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Rhesus Negative This information leaflet has been produced by Gateshead Health NHS Foundation Trust Maternity Unit to provide information to pregnant women who are Rhesus Negative What does being rhesus negative mean? Rhesus factor is the name given to a special protein or antigen, which is attached to the surface of the red blood cells. Approximately 15% of people do not have this, and are known as being Rhesus Negative (RhD negative), like you. The 85% who do have this antigen are known as being Rhesus Positive (RhD positive). The lack of this antigen does not affect the health of the person, but occasionally, problems can arise if a mother has a different Rhesus factor from her baby. Why is it important to know if I am rhesus negative? Rhesus status is important during pregnancy. If blood cells from a Rhesus Positive baby get into the bloodstream of a Rhesus Negative mother, she will react by producing Anti-D antibodies as though the baby’s blood was a foreign body. The most common time for this to happen is during birth, but it can happen at other times during pregnancy. This is not usually dangerous in a first pregnancy, but in later pregnancies, these antibodies can cross the placenta (afterbirth) and attack the blood cells of a Rhesus Positive unborn baby. This can cause ‘Haemolytic Disease of the Newborn’, or HDN, which can be very mild, but which is only detectable by blood tests in a laboratory. Each year in England and Wales, around 500 babies will develop HDN. It can cause anaemia and jaundice, but in severe cases, it can cause a baby to be stillborn or severely disabled. How is HDN treated? An injection is given to Rhesus Negative mothers in order to prevent HDN. The injection, Anti-D Immunoglobulin (or Anti-D injection), contains antibodies, which destroy any Rhesus Positive red blood cells passed from baby to mother before the mother’s system has time to recognise the foreign bodies, and produce her own. 1 What is Anti-D immunoglobulin? Anti-D Immunoglobulin, or Anti-D, is made from plasma in the blood, and is collected from donors. It is screened to reduce the risk of passing on viruses from the donor to the person receiving the injection. Are there any risks with Anti-D? Anti-D has been used for many years and is thought to be very safe. Occasionally, it may cause an allergic response in the mother, but this is very rare. For this reason, you should stay in the surgery / clinic for about 20 minutes following the injection, and if you do feel unwell, you should inform the midwife immediately. When would I receive Anti-D? To prevent HDN occurring, the National Institute of Clinical Excellence (NICE), a government agency, recommends that all Rhesus Negative mothers have a blood test to screen for antibodies at 28 weeks of pregnancy and that a routine injection of the Anti-D be given between 28 and 30 weeks. In Gateshead, a single dose of 1500IU is administered. It is also important to be given Anti-D following a late miscarriage, termination of pregnancy, amniocentesis, chorionic villus sampling, external cephalic version (turning the baby head down), any vaginal bleeding during pregnancy and after any abdominal trauma, such as a fall or road traffic accident. In these circumstances, your midwife or doctor will discuss this further with you. Following delivery, the midwife will obtain blood from yourself and the umbilical cord to check the baby’s blood group, and this will tell us if further Anti-D is needed. If it is, this will need to be given within 72 hours of the baby’s birth. What if I decide not to have the Anti-D injection? Even if you decide not to receive the Anti-D injection during your pregnancy, you will still be offered the blood test to identify the presence of any antibodies in your bloodstream. This would be done at 28 weeks, following the birth of your baby, or at any stage of your pregnancy where you experience vaginal bleeding. 2 How can I find out more information? Please discuss any queries or concerns with your midwife or consultant during your appointment; alternatively if you need any more information please do not hesitate to contact the Maternity Pregnancy Assessment Unit to speak to a midwife. Pregnancy Assessment Unit (24 hours 7days) 0191 445 2764 0191 445 3678 National Institute for Clinical Excellence (NICE) 11 Strand, London. WC2N 5HR www.nice.org.uk NHS Direct: Tel: 0845 46 47 www.nhsdirect.nhs.uk Data Protection Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible. In order to assist us improve the services available your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews. Further information is available in the leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust website or the PALS Service REFERENCE: NICE (2008) Routine antenatal anti-D prophylaxis for women who are rhesus D negative. NICE technology appraisal guidance 156 Information Leaflet: Version: Title: First Published: Last Reviewed: Review Date: Original Author: Reviewed by: No IL75 6 Rhesus Negative February 2007 August 2015 August 2017 Modern Matron Midwife This leaflet can be made available in other languages and formats upon request 3