NICE Issues Updated Guidance For Rhesus Negative Women During Pregnancy

Main Category: Pregnancy / Obstetrics
Article Date: 28 Aug 2008 - 2:00 PDT

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The National Institute for Health and Clinical Excellence (NICE) has published guidance on the use of routine antenatal anti-D prophylaxis for rhesus D negative women in the NHS in England and Wales.

The guidance states that:

- Routine antenatal anti-D prophylaxis is recommended as a treatment option for all pregnant women who are rhesus D negative and who are not known to be 'sensitised' to the rhesus D antigen.

- When a decision has been made to give routine antenatal anti-D prophylaxis, the preparation with the lowest cost should be used. This cost should take into account the lowest acquisition cost available locally and costs associated with administration.

Women who are rhesus negative are missing a substance called D antigen on their red blood cells. Most of the time this is not an issue, but if they become pregnant and their baby is rhesus positive (has the D antigen on their blood cells) it may cause problems. If blood cells from a rhesus-positive baby get into the mother's bloodstream and she is rhesus negative, her blood will react as if it is a foreign substance and will produce antibodies against it. This is not usually dangerous in a first pregnancy, but in later pregnancies if the baby she is carrying is also rhesus positive these antibodies can cross the placenta and attack the blood cells of the unborn baby.

.Dr Gillian Leng, NICE Deputy Chief Executive and Executive Lead for this appraisal, said: "Our guidance published today updates and expands the previous recommendations issued in 2002 and is good news for women with this condition. Anti-D prophylaxis is an effective preventative treatment that can be given to rhesus negative mothers to prevent her producing antibodies to her baby's blood. This prevents the development of haemolytic disease which in a small number of cases can cause the baby to be stillborn, severely disabled or to die after birth as a result of anaemia and jaundice."

Notes

1. The guidance is available at http://www.nice.org.uk

2. The rhesus factor is found in the red blood cells. People who are rhesus positive have a substance known as D antigen on the surface of their red blood cells - they are said to be RhD positive. People who are rhesus negative do not have the D antigen on their blood cells - they are RhD negative. Whether a person is RhD positive or RhD negative is determined by their genes.

3. If the blood cells from an RhD-positive baby get into the blood of an RhD-negative woman, she will react to the D antigen in the baby's blood as though it is a foreign substance and will produce antibodies. This is not usually dangerous in a first pregnancy, but in later pregnancies the antibodies in the mother's blood can cross the placenta and attack the blood cells of an RhD-positive unborn baby. This can cause 'haemolytic disease of the newborn', (HDN). HDN can be very mild and only detectable by laboratory tests. But it can be more serious and cause the baby to be stillborn, severely disabled or to die after birth as a result of anaemia (lack of iron in the blood) and jaundice.

4. For 2005, it was estimated that approximately 65,000 RhD-positive babies were born in the UK to women who were RhD negative (10% of all births).

About NICE

5. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

6. NICE produces guidance in three areas of health:

- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector

- health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS

- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

http://www.nice.org.uk