Targeted RAADP: The Impact on Maternity and Laboratory Services
Time: 12:40 - 13:00
Date: 25 April 2018
Theatre: Dodder A
Introduction: Non-invasive prenatal testing (NIPT) using cell free foetal DNA from maternal plasma allows the RhD status of the foetus to be determined.1, 2 This information is required for targeting Routine Antenatal Anti-D Prophylaxis (RAADP). If a RhD negative pregnant woman is carrying a RhD negative baby, anti-D is not required during that pregnancy, whether it be for RAADP or sensitising events where anti-D may be administered. 40% of RhD negative women carry a RhD negative baby. Employing a targeted approach to RAADP results in 40% RhD-negative pregnant women not being exposed to a pooled human blood product that they do not need.
Material and Methods: targeted RAADP began in July 2017. At all antenatal clinics, booking bloods included a sample for cffDNA testing on all known RhD negative women and women of unknown RhD status. Testing was performed by the International Blood Group Reference Laboratory, Bristol, UK.3 Results were entered into the woman’s record on the laboratory information Management System (LIMS) with appropriate instructions pertaining to her anti-D requirement for the current pregnancy. Hard copy reports were also distributed. Labortaory staff also checked the LIMS record before issuing anti-D.
Results: the seven-month audit showed 69 (36%) women carried a RhD negative baby out of a total of 190 RhD negative women sampled. This resulted in 36% fewer Kleihauer tests, 36% saving in anti-D use and a cost saving of over €6000 when extrapolated to a full 12 months.
Conclusions: targeted anti-D administration can be implemented on a routine basis together with financial benefits, reduced laboratory testing and avoiding overnight stays or queueing for those women who don’t require anti-D.
- Leo Mulvany Chief Medical Scientist, Haematology/Blood Transfusion - Portiuncula University Hospital