1. Salwa Hindawi Rh-D Immunoglobulin Administration Salwa Hindawi Blood Transfusion Services KAUH

2. Salwa Hindawi TestTiming ABO determination  All pregnancies  Other  Initial visit  Pre-transfusion testing Rh status  All pregnancies  First pregnancy  Other  Initial visit  At 26-28 weeks (unless known to be Rh positive on 2 separate occasions)  Pre-transfusion testing Antibody screen  All pregnancies  D- pregnancies  D+ pregnancies  Other  Initial visit  Before RhIg Administration  Third trimester if transfused or history of unexpected antibodies  Pre-transfusion testing Antibody identification When initially detected Recommended schedule for serological testing in pregnancy:

3. Salwa Hindawi IndicationSystemAntigens RBC antibodies that may be associated with severe HDFN  Rhesus  Kell  Duffy  Kidd  D, C, c, E  K, k  Fy a  Jk a, Jk b RBC antibodies that may be associated with mild HDFN  ABO  li  Duffy  Lutheran  A, B  i  Fy b  Lu a, Lu b RBC antibodies not associated with HDFN  Lewis  li  P  Le a, Le b  l  P 1 Common red cell (RBC) antibodies that may be associated with the hemolytic disease of the fetus or newborn (HDFN), according to blood group system and antigen specificity

4. Salwa Hindawi Rh-Immunoglobulin Administration Incidence of alloimmunization is decreased from 12-13% to 1-2% when RhIg is administered within 72 hours of a full-term delivery. The incidence is farther decreased to 0.1% if RhIg is administered at 28 weeks.

5. Salwa Hindawi IndicationDose of RhIg (WinRho) Pregnancy (28 weeks gestation) 300  g (1,500 IU) IV or IM Postpartum, if newborn is D-positive, including weak D-positive 120  g (600 IU) IV or IM* or 300  g (1,500 IU) IV or IM Threatened abortion (at any time) 300  g (1,500 IU) IV or IM Abortion before 34 weeks (including very early pregnancy loss) 300  g (1,500 IU) IV or IM Amniocentesis and chorionic villus sampling before 34 weeks gestation 300  g (1,500 IU) IV or IM Abortion, amniocentesis, or any other manipulation after 34 weeks gestation 120  g (600 IU) IV or IM Other indications300  g (1,500 IU) IV or IM Recommended doses of Rh immune globulins for D-negative women without anti-D during pregnancy

6. Salwa Hindawi Other Indications: ectopic pregnancies abortions ante-partum hemorrhages fetal deaths amniocentesis patients.

7. Salwa Hindawi 20 µg of RhIg neutrlizes 1 ml of D-positive RBCs or 2 mls of D-positive blood. If additional doses needed Kliehour test or flowcytometry for fetomaternal haemorrage quantitation should be done.

8. Salwa Hindawi References: 1- AABB Technical Manual 2005. 2-Clinical Guide to Transfusion, Canadian Blood Services 2006. 3-KAUH Blood Transfusion Services Policies 2006.