Anti-D Injection
All interventions have pros and cons. It is really important that you and your family are able to get good enough information to understand this issue and make the right decision that’s right for you. It is your right to accept it or decline it.
What is Anti-D injection (also called Anti-D (Rho) Immunoglobulin, Rho (D) Immune Globulin and Rhophylac® in the USA )?
Anti-D is a medicine made from blood which is offered to women who have rhesus negative blood and who have given birth to a baby with rhesus positive blood, in the hope of preventing their future babies from developing a condition known as rhesus disease or Haemolytic Disease of Fetus and Newborn (HDFN). It is given to stop the human body from producing its own antibodies. It is given as a prophylactic (preventative) treatment to prevent sensitisation from occurring. It can be given during pregnancy, at birth and at postnatal period. It is recommended to take it 72 hours after PSE (Potential Sensitising Event) or any sensitizing event.
Anti-D doesn’t protect the current baby. It is given to a mother only for the benefit of future rhesus positive babies.
Anti-D tests were done in 1967 and 1971 in nine clinical trials. Almost all of the women in the groups who received Anti-D were protected from sensitisation and since then it was recommended to all rhesus negative women who had given birth to rhesus positive babies. Randomisation and double blinding had not been used. No major test were done after that*
What are the Anti-D ingredients?
Anti-D is a medicine made from pooled blood, which means from mixing the number of people’s blood to make the Anti-D. It’s made from the donor’s blood who have been sensitized and/or have been able to produce anti-D antibodies. In a few cases, they became sensitized after accidentally receiving rhesus positive blood (pregnancy or a blood transfusion). But many Anti-D donors have been sensitized on purpose so they could donate their blood to make Anti-D. Thiomersal is not used anymore.*
“In the USA it’s known as a brand name Rhophylac®. It is a solution for injection that is clear or opalescent. The product is supplied as a pre-filled syringe. Each syringe of Rhophylac® contains a solution of gamma globulin (IgG) fraction of human plasma containing antibodies to Rh(D). It also contains glycine, sodium chloride and human albumin.”**
What is anti-D?
Lower-case “a”. It is a type of antibody that is naturally produced by the human body when the body encounters a particular substance.*
What is Antigen?
Antigen is a substance that can provoke an immune response and make the body produce antibodies. The “job” of antibodies is to fight off the invading substance.The current thinking is that we are born with some antibodies, we gain some from our mother during birth and breastfeeding, and we develop others throughout our lives.*
What is sensitization or isoimmunization?
The woman’s blood makes antibodies to an antigen. This process is called primary immune response. It leads to the production of a type of antibody called immunoglobulin M / IgM antibodies known as sensitisation or isoimmunization. If someone becomes sensitized to an antigen, they will always be sensitized.*
What is fetomaternal transfusion or transplacental haemorrhage (FMH)
When a woman’s rhesus is negative and the baby is positive and some blood enters the woman’s bloodstream (It usually is a small amount of blood, less than a teaspoon). These antibodies won’t hurt her current baby but the presence of antibodies can be a problem if she later becomes pregnant with a rhesus positive baby.
Some of the interventions named by the midwives as being possible causes of fetomaternal transfusion included ultrasound scans, exogenous oxytocin, artificial rupture of the membranes, amniocentesis, other invasive procedures involving the uterus, and even epidural.*
What is the PSE (Potential Sensitising Event)?
Some PSE events are: any kind of vaginal bleeding, abdominal trauma like car accident, ectopic pregnancy, intrauterine death, stillbirth, miscarriage, abortion, transfusion, surgery, C-section, laser.*
What is rhesus disease (HDFN) / Rh(D) disease?
It’s known as haemolytic disease of the fetus and newborn. It might impact a baby before and after the birth. When a baby develops a rhesus disease in the womb it might develop anemia or heart failure and after the baby is born it might also be jaundiced but only affects a small number of babies. Before anti-D was offered to women, rhesus disease often didn’t manifest until the third or fourth child.*
Common Side-Effects of the Anti-D?
● The first and most common side effects are: local inflammation, swelling, warmth, redness and soreness at the injection site*
● The second type of side effects are: chills, fever, skin rashes or aches. In more than one case when given after birth, it affected breastfeeding and made the first few days more difficult*
● The third type is rare but serious: hyper-sersitivity, anaphylaxis or shock (that’s why you will be asked to stay in the clinic/hospital for another 20 minutes)*
● Anti-D has a potential to carry infections.*
● No research has been undertaken to look at potential long term effects. And no research has been done when Anti-D was given in pregnancy and effect on the unborn baby*
● There are possible adverse effects on the growing baby’s immune system*
Routine Interventions
Anti-D has been used as a routine intervention. It’s highly overused in high-income areas. It has been used because of fear of litigation or “just-in-case.”*
How to find out what your and your partner's blood and rhesus type are?
Donating blood or self test from Amazon by Eldon
When you don’t need Anti-D?
● The woman is rhesus negative and the father is rhesus negative*
● The woman is rhesus negative and the baby is rhesus negative. You can take a test during pregnancy to find out the baby rhesus type. It is an antenatal screening test called a fetal RhD genotyping or a prenatal test called NIPT to find out if the baby is rhesus type. It can also find out other conditions like Down syndrome and can determine the baby’s sex*
● You can also get a test to find out if a rhesus positive partner has a heterozygous gene (which means that he has one rhesus positive and one rhesus negative gene) because then the baby will be rhesus negative. Two rhesus negative genes equal to a rhesus negative baby*
● This is your first (or even second) child and you plan not to have any more babies. There is also a chance that you might not be sensitized after the first baby*
Considerations when you decide to take the Anti-D
1. If you have PSE during 2nd pregnancy (can be taken 72 hours after the PSE but after 12 weeks of pregnancy).*
2. Wait at least three months after you take a live vaccine*
3. When after birth you find out the baby is rhesus positive, then you can take a Kleihauser test (also called Kleihauser-Betke or acid elution test). It takes a drop of maternal blood to ensure that the correct amount of Anti-D is given. You can wait 72 hours or more after the baby is born to take the Ani-D*
Other options to consider
Midwives thought it might be worth researching: nutrition, herbs like elderflower, red raspberry leaf, echinacea, and vitamins like bioflavonoids, magnesium, iodine. Others wondered whether breastfeeding might play a role in protecting against sensitisation.*