Preventing RhD haemolytic disease of the fetus and newborn: where to next?

Isbister, James P; Thomson, Amanda

doi:10.5694/mja2.50325

Non‐invasive fetal RhD genotyping will enable ethical and cost‐effective targeting of prophylaxis

There are many unique and inspiring aspects to the story of haemolytic disease of the fetus and newborn. This once common, mysterious, and potentially devastating disease has been known for centuries. It may have been the reason for the shocking obstetric history of Katherine of Aragon, the first wife of Henry VIII; the course of British history might have been very different had anti‐RhD been available in Tudor England.1

1 Sydney Medical School, Sydney, NSW
2 Australian Red Cross Blood Service, Sydney, NSW

Correspondence: james.isbister@sydney.edu.au

Competing interests:

James Isbister is a member of the Independent Advisory Committee of the Australian Red Cross Blood Service and Chair of the National Blood Authority Patient Blood Management Implementation Steering Committee. Amanda Thompson is a member of the National Blood Authority expert reference group for development of a clinical practice guideline on the use of RhD immunoglobulin in maternity care.

1. Maclennan H. A gynaecologist looks at the Tudors. Med Hist 1967; 11: 66–74.
2. Diamond L, Blackfan K, Baty J. Erythroblastosis fetalis and its association with universal edema of the fetus, icterus gravis neonatorum and anemia of the newborn. J Pediatr 1932; 1: 269–309.
3. Darrow RR. Icterus gravis (erythroblastosis) neonatorum. An examination of etiologic considerations. Arch Pathol 1938; 25: 378–417.
4. Levine P, Burnham L, Katzin EM, Vogel P. The role of iso‐immunization in the pathogenesis of erythroblastosis fetalis. Am J Obstet Gynecol 1941; 42: 925–937.
5. Bowman J. Thirty‐five years of Rh prophylaxis. Transfusion 2003; 43: 1661–1666.
6. McBain RD, Crowther CA, Middleton P. Anti‐D administration in pregnancy for preventing Rhesus alloimmunisation. Cochrane Database Syst Rev 2015; CD000020.
7. Thyer J, Wong J, Thomson A, et al. Fifty years of RhD immunoglobulin (anti‐D) therapy in Australia: celebrating a public health success story. Med J Aust 2018; 209: 336–339.
8. White SW, Cheng JC, Penova‐Veselinovic B, et al. Single dose v two‐dose antenatal anti‐D prophylaxis: a randomised controlled trial. Med J Aust 2019; 2011: 261–265.
9. Brinc D, Lazarus AH. Mechanisms of anti‐D action in the prevention of hemolytic disease of the fetus and newborn. Hematology Am Soc Hematol Educ Program 2009; 185–191.
10. Breveglieri G, D'Aversa E, Finotti A, et al. Non‐invasive prenatal testing using fetal DNA. Mol Diagn Ther 2019; 23: 291–299.

Online responses are no longer available. Please refer to our instructions for authors page for more information.