Article PubMed Google Scholar. J Hepatol. Bolton—Maggs, et al: op cit see note 5 above. BMC Pregnancy Childbirth.
Transfus Clin Biol. Ethics, Innovation and the Regulation of Risk. Book Google Scholar. Rhesus negative ffDNA pilot. Download references.
You can also search for this author in PubMed Google Scholar. Correspondence to Julie Kent. JK contributed to the design of the ESRC study, conducted fieldwork, including interviews, analysed the data and reviewed the literature, developed the idea for the paper and wrote the paper. AMF contributed to the design of the ESRC study, the analysis of the data and literature, commenting on the paper and assisting in its revision. PS provided information about current clinical practice, commented on the paper and assisted in its revision.
All authors approved the final version of the paper. This article is published under license to BioMed Central Ltd.
Reprints and Permissions. Kent, J. Routine administration of Anti-D: the ethical case for offering pregnant women fetal RHD genotyping and a review of policy and practice. BMC Pregnancy Childbirth 14, 87 Download citation. Received : 07 October Accepted : 14 February Published : 25 February Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.
Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Since its introduction in the s Anti-D immunoglobulin Anti-D Ig has been highly successful in reducing the incidence of haemolytic disease of the fetus and newborn HDFN and achieving improvements to maternal and fetal health.
Discussion This paper considers whether it is ethically acceptable to continue administering antenatal Anti-D Ig to all RhD negative women when fetal RHD genotyping using maternal blood could identify those women who do not need this product.
Summary The antenatal administration of Anti-D Ig to a third of RhD negative pregnant women who carry a RhD negative fetus and therefore do not need it raises important ethical issues. Background Currently about one third of pregnant women who are blood group RhD negative in the United Kingdom UK approximately 40, women per year in England and Wales [ 1 ] , receive antenatal Anti-D immunoglobulin Anti-D Ig in pregnancy when they do not require it because they are carrying a RhD negative fetus [ 2 ].
If the antigens have been neutralised, the mother's blood won't produce antibodies. You'll be offered anti-D immunoglobulin if it's thought there's a risk that RhD antigens from your baby have entered your blood — for example, if you experience any bleeding, if you have an invasive procedure such as amniocentesis , or if you experience any abdominal injury. Anti-D immunoglobulin is also administered routinely during the third trimester of your pregnancy if your blood type is RhD negative.
This is because it's likely that small amounts of blood from your baby will pass into your blood during this time. This routine administration of anti-D immunoglobulin is called routine antenatal anti-D prophylaxis, or RAADP prophylaxis means a step taken to prevent something from happening. There doesn't seem to be any difference in the effectiveness between the 1-dose or 2-dose treatments.
Your local clinical commissioning group CCG may prefer to use a 1-dose treatment, because it can be more efficient in terms of resources and time. RAADP is recommended for all pregnant RhD negative women who haven't been sensitised to the RhD antigen, even if you previously had an injection of anti-D immunoglobulin. As RAADP doesn't offer lifelong protection against rhesus disease, it will be offered every time you become pregnant if you meet these criteria.
But for that, they required a medical breakthrough made in New York by a group of three researchers: one English, one American and a young Australian from Bendigo called John Gorman. In his later, distinguished years , photographs of Dr John Gorman — all dramatic eyebrows and sweeping comb-over — make him look slightly forbidding, but his face retains a kind of broad openness, as if he's about to kick a footy or whistle to a blue heeler.
The disease had first been described 20 years earlier, but there was and still is no cure. Gorman and his colleagues came up with a radical suggestion: to try to avoid the sensitisation that causes HDN in the first place. The theory was that the introduced antibody would "mop up" any of the baby's blood cells circulating in the mother's system, thus preventing her from mounting her own response.
The introduced antibodies would be present in such low numbers, and for such a short amount of time, that they wouldn't harm the baby. So the very thing known to kill babies was being proposed as their salvation. To the man on the street it seemed insane — and apparently the medical establishment felt the same.
The American National Institutes of Health called the idea "a nonsense", and the major funding bodies refused to support it. Nonetheless, Gorman and co ran a trial on Rh- volunteers at New York's Sing Sing prison, of all places and found that it worked.
On January 31, , they performed the first anti-D injection on a pregnant woman in history: Gorman's sisterin-law, Australian Kath Gorman. She went on to have seven children. It caused a sensation. Only months later, the first anti-D donors in Australia were recruited, and the country's anti-D donor program began the following year. Two years later, Australia became the first country in the world to be self-sufficient in its supply of anti-D.
A vial of anti-D. Today, every Rh- woman in Australia receives the treatment at 28 and 34 weeks of pregnancy, and again post-natally. Credit: Darren James. In some ways, these donors are the most incredible part of the entire anti-D story. Because the very first people asked to participate were the same women who had had HDN-affected babies themselves.
These women had watched their babies die or seen them grow up brain-damaged or deaf or with other permanent impairments. Some of these women had been sterilised after repeated stillbirths or neonatal deaths. And the treatment itself was too late for them: anti-D can't help once a woman is already sensitised. So these women were being asked to help others be luckier than they had been.
Almost without exception, they said yes. Such women are still recruited today. Robyn Barlow can recall, not so long ago, sitting in a doctor's reception waiting to talk to one. She was absolutely stricken: her eyes didn't leave the floor the entire time I was talking.
So I said, 'We've come to ask you to donate, but please don't think about it now. I'll ring you in a few days. Later I thought, 'I can't do this anymore. And she said yes, she'd do it. We made thousands of ampoules of anti-D with her blood. In the early days, these men risked viral infections such as Hepatitis C and later HIV from the booster shots, but they joined up anyway.
At 14, he received a lifesaving blood transfusion and, at 18, in a spirit of repayment, he became a blood donor. He is known in antiD circles as "the man with the golden arm". James Harrison, year-old blood donor extraordinaire. In 50 years, Harrison has never missed an appointment. Every fortnight, his blood like that of all anti-D donors is extracted at the blood bank, then his plasma is separated from his red blood cells; then his red blood cells are reinjected to prevent anaemia.
The whole process is "a major impost", points out the Red Cross's Robert Flower. It's an extraordinary level of dedication. Harrison, however, is unfazed. Until , every batch of anti-D made in Australia contained his antibodies.
His daughter Tracey, who is Rh-, received anti-D containing his antibodies in both her pregnancies. Harrison turned 80 last year, but has no plans to stop donating. Today anti-D remains the only preventative treatment for HDN. Every Rh- woman in Australia receives it at 28 and 34 weeks of pregnancy, and again post-natally.
Indeed, for the past several decades it's been so routine that one woman I speak to had mistaken it for a vitamin shot. Thanks to it, the number of Australian children who die from HDN has fallen over a hundred-fold, to approximately 0. In , Gorman and his two colleagues, plus two English research scientists who worked on anti-D at the same time, received the Lasker Award — the American equivalent of the Nobel Prize.
Associate professor Cate Hyland is a principal research fellow at the Blood Service. She and her team recently developed a test strategy that, for the first time, identifies the Rh status of certain groups of African women in the Australian population whose blood groups may not be identified by normal testing.
Africans have an Rh- incidence of 5 to 8 per cent — but that's still significant. So we've designed a test strategy that allows us to define exactly what their blood group variants are, and we've actually discovered some novel blood group gene types.
It's important for the management of the mother, because you can absolutely pinpoint whether she's at risk for making the antibody. The Blood Service has shared this knowledge and expertise via the Africa Society for Blood Transfusion, and recently began negotiations with African scientists who hope to apply these principles, and newly discovered genetic variants, in their own testing development.
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