How to administer Anti-D - Quick Guide



Presentation

  • Rh(D) Immunoglobulin-VF (Anti-D) in 2mL vial (with variable volume inside)
    • 250 IU and 625 IU of anti-D antibody for intramuscular use. (In other countries this would be referred to as 50 micrograms and 125 micrograms respectively.)
  • If Anti-D needs to be given intravenously (large doses or thrombocytopenia), please contact Blood Bank for advice.
CSL Anti-D 625IU
CSL Anti-D 250IU

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ABO Compatibility

  • Compatibility is not relevant for manufactured (fractionated) plasma product transfusion

Storage

  • If any delay store at 2-8°C in a blood or vaccine fridge. Domestic fridges are not recommended due to the variable temperature control.

Precautions

  • If Anti-D is given for large fetomaternal bleeds, febrile reactions due to haemolysis of the Rh(D) positive cells are common. Consider pre-medicating with paracetamol and ensure the patient is well hydrated.
  • Read manufacturer's instructions carefully
  • Always observe for turbidity, floating material and sediment
  • Intra-muscular use - follow recommended best practice.
  • Specific information is given in the manufacturer's product information
  • Although the manufacturer has raised concerns about giving Anti-D to women with a BMI greater than 30, an Expert Consensus Position Statement, endorsed by NZBS, has made somewhat different recommendations.

Kleihauer testing

  • Kleihauer testing is indicated in Rh(D) negative women where in the following circumstances:
    • at or after 20 weeks gestation:
      • Antenatal bleeding
      • Termination of pregnancy
      • Invasive procedures (amniocentesis, chorionic villus sampling)
      • External cephalic version or significant abdominal trauma
    • Following the birth of any Rh(D) positive or Rh(D) unknown baby, regardless of previous Anti-D administration
  • A full dose of Anti-D (625 IU Rh(D) Immunoglobulin) will provide protection for up to 6mL of fetal red cells.
  • For Kleihauer tests showing greater than 6mL fetal red cells, please contact a Transfusion Medicine Specialist (see Need Advice)
  • If you request a Kleihauer test, please remember to follow up the result, or hand it over if the patient is discharged or care transferred to someone else.

Administration

  • Rh(D) Immunoglobulin (CSL's Anti-D) may only be given intra-muscularly.
  • If Anti-D needs to be given intravenously - if the patient is thrombocytopenic or if large dose of Anti-D immunoglobulin is required (a large fetomaternal bleed) - please contact Blood Bank for advice

Monitoring

  • Recipients should remain under observation for 20 minutes following administration in case they experience an immediate adverse event requiring treatment.

DO NOT

  • DO NOT add medications to blood products.

Dose

  • For first-trimester indications only: 250 IU
  • Post-partum or following an antenatal sensitising event after 12 weeks gestation, or following termination after 12 weeks: 625 IU
  • For fetomaternal bleeds (positive Kleihauer test): 625IU for bleeds less than 6mL fetal red cells.
  • For fetomaternal bleeds greater than 6mL or for other indications, please consult a Transfusion Medicine Specialist (see Need Advice)
  • For other exposures to Rh(D) positive red cells (e.g. platelet transfusions or tissue implantation), please consult a Transfusion Medicine Specialist (see Need Advice)

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