Use of Anti-D

Current guidelines state that Anti-D immunoglobulin should be administered as soon as possible and always within 72 hours of a sensitising event. [23] If this deadline has not been met, some protection may be offered if anti-D Ig is given up to 10 days after the sensitising event.

In pregnancies <12 weeks gestation, Anti-D is only indicated following ectopic or molar pregnancies, therapeutic termination of pregnancy and in cases of heavy or repeated uterine bleeding, or bleeding associated with abdominal pain, if these events occur as gestation approaches 12 weeks. The minimum dose is 250IU, and a Kleihauer test is not required.

For potentially sensitising events between 12 and 20 weeks, again the minimum dose is 250IU, and a Kleihauer test is not required.

After 20 weeks, a minimum dose of 500IU of Anti-D immunoglobulin and a Kleihauer test are both required.

If a patient requires Anti D but is declining this (for example some Jehovah’s witness may decline), offer for rhesus testing of the ‘father’ to establish if they are rhesus negative. If so, anti-D would not be required.