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The page below is a sample from the LabCE course Hemolytic Disease of the Fetus and Newborn. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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RhIG 'Failures'

Numerous studies have shown that, if administered correctly, RhIG is effective at preventing D immunization. To work, RhIG must be given in sufficient dose, and it must be given before Rh immunization has begun.
Unfortunately, despite RhIG's proven efficacy, some women continue to make anti-D in the perinatal period. Such 'failures' are mainly (but not totally) due to human error.
Examples of how women may still produce anti-D some 40+ years after the implementation of RhIg prophylaxis:
  • Immunization to D occurred before the administration of RhIG, eg, before 28 weeks gestation*;
  • Immunization to D occurred after the administration of RhIG at 28 weeks and before delivery because an antenatal fetomaternal hemorrhage (FMH) occurred that was too large for residual passive anti-D to give protection;
  • Female was already immunized from a prior pregnancy but anti-D was too weak to be detected in antibody screen tests prior to RhIG administration;
  • RhIG dosage was insufficient to clear a larger fetal bleed at delivery (eg, FMH screen was not done or a false negative occurred);
  • Incorrect calculation of RhIG dosage;
  • RhIG administered too late , ie, well after 72 hours of delivery;
  • Antenatal RhIG not given, eg, mother had no, or limited, access to prenatal care, or did not seek it, and a FMH occurred during pregnancy;
  • Failure of physician to carry out prenatal blood testing;
  • RhIG not given due to laboratory clerical or technical error in Rh typing the mother or child;
  • RhIG not given in cases such as abortions, ectopic pregnancies, and trauma (eg, car accidents).
* Because anti-D production before 28 weeks is rare (the order of 0.24% to 0.31%), RhIG's use earlier in pregnancy is not recommended. It is not cost effective and would expose most women to an unneeded blood product.