Optimizing Rh(D) Hemolytic Disease Management: A Comprehensive Guide to Prenatal and Postnatal Immunohematology Testing

By Lani Lieberman, MD, FRCP(C); Gwen Clarke, MD, FRCP(C); Mark Fung, MD, PhD; Wen Lu, MD; Theresa A. Nester, MD for the Transfusion Medicine Section Coordinating Committee

In the era before advanced medical interventions, Rh(D) hemolytic disease of the fetus and newborn (HDFN) was a significant contributor to perinatal mortality. However, with the advent of life-saving techniques such as neonatal exchange transfusion, intrauterine transfusion, amniocentesis, ultrasonography, and Rh immunoglobulin (RhIG) prophylaxis, the morbidity and mortality rates associated with Rh(D) HDFN have decreased substantially.

While these advancements have improved patient outcomes, they have also introduced new challenges. The increased size and complexity of multi-hospital healthcare systems, coupled with greater specialization among hospitals, practitioners, and laboratories, can lead to communication gaps and fragmented care. This is particularly concerning in the management of prenatal and perinatal patients, especially those with a history of sensitization, where close collaboration between clinicians, pharmacists, and transfusion service personnel is crucial.

The AABB Guide to Prenatal and Postnatal Immunohematology Testing aims to bridge this gap by promoting a shared understanding among healthcare professionals and discouraging outdated, non-evidence-based practices. The guide provides a comprehensive foundation on the fourfold objectives of prenatal and perinatal testing, followed by an in-depth exploration of key topics, including:

Routine Testing During Pregnancy

• Purpose and timing of routine testing
• Effectively managing the alloimmunized patient, including those with non-Rh(D) alloantibodies that can cause HDFN

Testing at Delivery

• Testing for both mother and neonate/cord blood

RhIG Prophylaxis

• Timing and dose of RhIG administration

Where possible, the guide presents complex information in a concise, tabular format. In areas where controversy exists or data is limited or inconsistent, the guide presents both pros and cons, encouraging practitioners to stay up-to-date with the latest discoveries and advancements.

DIGITAL EDITION: AABB, 2023