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Systematic Review of the Critical Evaluation of the Literature Relating to the Effectiveness of RhD Immunoglobulin (Anti-D) in Obstetrics [Printed in: Guidelines on the Prophylactic Use of Rh D Immunoglobulin (Anti-D) in Obstetrics. Main Report]
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Systematic Review of the Critical Evaluation of the Literature Relating to the Effectiveness of RhD Immunoglobulin (Anti-D) in Obstetrics [Printed in: Guidelines on the Prophylactic Use of Rh D Immunoglobulin (Anti-D) in Obstetrics. Main Report]

J Gambel, Alison Craswell, James King and V Flennady
National Health and Medical Research Council
1999
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Abstract

obstetrics RhD Immunoglobulin (Anti-D)
The discovery, introduction and utilisation of Rh D immunoglobulin (anti-D) for prophylaxis against haemolytic disease of the newborn has been one of the major medical achievements of the past half century. This condition is caused by Rh blood group incompatibility between a woman and her baby, leading to the isoimmunisation (sensitisation) of a woman with Rh D negative blood against Rh D positive blood. It was previously a major cause of perinatal mortality, morbidity, long-term disability and mental handicap, and associated emotional and health costs were high. In the 1960s, it was demonstrated that administration of Rh D immunoglobulin (anti-D) to Rh D negative mothers soon after the delivery of Rh D positive babies dramatically reduced the incidence of immunisation. A mechanism for producing Rh D immunoglobulin in Australia was then sought, and, in 1968, Australia became the first country in the world to be self-sufficient in Rh D immunoglobulin. However, for a variety of reasons both within Australia and worldwide, antibody levels have declined, and in recent years there has been insufficient anti-D to meet Australian requirements. While the recruitment and boosting program is still underway and national production of anti-D has increased, there are continuing difficulties in rectifying the shortfall and maintaining the increased supply. In 1997, the National Health and Medical Research Council appointed a Working Party to develop guidelines which balance best practice in the use of Rh D immunoglobulin with limited supply. These guidelines are intended to cover the two years from their publication, to address the period of constraint between now and future self-sufficiency in anti-D.

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