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One single dose of 200 μg of antenatal RhIG halves the risk of anti-D immunization and hemolytic disease of the fetus and newborn in the next pregnancy

Authors

  • Joke M. Koelewijn,

    1. From Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam; Academic Medical Center, Amsterdam, the Netherlands; and the Institute of Health Policy and Management, Erasmus Medical Center, Rotterdam, the Netherlands.
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  • Masja De Haas,

    1. From Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam; Academic Medical Center, Amsterdam, the Netherlands; and the Institute of Health Policy and Management, Erasmus Medical Center, Rotterdam, the Netherlands.
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  • Tanja G.M. Vrijkotte,

    1. From Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam; Academic Medical Center, Amsterdam, the Netherlands; and the Institute of Health Policy and Management, Erasmus Medical Center, Rotterdam, the Netherlands.
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  • Gouke J. Bonsel,

    1. From Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam; Academic Medical Center, Amsterdam, the Netherlands; and the Institute of Health Policy and Management, Erasmus Medical Center, Rotterdam, the Netherlands.
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  • C. Ellen Van Der Schoot

    1. From Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam; Academic Medical Center, Amsterdam, the Netherlands; and the Institute of Health Policy and Management, Erasmus Medical Center, Rotterdam, the Netherlands.
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  • Source of the study: OPZI (detection and prevention of pregnancy immunization)-project: the nationwide evaluation of pregnancy screening for RBC antibodies other than anti-D, and of antenatal anti-D-prophylaxis in the Netherlands, performed by Sanquin Research and the Academic Medical Center of the University of Amsterdam, financed by the Council of Health Insurances. The study was supported by the Dutch Council of Health Insurances.

C.E. van der Schoot, Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Plesmanlaan 125, 1066 CX Amsterdam, the Netherlands; e-mail: e.vanderschoot@sanquin.nl.

Abstract

BACKGROUND: The objective was the evaluation of the effect of the Dutch national routine antenatal RhIG (anti-D) immunization prevention (RAADP) program comprising one single dose of 200 μg (1000 IU) of RhIG in the 30th week of pregnancy, restricted to women without a living child.

STUDY DESIGN AND METHODS: A nationwide historic control study was performed. All newly detected anti-D–immunized para-1 in 1999, 2002, and 2004 were included and classified on the basis of received prophylaxis during the first pregnancy: antenatal and postnatal versus only postnatal RhIG. The numbers of D– parae-1 who delivered a D+ first child before the introduction (control group) or after the introduction (intervention group) of the RAADP were calculated from Vital Birth Statistics (8,700 and 12,000, respectively).

RESULTS: Fifty-eight newly detected anti-D immunizations in the first trimester were observed in the control group and 39 in the intervention group, which resulted in a significant reduction of the prevalence of new anti-D immunizations from 0.67 percent (95% confidence interval [CI], 0.50%-0.84%) to 0.31 percent (95% CI, 0.21%-0.41%). No reduction was observed in anti-D immunizations newly detected at the 30th-week screening (0.25%). A nonsignificant risk reduction of the risk of severe hemolytic disease of the fetus and newborn (HDFN) was found (0.23% vs. 0.10%). The numbers needed to treat to prevent one anti-D–immunized pregnancy and one case of subsequent severe HDFN were 357 and 1255, respectively.

CONCLUSIONS: RAADP of one single dose of 200 μg of RhIG in addition to postnatal RhIG (200 μg) halves the risk of anti-D immunization and subsequent severe HDFN.

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