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Sir,

We have read with interest the retrospective review on errors in anti-D immunoglobulin administration[1] and would like to highlight the publication of the National Institute for Clinical Health and Excellence (NICE) guidance on miscarriage and ectopic pregnancy published in December 2012 and specifically the change in guidance relating to the administration of anti D to Rhesus D-negative women before 12 weeks of gestation. This guidance has replaced the green-top guideline published by the Royal College of Obstetricians and Gynaecologists in 2011.[2]

NICE has recommended that anti-D is not required for women <12 weeks pregnant with vaginal bleeding, spontaneous miscarriage, medically managed miscarriage or medically managed ectopic pregnancy. Anti-D should still be administered for surgical management of miscarriage (replacement term for evacuation of retained products of conception) and surgical management of ectopic pregnancy.[3]

It would be valuable to know the number of sensitisations that occurred when anti-D was not administered or was administered late in women who were < 12 weeks pregnant.

References

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  2. References
  • 1
    Bolton-Maggs P, Davies T, Poles D, Cohen H. Errors in anti-D immunoglobulin adminis-tration: retrospective analysis of 15 years of reports to the UK confidential haemovigilence scheme. BJOG 2013;120:8738.
  • 2
    RCOG. The Use of Anti-D Immunoglobulin for Rhesus D Prophylaxis. Greentop Guideline No. 22. London: RCOG, 2011.
  • 3
    NICE Ectopic pregnancy and miscarriage. Diagnosis and initial management in early pregnancy of ectopic pregnancy and mis-carriage. NICE clinical guideline 154. Issued: December 2012. [www.guidance.nice.org.uk/cg154]. Accessed 3 June 2013.