This guideline covers fetal RhD testing, anti-D prophylaxis for prevention of haemolytic disease of the fetus & newborn, & management of maternal antibodies. Prevention of haemolytic disease of the fetus & newborn is primarily through non-invasive pre-natal testing of RhD negative pregnant women’s blood, to detect cell free fetal DNA which determines whether the fetus is RhD negative or RhD positive.

A regime of prophylactic anti-D is then given if the fetus is RhD positive or RhD inconclusive/unknown. Management of pregnant women with D & other red cell antibodies is essential to ensure the best outcome for both baby & mother.

When an RhD negative woman becomes pregnant, there is a 60% chance that the fetus will be RhD positive. If any RhD positive fetal blood goes into the maternal circulation (feto-maternal haemorrhage – FMH) there is a risk that the woman will create D antibodies (immune anti-D) against the RhD positive fetal blood.

There are many events that may cause fetal blood to go across the placenta into the maternal circulation (see Appendix 1). The first pregnancy where this occurs does not generally cause any problems for that fetus; however in future pregnancies, if the fetus is RhD positive, the maternal D antibodies will attack the fetal red cells which can lead to fetal anaemia, jaundice & even death.

Prophylactic anti-D can prevent the creation of maternal D antibodies (sensitisation) which then prevents haemolytic disease of the fetus/new-born. However Anti-D prophylaxis only works in women who have not already been sensitised to the D antigen.

NB BSH guidance states at least 500IU of anti-D should be given; the anti-D product currently used at all BSPS sites is 1500IU so this will be supplied instead and the entire 1500IU dose should be given.

NICE Guidelines on High-Throughout non-invasive prenatal testing for fetal RHD genotype (Nov 2016) recommends use of cell free fetal DNA genotyping testing from 11+2/40 to predict the RhD status of the fetus and to guide anti-D prophylactic management.

This test is >99.9% accurate at predicting RhD negative status, so there is <0.1% risk of a false negative. To mitigate against this risk, cord grouping at delivery is recommended for baby’s predicted to be RhD negative. As delivery is the primary sensitising event this reduces the risk significantly. If the cord/baby result is RhD positive the woman will be offered anti-D. simulation studies reported by NICE 2016 estimates there would be 13 extra sensitisations per 100,000 women if cord typing is not done; if cord typing is done he estimates there will only be 3 extra sensitisations per 100,000 women (the previous regime where all RhD negative women were given anti-D resulted in 281 sensitisations per annum).

There is a 2% chance that a baby predicted to be RhD positive will be RhD negative. This does not pose any greater risk than the previous regime where all women with an RhD negative fetus had anti-D during pregnancy.

Benefits for women with RhD positive fetus

the woman will know that she requires anti-D for routine prophylaxis at 28-30/40, for any sensitising events, & she will have anti-D as soon as possible after delivery, eliminating the wait for cord testing.

Benefits for women with RhD negative fetus

the woman will not receive unnecessary anti-D.

Inconclusive results

• There will be a small number of women whose result is inconclusive

• These women will be treated as if the fetus was RhD positive during pregnancy

• At birth they will require a cord sample to conclusively determine the RhD status, & will need further anti-D if the baby is RhD positive or a cord sample cannot be obtained

Detection of weak RhD positive maternal blood groups by Fetal D testing

There is the possibility that fetal D testing will detect that the mother is ‘weak D positive’. In these cases, the woman will not need anti-D.

Future in-house maternal groups may still result as RhD negative (as the laboratory analysers are not as sensitive as NHSBT analysers) but the laboratory BT Manager should correct these results along with a comment that NHSBT testing has confirmed the patient is RhD positive.

3.1 Booking appointment

All women will require a blood group & antibody screen to determine RhD status (6mL pink top EDTA) which must be requested on EPR and sent to the blood transfusion laboratory.

3.2 Antenatal visit: (usually 14-16/40)

If the woman is RhD negative, the midwife should

• Explain the implications of RhD type & the cffDNA test

• Supply the woman with the NHSBT patient information leaflet ‘Mother’s blood test to check her unborn baby’s blood group’.

• If the woman wishes to have the cffDNA test complete the request and take a single 6mL EDTA and send to the laboratory, who will refer the test to NHSBT

• If the woman does not wish to have the test, follow the ‘Fetal RhD result inconclusive / unknown’ pathway.

If the woman has a Positive antibody screen to any antibody see also sections 9 and 10.

3.2.1 Cell Free Fetal DNA results

• The result will usually be available within 14 days

• The Transfusion Laboratory will copy the result (from NHSBT Sp-ICE database) onto the Laboratory Information Management System (LIMS); this will be checked & verified by another member of staff

• The result will read

  • ‘The fetus with an EDD of xx/xx/xx is predicted to be RhD negative / positive / inconclusive’

Multiple births: a positive result means that at least one of the babies is RhD positive, a negative result means that all of the babies are RhD negative. Follow the ‘Midwifery flowchart for fetal RhD testing’.

4.1 Sensitising events

These are events that have the potential to cause a feto-maternal haemorrhage (FMH) which can lead to sensitisation; see Appendix 1.

• Establish the details of the sensitising event including when it occurred, & whether there was any obvious cause, especially for vaginal bleeding

• If the women are present, ensure samples are taken and sent to the laboratory to confirm the blood group and confirm sensitisation has not already occurred. If the women is not present this should be done prior to administration of the prophylactic anti-D

Samples required:

• 1 pink EDTA specimen for blood group & antibody screen

• For pregnancies >20 weeks gestation a Kleihauer will be performed to ascertain the size of bleed and calculate any additional anti-D required.

• Ensure anti-D is prescribed by Medical staff following a sensitising event (outside of midwifery exemptions) as follows:

4.1.1 Sensitising events that occur before cffDNA test result

If any RhD negative woman has a sensitising event before the result of the cffDNA test is known, the woman should be treated as if the fetus was RhD positive.

Women with fetus predicted RhD negative

These women will not require any anti-D during pregnancy.

Women with fetus predicted RhD positive

These women will require both:

• Routine antenatal anti-D prophylaxis: 1500IU anti-D between 28-30/40

• Sensitising event prophylaxis

Women with inconclusive / unknown result

These women will require both:

• Routine antenatal anti-D prophylaxis: 1500IU anti-D between 28-30/40

• Sensitising event prophylaxis

4.1.2 Women with recurrent per vagina (PV) bleeding

In the event of recurrent PV bleeding which is clinically judged to represent the same sensitising event, with no features suggestive of a new presentation or a significant change in pattern or severity of bleeding, a minimum dose of 500 IU anti-D Ig should be given at 6 weekly intervals.

Feto-maternal haemorrhage (FMH) screening (i.e. a Keilhauer blood test) should be performed every 2 weeks from 20 weeks onwards in this instance.

4.1.3 Prophylaxis in women where intraoperative cell salvage has been used.

Where intra-operative cell salvage has been used during Caesarean section in D-negative, previously non-sensitised individuals and where cord blood group is confirmed as D positive (or unknown) a minimum of 1500IU of anti-D should be administered and Clinicians must inform the transfusion laboratory if intra-operative cell salvage has been used to ensure that correct dose of anti-D Ig is issued. Fetal bleed volume needs to be ascertained by confirmatory methodologies e.g., flow cytometry

4.2 Routine antenatal anti-D prophylaxis

• Anti-D 1500IU should be given between 28 – 30 weeks

• Anti-D 1500IU must be given regardless of when, or if, any sensitising doses of anti-D have been given

• Request the anti-D as soon as possible, using EPR or ICE, including the date of the appointment at which the anti-D will be required and where the anti-D should be delivered to.

• Use of the NHS number is preferred

• No sample is required with this request

• For late or missed doses of anti-D refer to section 8 and report to the Transfusion Practitioner who must report them to SHOT.

4.2.1 Women transferring in mid-pregnancy & late bookers

• The woman should be assessed according to standard booking procedure, including routine booking bloods.

• The cffDNA test will be offered up 26/40 to allow for results & anti-D ordering for RAADP

• If already known to be RhD negative, it must be clearly established & documented whether she has received any doses of anti-D

• If she has received 500IU anti-D at 28/40 weeks elsewhere, a second dose of a minimum of 500IU should be given at 34/40

• If she is already greater than 28/40 gestation, has not received any prophylaxis & no antibodies to RhD have been detected, she should be recalled as soon as possible for her routine dose of 1500IU anti-D.

4.3 Administration Process

• Before administering anti-D, the midwife must review the woman’s blood group & antibody results, & the fetal RhD result

• 1 pink EDTA specimen for blood group & antibody screen (regardless of gestation) must be taken & sent with the request form to the Transfusion laboratory before giving anti-D.

• This is to confirm the blood group and ensure sensitisation has not already taken place.

• For pregnancies >20 weeks gestation a Kleihauer will be performed to ascertain the size of bleed and calculate any additional anti-D required.

Requests don’t need to be processed prior to issue of anti-D.

• Remove anti-D from storage

• Check patient’s identity & confirm against the compatibility label on the box containing the anti-D

• Check that the patient’s blood type is the same in her hand-held notes & on the blood transfusion tag. The woman must be Rh-D negative & the Fetal RhD result must be RhD positive or inconclusive/unknown.

• If the patient has a positive antibody screen, please see section 10.

• Do not administer anti-D if there is any discrepancy with patient demographics or the product.

• Administer one dose of anti-D (one vial of 1500IU) into the deltoid muscle. Women who have a bleeding disorder should receive the anti-D via the subcutaneous route.

• The woman should wait for at least 20 minutes after administration before leaving the clinic/surgery to detect cases of allergy/anaphylaxis

• Return fully completed compatibility tag to the Transfusion Laboratory.

Delivery of baby predicted to be RhD negative

There is < 0.1% risk of a false negative; to detect false negatives a cord sample must be taken at delivery & tested. A maternal sample is also required.

• If the cord/baby result is RhD negative no further action is required.

• If the cord/baby result is RhD positive the woman will be offered anti-D. The result discrepancy will need to be carefully explained to the woman & an incident form completed. Please involve the Transfusion Practitioner.

• If cord/baby sample is unavailable the midwifery team should council the women regarding risks and the mother should be offered prophylactic anti-D (at least 500IU anti-D within 72 hours of delivery. Check the Kleihauer result & administer any further anti-D as advised.)

Delivery of baby predicted to be RhD positive

A maternal sample is required and will be tested for group and Kleihauer to establish whether further anti-D is required

These women should have anti-D requested & given without delay (within 72 hours of delivery). Check the Kleihauer result & administer any further anti-D as advised.

There is a 2% chance that a baby predicted to be RhD positive will be RhD negative. This does not pose any greater risk than the previous regime where all women with an RhD negative fetus had anti-D during pregnancy; therefore, a cord sample is not required.

Delivery of baby with inconclusive / unknown result

A cord sample is required to determine the baby RhD result. A maternal sample is also required.

• If the cord/baby result is RhD negative no further action is required.

• If the cord/baby result is RhD positive or no cord/baby sample is available the woman will be offered at least 500IU anti-D (within 72 hours of delivery). Check the Kleihauer result & administer any further anti-D as advised.

Anti-D should be given immediately; for all sensitizing events after 20 weeks gestation including delivery a Kleihauer test is required on maternal blood to determine the size of the FMH & determine whether more anti-D is required.

If the Kleihauer result indicates additional anti-D is required:

• The additional dose of anti-D will be calculated by Transfusion Laboratory

• If a large dose is required intravenous anti-D may be suggested on the advice of clinical Hematologist; this may be a different preparation to the IM anti-D usually supplied.

• Follow up maternal samples will be required at 48 hours if given IV, & 72 hours if given IM; this will be tested to assess the clearance of fetal cells

• More anti-D, & therefore more follow up Kleihauer requests, may be necessary if fetal cells remain (BSH 2014). A clinical decision may need to be made in determining the dose & frequency of more injection dependent upon the volume of residual fetal cells detected.

• The clinical service must ensure patients return for these follow-up services.

A woman may choose to decline anti-D; this decision must be respected by the obstetrician /midwife. However, the healthcare professional must clearly document in the woman’s electronic maternity notes her reasons for declining. The healthcare professional must be fully satisfied that the woman understands the implications of this decision. The Transfusion Laboratory must be informed so they can record this in the LIMS.

Late anti-D is classified as being given more than 72 hours after a sensitising event, or for the routine antenatal dose it was given outside of the 28-30/40 time frame. These events have to be reported both at Trust level using the incident reporting scheme, & by the TP team to the Serious Hazard of Transfusion (SHOT) scheme.

8.1 Antenatal Patients

Routine dose

if the dose has not been given by 30/40 gestation it should be given as soon as possible.

Sensitising doses

If it is detected that a woman required anti-D but did not have it within 72 hours, it should still be given within 14 days from the sensitising event. The midwife must make every effort to contact the patient & arrange to administer the anti-D as soon as possible. The midwife must document in the patients hand held antenatal notes the reason for the late/missed administration of anti-D. The patient may need extra information/support (contact the Transfusion Practitioner team if needed).

8.2 Postnatal Patients

If a patient with an RhD positive baby is not given anti-D within 72 hours of delivery, the dose must still be given as soon as possible, up to 14 days after delivery.

8.3 Follow Up

Patients should have a Duty Of Candour documented and be informed that they did not receive the correct anti-D prophylaxis (for whatever reason i.e. could be due to patients non-compliance or failure of internal processes).

Patients who have missed a dose antenatally (whether routine or for a sensitising event), had a subsequent G+S which is negative, & from then on have had correct prophylaxis do not require follow up.

Most patients will have a positive antibody screen as they will have had anti-D at some point. Follow up tests of group and save are advised 6 months post delivery (by which point any prophylactic anti-D will no longer be in the system) to establish whether sensitisation has occurred. If sensitisation has occurred this should be reported as a trust incident and to the TP team who will complete a report for SHOT

The TP team will advise the clinical teams and then detail the follow up required in the management section of the incident reporting system.

It is the responsibility of the community midwives to ensure these women are followed up appropriately and additional samples are taken in accordance with guidelines below, and comments added by the laboratory teams. This includes consideration by the treating obstetric consultant of paternal testing where indicated on the report. They need to also ensure that the screening teams are aware and that appropriate neonatal plans are put in place.

9.1 Positive antibody screen showing D antibodies:

Women may present with existing D antibodies at booking or develop them during pregnancy. If a woman develops D antibodies after they have had a negative cffDNA result, this could indicate that the result was a false negative.

9.1.1 Anti-D antibodies detected BEFORE or at 28 weeks gestation:

Anti-D detected at or before 28 weeks gestation will only be identified in a relatively small proportion of pregnancies. It poses a greater risk of rising in levels and causing significant HDFN if it is proven to be immune.

For this reason (regardless of gestation and whether the women has recently received prophylactic anti-D or not) samples will be sent to NHSBT to confirm the antibody specificity and level of antibody present. The following comments will be added to the laboratory report:

‘Positive antibody screen-Samples sent to NHSBT for further investigation, further details to follow’.

Additional testing for anti-D quantification should be undertaken at 4 weekly intervals up to 28 weeks and then every 2 weeks until delivery. At least 6mL of EDTA (pink top) should be sent as per lab instructions.

These women who have antibodies from booking should be under the remit of the Antenatal Screening midwives, given it is more likely to be immune in nature.

If anti-D quantification levels are <0.4IU/mL, prophylactic anti-D (RAADP and following sensitising events) should be administered as for a non-sensitised women.

• If the woman is confirmed as having developed immune anti-D she should be referred to a Fetal Medicine Consultant to discuss the risks in the pregnancy and plan of care for the pregnancy. No further doses of prophylactic anti-D should be administered but repeat quantification will be required at 4 weekly intervals up to 28 weeks and then every 2 weeks until delivery. The laboratory will add appropriate comments confirming the above.

• The exception to this is where the cffDNA result has subsequently confirmed that the fetus is predicted as RhD negative, when no further testing is required. However, she should be offered a conversation with a fetal medicine consultant to discuss the risks in any future pregnancy.

9.1.2 Anti-D antibodies detected AFTER 28 weeks gestation

If anti-D is detected after the 28 weeks gestation in women where there is no history of immune anti-D and there is clear evidence of anti-D prophylaxis samples will be sent to NHSBT to confirm antibody specificity and level of antibody in the sample (Quantification).

If the quantification level is low (<0.2IU/mL) it is almost certainly passive (due to prophylaxis) and the following comment will be issued by the laboratory: Anti-D detected of probable prophylactic origin, no further testing required. Continue to offer anti-D prophylaxis as per policy.

If the quantification is >0.2IU/mL but <0.4IU/mL it is not possible to determine the origin of anti-D. The following comment will be added by the lab: Anti-D detected of unspecified origin, please continue to offer anti-D prophylaxis and send repeat samples at 4 weekly intervals up to 28 weeks gestation and every 2 weeks thereafter. Cord samples to be taken at delivery for group and DAT. Antenatal teams do not need to refer to the Fetal Medicine Consultant if the quantification is <0.4IU/mL.

Of note, the prophylactic anti D may be present in blood serum samples for up to 3 months after administration.

If the quantification is >0.4IU/mL, it is less likely to be related solely to anti D administration and the pathways should be followed for referral to a fetal medicine consultant where appropriate.

Figure 1: Guidelines on interpretation of anti-D quantification from Guideline for the investigation and management of red cell antibodies in pregnancy: A British Society for Haematology guideline (2025)

Red cell antibodies have implications for the woman & for the fetus/new born.

Implications for the fetus / new born

Anti-D, -c and antibodies within the Kell system are the antibodies most likely to cause significant fetal disease. Therefore, pregnant women with these antibodies should be followed up at monthly intervals until 28 weeks of gestation and at two weekly intervals thereafter to term. The concentration of antibodies will predict the clinical outcome as follows taken from British Society of for Haematology [BSH] (2025) Guideline for the investigation and management of red cell antibodies in pregnancy:

Pregnant women with antibodies, other than anti-D, -c and Kell should be retested (titrated and further antibodies excluded) once in the third trimester, normally at 28 weeks; the results at this time will determine the frequency of follow-up testing required thereafter.

Implications for the woman with red cell antibodies

It may take much longer to get blood for women with Anti-e, Jka, Jkb, M, S, s, Fya & Fyb antibodies. Specific blood may need to be pre-ordered from NHS Blood & Transplant at either Oxford or Tooting. It is therefore essential to inform the Transfusion laboratory, & to send an urgent crossmatch for a minimum of 2 red cells (rather than a G&S), in advance of delivery to allow time to order red cell units in case they are required.

11.1 Laboratory

If the laboratory identify an antibody, they will send the sample off for confirmation to NHSBT and send a report to this effect via EPR/ICE. This result will alert the midwife that antibodies are present and if any further testing is required.

The lab will notify the screening midwives via generic email boxes or telephone of any urgent results only as follows:

• New incidents of antibodies detected

• High Titre levels

• Big increase in titre/quantification levels

• Any women with clinically significant antibodies identified after 28 weeks gestation.

Laboratory reports will be sent to the requester with full details of the antibody status and instructions on when subsequent tests need to be taken.

Results are also available on SpICE. Log ins and training available from the laboratory.

11.2 Antenatal community midwifery teams

Antenatal community teams must take responsibility for checking all booking and subsequent blood tests. They are also responsible for the follow-up blood tests in women where anti-D concentration is <4.0IU/mL or anti-c concentration <7.5IU/mL.

The laboratory will only email or phone results that are urgent as above - these will be sent to the antenatal screening midwifery team.

Ensure the women is under the care of a Consultant Obstetrician, they may also need referral to a specialist unit.

The presence of the antibodies should be highlighted with the maternal maternity records for easy recognition.

Any woman with abnormal antibodies should have samples sent and a crossmatch should be requested as soon as the women presents in labour. The request must clearly specify that the sample is ‘pre-delivery’. This will ensure the sample remains on site for testing rather than being sent to NHSBT for further antibody quantification/titration.

It may be necessary to have blood available for the baby at delivery if there is known fetal anaemia. The blood must be irradiated if intrauterine transfusions have taken place. Any neonatal blood requirements must be communicated in advance to the Transfusion laboratory. See BSPS Blood Transfusion Policy for Neonates & Paediatric Patients.

Samples on mum and baby should be sent post-delivery as per laboratory instruction.

Serious Hazards of Transfusion [SHOT]. Shot Annual Reports and Summaries. Available at: https://www.shotuk.org/shot-reports/ (Accessed: 18 September 2023).

British Society for Haematology [BSH] (2016). Blood Grouping and Antibody Testing in Pregnancy. Available at: https://b-s-h.org.uk/guidelines/guidelines/blood-grouping-and-antibody-testing-in-pregnancy (Accessed: 18 September 2023).

British Society for Haematology [BSH] (2014). Use of Anti-D Immunoglobin for the Prevention of Haemolytic Disease of the Fetus and Newborn. Available at: https://b-s-h.org.uk/guidelines/guidelines/use-of-anti-d-immunoglobin-for-the-prevention-of-haemolytic-disease-of-the-fetus-and-newborn (Accessed: 18 September 2023).

National Institute for Health and Care Excellence [NICE]. Routine antenatal anti-D prophylaxis for women who are rhesus D negative. TA156. Available at: https://www.nice.org.uk/guidance/ta156 (Accessed: 18 September 2023).

British Society of for Haematology [BSH] (2025) Guideline for the investigation and management of red cell antibodies in pregnancy. Available at Guideline for the investigation and management of red cell antibodies in pregnancy: A British Society for Haematology guideline - Regan - 2025 - Transfusion Medicine - Wiley Online Library (accessed Jun 2025)

Rapid Evidence Search

Topic: Prophylactic anti-D

Sources checked: NICE, Pubmed, Cinhal, Cochrane, UpToDate, Trip pro and BMJ Best Practice
Search terms: Prophylactic anti-D, anti D prophylaxis, anti-D, RhD, anti d immunoglobulin

Limits: Published since 10 years

Guidelines Moise, K. J. (2023) ‘RhD alloimmunization in pregnancy: Overview’, in T.W. Post (ed) UpToDate. Waltham, MA: UpToDate. Available at: RhD alloimmunization in pregnancy: Overview (Accessed: 18 September 2023). [NB. This is a time-limited URL to the full-text. If adding this reference to a guideline, use https://www.uptodate.com/]

Moise, K. J. (2023) ‘RhD alloimmunization: Prevention in pregnant and postpartum patients’, in T.W. Post (ed) UpToDate. Waltham, MA: UpToDate. Available at: RhD alloimmunization: Prevention in pregnant and postpartum patients (Accessed: 18 September 2023). [NB. This is a time-limited URL to the full-text. If adding this reference to a guideline, use https://www.uptodate.com/]

National Institute for Health and Care Excellence [NICE] (2016) High-throughput non-invasive prenatal testing for fetal RHD genotype. DG25. Available at: https://www.nice.org.uk/guidance/dg25 (Accessed: 18 September 2023).

National Institute for Health and Care Excellence [NICE] (2021) Antenatal care. NG201. Available at: https://www.nice.org.uk/guidance/ng201 (Accessed: 18 September 2023).

National Institute for Health and Care Excellence [NICE] (2016) New blood test for pregnant women could help thousands avoid unnecessary treatment. Available at: https://www.nice.org.uk/news/article/new-blood-test-for-pregnant-women-could-help-thousands-avoid-unnecessary-treatment (Accessed: 18 September 2023).

Royal College of Obstetricians and Gynaecologists (2014) The Management of Women Red Cell Antibodies during Pregnancy. Green-Top Guideline n. 65. Available at: https://www.rcog.org.uk/media/oykp1rtg/rbc_gtg65.pdf (Accessed: 18 September 2023).

Anti-D is a blood product & as such all aspects of sampling, request, administration & traceability are as outlined in the Blood Transfusion Policy for Adult Patients.

Anti-D is produced from plasma collected from donors across a number of sites in the USA, all of which comply with US Food & Drug Administration standards. The production process includes steps to minimize the risk of viral contamination.

Safety

The CSL Behring Rhophylac patient information leaflet currently states that:

‘When medicines are made from human blood or plasma, certain measures are put in place to prevent infections being passed on to patients. These include:

• Careful selection of blood and plasma donors to make sure those at risk of carrying infections are excluded,

• The testing of each donation and pools of plasma for signs of virus/infections,

• The inclusion of steps in the processing of the blood or plasma that can inactivate or remove viruses.

Despite these measures, when medicines prepared from human blood or plasma are administered, the possibility of passing on infection cannot be totally excluded. This also applies to any unknown or emerging viruses or other types of infections.

The measures taken are considered effective for enveloped viruses such as human immunodeficiency virus (HIV, the AIDS virus), hepatitis B virus and hepatitis C virus.

The measures taken may be of limited value against non-enveloped viruses such as hepatitis A virus and parvovirus B19.

Immunoglobulins have not been associated with hepatitis A or parvovirus B19 infections, possibly because the antibodies against these infections, which are contained in the product, are protective.’

https://www.medicines.org.uk/emc/product/6791/pil

Storage

Anti-D is usually kept in a refrigerator at 2-8ºC until ready for use, but it has been confirmed by CSL Behring that Rhophylac is stable at room temperature for up to four days if stored at 8-25⁰C. It is the responsibility of the GP surgery or ward to ensure that the anti-D is correctly stored as soon as it is received. The drug fridge should be correctly maintained & monitored as appropriate for a drug fridge. In the event that an alternative product is supplied please check the product insert for storage times. Fridges used for anti-D storage should be checked daily and any unused anti-D returned to the laboratory ASAP.

Contingency plan for management of Anti-D stock crises

Supplier stock crises have necessitated the creation of a contingency plan in case of failure of stock. In the event of a failure of stock the Transfusion Laboratory will supply an alternative. The Head of Midwifery will be consulted & advised of the option that will be used & will be responsible for ensuring staff are aware of this change. The TP team will support the midwifery department with this temporary change in practice.

This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

This guideline is for use in Frimley Health Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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