Internationale richtlijnen voor het gebruik van Rhesus D immunoglobuline: een vergelijkend onderzoek en de plaats van foetale Rhesus D genotypering

Abstract

International guidelines for the use of Rhesus D immunoglobulin: a comparative study and the contribution of fetal Rhesus genotyping The introduction of immunoglobulin D (Anti-D, Rhogamâ) has been a major advancement in the prevention of Rhesus D alloimmunisation. However, the required dose and timing of administration remain unclear. Fetal Rhesus genotyping, to administer Anti-D more selectively, is not yet available as part of standard care for Rhesus negative pregnant women in Belgium. We performed a comparative literature search, using the most recent international guidelines regarding the use of Anti-D and fetal Rhesus genotyping. There is international consensus that Anti-D should be administered prophylactically between 28-34 weeks of gestation and especially postpartum. The recommended dose and number of administrations vary strongly in different countries. There is no international consensus regarding the necessity to administer Anti-D nor the dose of Anti-D to be administered in the event of possible sensitisation during pregnancy. The results of our guideline study suggest that several possible causes of sensitisation require a lower dose of Anti-D than the currently available dose in Belgium (1500 IU). One could consider introducing a lower dose in Belgium in order to use Anti-D more efficiently. Nonetheless, further research concerning the ideal dose per indication and the ideal timing of administration is indicated. Fetal Rhesus D genotyping has a sensitivity of 99.9% and specificity of 99.2% when performed after 11 weeks of gestation. Given the high sensitivity and specificity of fetal Rhesus genotyping, a standard implementation of this test in Belgium certainly seems worth considering.