EmailHospital Circular 35/2002
Date Issued: 25 November 2002
Publication: 35/2002
Distribution: Public Hospitals, Private Hospitals, Obstetricians/Gynaecologists/General Practitioners
Enquiries: Regional Office
Subject: Rh D Immunoglobulin (Anti-D) in Obstetrics
Purpose: This circular details advice regarding changes to the availability of Anti-D and its appropriate use.
In March 1999 the National Health and Medical Research Council (NHMRC) issued Guidelines on the Prophylactic Use of Rh D Immunoglobulin (Anti-D) in Obstetrics that suggested ways to balance best practice in the use of Anti-D with a limited national supply.
CSL Ltd has now, in addition to the normal 625 IU dose, developed a 250 IU dose of Anti-D for first trimester use and has arranged for the importation of WinRho SDF tm, a 600 IU dose from Canada. All three doses are registered with the Therapeutics Goods Administration (TGA). The additional supply of product has allowed for the introduction of antenatal prophylaxis for women who are Rh negative having their first baby reaching at least 28 weeks gestation. Note that the introduction of antenatal prophylaxis for these women does not remove the need to continue the practice of administration of Anti-D for sensitising events.
The introduction of antenatal prophylaxis for women who are Rh negative having their first baby reaching at least 28 weeks gestation is the first stage of a three-stage process towards universal antenatal prophylaxis using solely domestic Rh D Immunoglobulin. To ensure the most efficient use of these resources and to ensure the integrity of supply, it is essential that the three products be used as indicated below:
- first trimester indications (<12 weeks) - Rh D Immunoglobulin 250 IU;
- second and third trimester indications - Rh D Immunoglobulin 625 IU;
- antenatal prophylaxis at 28 and 34 weeks in women who are Rh negative having their first baby reaching at least 28 weeks gestation - Rh D Immunoglobulin 625 IU; and
- postpartum prophylaxis - WinRho SDF tm 600 IU.
To assist in the efficient use of Anti-D and to enable Australia to return to self-sufficiency as soon as possible, appropriate laboratory tests should be performed. For example, the Rh D status of the mother should be determined as early as possible in the pregnancy. Also, the NHMRC guidelines state that postpartum prophylaxis is effective when Anti-D is given within 72 hours of birth, therefore in most instances, there should be sufficient time to determine the Rh D status of the baby and to assess the magnitude of any fetomaternal bleed (preferably by flow cytometry, if available).
Further advice on stages two and three of the introduction of universal antenatal prophylaxis for all Rh D negative women will be provided as additional supplies of domestic product becomes available.
For further information on Anti-D and to order any of the products, please contact the Australian Red Cross Blood Service - Victoria, phone:- 9694 0200. WinRho SDF tm will be available in Victoria from 1 December 2002.
| Shane Solomon Executive Director Metropolitan Health and Aged Care Services |
Dr C W Brook Executive Director Rural & Regional Health & Aged Care Services |
