Pregnancy App Article: "Rhesus negative and the anti-D injection"

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Rhesus negative and the anti-D injection
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What does it mean for you and your baby?
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When you have your booking appointment, a blood sample is taken and tested for its rhesus status (among other things). If you are rhesus-D negative there could be health implications for any future pregnancies, but happily, these can be avoided by an anti-D injection. 

What does 'rhesus-D negative' mean?
It's quite possible you might not have known your blood type before you got pregnant - let alone your rhesus status - so why the sudden interest in the contents of your blood cells?

Most people are rhesus-D positive, which means the surface of their red blood cells contains a protein called the D antigen. But around 15% of people in the UK are rhesus negative (RhD negative).

If you are RhD negative but your baby has inherited a rhesus positive status from its father, then your blood and your baby's blood may be incompatible. If your blood then comes into contact, an immune response is triggered and you will develop antibodies that fight against your baby's blood as though it were a foreign invader. This process is called sensitisation.

It's unusual for maternal and foetal blood to mix during pregnancy and sensitisation does not normally occur until birth. But once the antibodies are created, they do not leave your blood system and so, if you have a second pregnancy where your baby is rhesus positive, the antibodies can cross the placenta and attack and destroy the baby's blood cells causing rhesus disease.

Rhesus disease can be mild, causing anaemia - but it can also be very serious, causing haemolytic disease of the foetus and newborn, which can be fatal.  

How does sensitisation occur?

Sensitisation can occur spontaneously during pregnancy, but this only happens in about 1% of RhD negative women. It is more likely to happen during a 'sensitising event', such as: 
  • Bleeding during pregnancy
  • Invasive procedures such as an amniocentesis or CVS
  • Abdominal injury during pregnancy
  • External cephalic version (where the baby is turned in the later stages of pregnancy)
It can also occur during a termination, miscarriage, ectopic pregnancy or blood transfusion. 

It is important that you let your midwife know if you are RhD negative and have experienced any of these events.
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The rhesus thing isn't a big deal but your midwife should be aware and you'll need to let them know if you sustain an impact (but you would anyway).
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I'm 25 weeks and have had two top-up anti-D injections already as I seem to be having a lot of unexplained bleeds. Everyone told me it was an awful injection to have, but I had one of them today and it wasn't that bad.
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Anti-D injection
The good news is that there is a simple way to prevent sensitisation during pregnancy. 

Anti-D immunoglobulin can be given whenever there is a risk of sensitisation. It can also be given routinely in the third trimester for all women who are RhD negative. This is not policy throughout the NHS, but if your area does offer this, it will probably be given at week 28 and week 34.

Anti-D neutralises the D antigen in foetal blood so maternal blood (ie yours) does not detect it and produce antibodies to fight it.

After your baby is born, a blood sample from the umbilical cord can be taken and tested for the D antigen. If the baby is RhD positive, another anti-D injection should be given within 72 hours to minimise the risk of sensitisation. 

Is Anti-D safe?
Anti-D is derived from donor blood, so it carries a very small risk of blood-borne infection. The risk is thought to be one in 10,000 billion doses - ie pretty low odds. If you have objections to receiving blood projects, you can refuse the anti-D injection.

It may cause a localised allergic reaction, but again this is rare. Women are asked to stick around for 20 minutes after the injection in case this happens.
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