOC \o "3-3" \h \z \t "Heading 1,1,Heading 2,2" Contents PAGEREF _Toc492639452 \h 1Purpose PAGEREF _Toc492639453 \h 3Alerts PAGEREF _Toc492639454 \h 3Scope PAGEREF _Toc492639455 \h 3Section 1 – Background PAGEREF _Toc492639456 \h 3Section 2 – Administration of Anti-D PAGEREF _Toc492639457 \h 4Administration of Anti-D PAGEREF _Toc492639458 \h 4Prophylactic Anti-D PAGEREF _Toc492639459 \h 4Anti-D for potential sensitising events during pregnancy PAGEREF _Toc492639460 \h 4Miscarriage, termination of pregnancy or genetic studies in the first trimester (weeks 1-12) PAGEREF _Toc492639461 \h 5Miscarriage, termination of pregnancy or genetic studies e.g. amniocentesis in the second and third trimester (beyond week 12) PAGEREF _Toc492639462 \h 5Trauma PAGEREF _Toc492639463 \h 5Women whose pregnancy is >12/40 with intermittent vaginal bleeding PAGEREF _Toc492639464 \h 5Postnatal Anti-D (within one hour of birth) PAGEREF _Toc492639465 \h 6Commence ‘Postnatal RhD Immunoglobulin (Anti-D) Pathway-for women with RhD negative blood group PAGEREF _Toc492639466 \h 6Postnatal ward/Birth Suite PAGEREF _Toc492639467 \h 6Intrauterine fetal death PAGEREF _Toc492639468 \h 6Cell salvage PAGEREF _Toc492639469 \h 6Storage PAGEREF _Toc492639470 \h 6Documentation PAGEREF _Toc492639471 \h 6Outcome PAGEREF _Toc492639472 \h 7Implementation PAGEREF _Toc492639473 \h 7Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc492639474 \h 7References PAGEREF _Toc492639475 \h 8Search Terms PAGEREF _Toc492639476 \h 8Attachments PAGEREF _Toc492639477 \h 8Attachment 1 – RhD Immunoglobulin (Anti-D) Pathway – for women with sensitising events during pregnancy PAGEREF _Toc492639478 \h 9Attachment 2 – Postnatal RhD Immunoglobulin (Anti-D) Pathway-for women with RhD negative blood group PAGEREF _Toc492639479 \h 10PurposeThe purpose of this procedure is to identify those women who require Anti-D (RhD) immunoglobulin and the administration of the required dose.RhD immunoglobulin is offered to all RhD negative women (with no preformed anti-D antibodies): prophylactically at 28 and 34 weeks as per NHMRC guidelinesfollowing a sensitizing event during pregnancyafter birth if their baby/babies has a RhD positive blood group. Back to Table of ContentsThis Standard Operating Procedure (SOP) describes for staff the process to ScopeAlertsRh D Immunoglobulin (RhD-Ig or Anti-D) is a blood product and the transmission of infective agents cannot be totally excluded even though there have been no documented reports of this product being responsible for the transmission of disease.There may be some mild reactions for example mild pyrexia, malaise and urticaria after intramuscular injections. True allergic responses are rare. Back to Table of ContentsScopeThis document applies to the following Canberra Hospital Health Services (CHHS) staff working within their scope of practice:medical officersmidwives and nurses student midwives and nurses under direct supervision.Back to Table of ContentsSection 1 – BackgroundRhD immunoglobulin can be recommended for RhD negative women with no preformed anti-D antibodies (level II evidence). The Australian product recommended for use in antenatal prophylaxis contains 625 IU (125 ?g), which is an appropriate dose.(NHMRC Guidelines 2003, p 9).Back to Table of ContentsSection 2 – Administration of Anti-DAdministration of Anti-D Anti-D (RhD) immunoglobulin should be administered by deep intramuscular injection. It should not be given subcutaneously. The deltoid muscle or the anterolateral thigh is the best site. The buttocks should be avoided. For women with a body mass index (BMI) of 30 or more, particular consideration should be given to factors which may impact on the adequacy of the injection, including the site of administration and the length of the needle used (National Blood Authority, Australia).Prophylactic Anti-DOffer antenatal RhD Immunoglobulin immunization to all RhD negative women at 28 and 34 weeks as per NHRMC Guidelines (2003).Check previous antibody titre results for any preformed Anti-D antibodies prior to administration at 28 weeks – test should have been attended within past two weeks and results clearly documented in the clinical record.Explain that the indication for the use of RhD immunoglobulin in RhD negative pregnant woman is to prevent RhD antibody formation. Give written information: The Use of Anti-D in Pregnancy Canberra Hospital Brochure or ACT Health Maternity Shared care Guidelines Fact Sheet Anti-D in PregnancyYou and Your baby: Important information for RhD-negative Women Australian Red Cross Brochure.Explain to the woman the potential risks and potential side effects of RhD immunoglobulinCheck blood group and recent antibody result with 2nd midwife/midwifery studentObtain consent and document in clinical record, prescribe and administer RhD immunoglobulin. Document administration in electronic medical record - Birthing Outcomes System (BOS), medication chart and pathway and handheld Maternity Record booklet.Following the administration of the 28 week RhD immunoglobulin ensure the woman has an appointment to return at 34 weeks. ALERTThe RhD immunoglobulin prophylactic dose of 625 IU is given at 28 and 34 weeks. It is only given after an antibody screen has been attended and results obtained at 28 weeks.When completing the pathology form for the antibody screen the woman’s gestation must be clearly documented.Anti-D for potential sensitising events during pregnancyRhD Immunoglobulin is given to RhD negative women for the following indications:miscarriage or threatened miscarriagetermination of pregnancyectopic pregnancyantepartum haemorrhagetrauma external cephalic version genetic studies where transplacental access is needed or puncture of fetal blood vessels is performed such as chorionic-villus sampling or amniocentesisIntrauterine fetal deathNote: Document in the clinical record and notify medical officer if the woman does not consent to the administration of RhD ImmunoglobulinAlert:Test for fetal maternal haemorrhage not required before 20 weeks.Miscarriage, termination of pregnancy or genetic studies in the first trimester (weeks 1-12)Administer one dose of RhD Immunoglobulin 250 IU for a single pregnancy.Administer one dose of RhD Immunoglobulin 625 IU for a multiple pregnancy.No further action is required.Miscarriage, termination of pregnancy or genetic studies e.g. amniocentesis in the second and third trimester (beyond week 12)Administer one dose of RhD Immunoglobulin 625 IUFollow Attachment 1 ‘RhD Immunoglobulin (Anti-D) Pathway – for women with sensitising events during pregnancy’Trauma Collect the woman's blood for feto-maternal haemorrhage (FMH) testing within one hour, or as soon as possible after the trauma.Transfusion serology / haematology will issue a report with the FMH quantification within 72 hours and notify the woman's ward of the dose of RhD Immunoglobulin that is required.Collect the woman's blood for an Anti D titre 36-48 hours following administration of RhD Immunoglobulin.Follow Attachment 1 ‘RhD Immunoglobulin (Anti-D) Pathway – for women with sensitising events during pregnancy’Women whose pregnancy is >12/40 with intermittent vaginal bleedingFollowing the first episode of bleeding collect the woman's blood for feto-maternal haemorrhage (FMH) testing within one hour of the bleed, or as soon as possible.Transfusion serology/haematology will notify the ward of the dose of RhD Immunoglobulin that is required.Follow Attachment 1 ‘RhD Immunoglobulin (Anti-D) Pathway – for women with sensitising events during pregnancy’Following each subsequent episode of bleeding repeat the group and antibody screen and Anti-D titre and consult with the Transfusion laboratory. DO NOT Administer RhD Immunoglobulin unless recommended by Transfusion Pathologist For women with continued bleeding repeat the group and antibody screen every 48 hours.Postnatal Anti-D (within one hour of birth)Commence ‘Postnatal RhD Immunoglobulin (Anti-D) Pathway-for women with RhD negative blood groupCollect blood from the woman for feto-maternal haemorrhage (FMH) testing within one hour of birth. Collect and send baby’s cord blood for group and Direct Coombs Test.Postnatal ward/Birth Suite Check baby’s blood group results from pathology transfusion lab within 24 hours of birthIf the baby’s blood group is RhD negative no further action is required.If the baby’s blood group is RhD positive, Anti-D will be required for baby’s mother.Administer intramuscular RhD Immunoglobulin (Anti-D) 625 IU to the woman with informed consent (within 48-72 hours of birth).Complete medication chart and ensure the standing order is signed by medical officer within 24 hours. If more than one dose of anti-D is required pathology transfusion lab will inform the ward staff within the next 36-48 hrs.Intrauterine fetal deathAn appropriate dose of anti D should be given within 24 hours of diagnosis of intrauterine death, irrespective of time of subsequent delivery.Cell salvageIf cell salvage is used the infused blood may contain up to 20mls of fetal cells; thus a large dose of anti D may be required, >1500 IU. If such a dose is required the please seek advice from transfusion laboratory pathologist re appropriate administration. A maternal sample for quantification of fetal cells should be done within 45 minutes of infusion.StorageAnti-D is to be stored in vaccine fridges with daily monitoring of temperature. Refrigerate between 2oC - 8oC, do not freeze. Protect from light.DocumentationDocument the administration of RhD immunoglobulin on the RhD immunoglobulin postnatal flow chart and the woman’s medication sheet.Ensure that the imprest card is returned to the pathology transfusion laboratory with the recipient’s full name, DOB and MRN (if available) and anti-D batch number. This ensures future traceability for the anti-D product. OutcomeWomen requiring RhD Immunoglobulin understand why this intervention was necessary RhD immunoglobulin has been administered to women with no preformed antibodies at 28 weeks and at 34 weeks gestation who have given their consent.RhD immunoglobulin has been administered to women with no preformed antibodies, following sensitising events during pregnancy and after birth if the baby’s blood group is RhD positive.Use of RhD Immunoglobulin has been safe and appropriate.Back to Table of Contents Implementation This guideline will be discussed at Multidisciplinary Education and Unit meetings. It will be available to access via Policy and Clinical Guidance on the ACT Health Intranet. Back to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationPoliciesHealth Directorate Nursing and Midwifery Continuing Competence PolicyConsent and treatmentProceduresCHHS Healthcare Associated Infections Clinical ProcedureCHHS Patient Identification and Procedure Matching PolicyGuidelines CHHS Fasting Guidelines – Elective and Emergency SurgeryLegislationHealth Records (Privacy and Access) Act 1997Human Rights Act 2004Work Health and Safety Act 2011Back to Table of ContentsReferencesACMI National Midwifery Guidelines for consultation and referral, 2008ACT Health, 2008, Maternity Shared Care Guidelines National Blood Authority, 2005, Guidelines on the prophylactic use of RhD immunoglobulin (anti-D) in obstetrics(D)%20Immunoglobulin%20(Anti-D)%20(C-Obs%206)%20Review%20November%202015.pdf.au/disease_therapeutics/pregnancy_anti-D : RhD immunoglobulin Material Fax Request SheetBack to Table of ContentsSearch Terms Rhesus, Anti D, RhD ImmunoglobulinBack to Table of ContentsAttachmentsAttachment 1 – RhD Immunoglobulin (Anti-D) Pathway – for women with sensitising events during pregnancyAttachment 2 – Postnatal RhD Immunoglobulin (Anti-D) Pathway – f or women with RhD negative blood group.Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Date AmendedSection AmendedApproved ByEg: 17 August 2014Section 1ED/CHHSPC ChairAttachment 1 – RhD Immunoglobulin (Anti-D) Pathway – for women with sensitising events during pregnancyAttachment 2 – Postnatal RhD Immunoglobulin (Anti-D) Pathway-for women with RhD negative blood group ................
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