The role of immunoglobulins in neonatal rhesus haemolytic disease

Rhesus (Rh) isoimmunisation is the most common form of severe haemolytic di sease of the newborn (HDN). The introduction of prophylaxis with anti-D Rh0 immunoglobulin (anti-D) has resulted in a marked reduction in the sensitis ation of Rh-negative women and deaths attributable to Rh HDN. The sensitisa tion rate could be further decreased if there was strict adherence to the g uidelines for administration of anti-D prophylaxis. Whether additional prop hylaxis at 28 and 34 weeks of gestation would be cost effective is controve rsial. Intrauterine transfusions to treat fetal anaemia, postnatal exchange transfusions and phototherapy are all part of the standard management of a ffected individuals. Intravenous immunoglobulin given to pregnant women can reduce fetal haemolysis, and when administered to neonates with Rh isoimmu nisation has been associated with a reduction in the requirement for exchan ge transfusion. There are, however, potential risks of immunoglobulin admin istration, including haemolysis due to the presence of anti-A or anti-B ant ibodies, allergy and the transmission of disease.