Competency: 14

Details

Perform FMH tests by acid elution, evaluate the need for referral for confirmation by flow cytometry, request follow-up samples and communicate with midwives/clinicians on the need for additional doses of anti-D.

Considerations

• Practical application of national guidelines for antenatal testing and anti-D prophylaxis (e.g. BCSH, NICE).
• The management of potentially sensitising events during pregnancy.
• Factors affecting the severity of HDFN:
  • stage when antibody first detected
  • previous history of HDFN
  • antibody specificity
  • antibody class and subclass
  • antibody concentration.
• Mode of action in causing HDFN and antenatal testing requirements if detected in a maternal sample:
  • anti-D
  • anti-c
  • anti-K
  • ABO antibodies
  • other clinically significant red cell antibodies.
• Role of anti-D in perinatal mortality and morbidity and the risk of anti-D sensitisation.
• Anti-D immunoglobulin:
  • how it works
  • dosage
  • timing of administration for RAADP, in response to a potentially sensitising event (PSE) and post delivery.
• Role of feto-maternal haemorrhage in sensitisation of the mother and how to measure and manage sensitising events.
• What to do if anti-D prophylaxis is ’missed’.
• Advice given to women whose pregnancies are at risk from anti-D.
• Reasons for estimating the size of FMHs.
• Use and limitations of the acid-elution technique to determine FMHs.
• Flow cytometry technique to determine FMHs and its limitations.
• Prophylactic anti-D estimation of dose.
• Problems encountered by the inability to distinguish between immune and prophylactic anti-D.
• Identification of what constitutes a PSE in the first, second and third trimesters of pregnancy.
• Consideration of different RAADP programmes – one-dose vs two-dose.

Relevant learning outcomes