Anti D injection to Rh negative mothers a relook
Journal Title: Journal of the Indian Medical Association - Year 2018, Vol 116, Issue 9
Abstract
Presence of fetal cells in maternal blood was demonstrated by application of Acid elution wayback in 1957. Woodrow and Finn first produced evidences that transplacental haemorrhage (TPH) occurs during labour, at term and at sensitizing events e.g miscarriage, antepartum haemorrhage, amniocentesis. Maternal alloantibodies (IgG) develop against the RhD positive fetal cells which cross the placenta and destroys the fetal red cells thus causing haemolytic disease of fetus and newborn(HDF/N). Routine post natal administration of anti D immunoglobulin (IgG) to the Mother who has delivered a Rh positive neonate has reduced incidence of alloimmunisation from 16% to 2%; and a further decrease in incidence to 0.07% was observed when Inj. Anti D prophylaxis was given to all Rh- Mothers at 28 weeks and again after delivery should the Neonate is Rh positive. Studies say that a dosage of 300 micrograms (1500 IU) Anti D immuglobulin can neutralize 15 ml of fetal red cells or 30 ml of fetal blood and by this principle when the fetomaternal haemorrhage (FMH) volume is larger than 30 ml an additional dosage of anti D would be required. Accordingly different countries have developed their own protocol of appropriate doses of anti D injection. In our institution we administer 300ug of anti D igG to all Rh negative mothers who has delivered an Rh positive baby within 72 hours of birth. The same procedure is followed after a miscarriage also. But a number of literature has shown that only 0.4% woman have a TPH of more than 15 ml and therefore it is logical to think that in nearly 99% cases a 300μg anti D IgG is excessive and unnecessary and carries not only the burden of huge cost but also an increased risk of parentally transmitted diseases. Hence the present study was undertaken to assess the fetomaternal haemorrhage in cases of normal delivery, caesarean section and miscarriages by kleihauer Betke test (KBT) of maternal blood samples. Fifty cases of normal delivery, 50 cases of caesarean section and 50 cases of late miscarriage were randomly selected and it was found that KBT was negative among 44 to 50 % cases. In majority of cases an FMH of less than 4 ml was seen in 38% after normal delivery, 32% after caesarean section and 38% after late miscarriages. An FMH of 4 to 10 ml occurred in 10% cases of normal delivery and miscarriages and 18% after caesarean sections. Larger volume FMH of 10 to 30 ml was seen only in 2 to 4% of cases and FMH of more than 30 ml was rare. So this study indicated that in nearly 84% cases a dose of 500 IU (100 μg) anti D IgG would be sufficient when administered within 72 hours post delivery or caesarean section or miscarriage. A KBT of maternal blood sample would indicate whether a larger fetal bleed has occurred or not. In that case an additional dose of anti D IgG can be calculated and administered on the following day thus saving a considerable cost and also reducing the risk of blood borne diseases.
Authors and Affiliations
Barunoday Chakraborty, Sibapada Mondal
Keywords
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