Anti-D Provision to Renal Transplant Patients

Publication: 31/01/2005  --
Last review: 31/01/2020  
Next review: 31/01/2023  
Clinical Guideline
CURRENT 
ID: 565 
Approved By: Hospital Transfusion Executive Committee 
Copyright© Leeds Teaching Hospitals NHS Trust 2020  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Guideline for the administration of ANTI-D to Renal Transplant Patients

  1. Introduction
  2. Indication
  3. Informed Consent
  4. Dose
  5. Requesting
  6. Administration
  7. Reactions
  8. Traceability & Documentation
  9. References
  10. Appendix 1- Flowchart for administration

1. Introduction

Immunoprophylaxis using anti-D immunoglobulin is necessary in women who could be potentially child-bearing to prevent Haemolytic Disease of the New-born (HDN). This condition can be severe, causing profound anaemia in the foetus and occasional severe morbidity and fatalities.

Prophylactic Anti-D should be administered/offered to Rh (D) negative women following any Rh (D) sensitisation event.  A sensitisation event is any situation when the Rh (D) patients’ immune system is introduced to the Rh (D) positive antigen.  This may occur during the renal transplant of a Rh(D) positive or Rh(D) weak donor to a Rh (D) negative recipient.

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2. Indication

Application to renal transplant where:

  • Female recipient aged 0-50 years of childbearing potential and
  • Donor grouped as Rh(D)Pos or Rh(D) weak and
  • Recipient grouped as Rh(D)Neg

Rh (D) negative female recipients of childbearing age should receive Anti-D immunoglobulin following renal transplant from a donor grouped as Rh (D) positive or Rh (D) weak.

Anti-D Immunoglobulin should be administered to the patient even if they have previously received Anti-D immunoglobulin during pregnancy/and or childbirth.  A number of Anti-D immunoglobulin injections can be administered throughout the childbearing lifetime of a Rh(D) negative female.

Please contact the Transfusion Laboratory (details below) to confirm these groupings before administering product.

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3. Informed Consent

Patient’s informed consent should be obtained before administration of Anti-D and then recorded in the patient’s case notes by the healthcare professional prescribing the Anti-D.

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4. Dose

  • One injection of 500iu Anti-D is required
  • The injection should be administered within 72 hours of the transplant taking place

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5. Requesting Anti-D

Anti-D will only be issued upon receipt in Blood Bank of a correctly completed Anti-D request form. Request forms are available for download or print form  http://lthweb/sites/hospital-transfusion-team/how-to-order-blood-and-blood-products/how-to-order-blood-and-blood-products

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6. Administration

Immediatley post-transplant, order the Anti-D by telephone and collect from the Transfusion Laboratory:

  • LGI Transfusion Laboratory: ext: 23398
  • SJUH Transfusion Laboratory: ext:65559

Ensure that the correct patient is identified to receive the product- use Trust ‘Policy for the Positive Identification of Patients’. Give as a slow injection into the deltoid muscle. For patients with a risk of haematoma formation (particularly those with thrombocytopenia) the injection may be given sub-cutaneously.

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7. Reactions

Possible reactions to Anti-D include some short-term discomfort at the site of injection. Some allergic reactions are also possible. If such a reaction occurs, treat appropriatley. For full details of side effects, see the summary of product characteristics.

Any reaction to the product should be noted and reported to the hospital Transfusion Team (ext. 23868 / 23984) (bleep 80-1485) and a Datix-web report completed and marked for the attention of a member of the hospital Transfusion Team. All reactions are reportable to the Medicines Healthcare Regulatory Agency (MHRA) via the ‘yellow card system’.

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8. Traceability & Documentation

All doses of Anti-D must be traceable. Therefore a clear and precise record of the donation number, strength of dose and route of administration must be documented within the patient’s case notes.

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Appendix 1 - Guideline for the administration of ANTI-D to Renal Transplant Patients

Provenance

Record: 565
Objective: Describe the process when renal transplant patients require Anti-D
Clinical condition: Renal transplant patients
Target patient group: Rh negative female patients aged 0 to 50 years of childbearing potential who receive a renal transplant
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Current local practice
Anti-D Patient Information Leaflet


Evidence base

British Committee for Standards in Haematology 2012: Guidelines for pre-transfusion compatibility procedures in blood transfusion laboratories.  Http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3148.2012.01199.x/pdf
LTHT Policy to Safer Blood Transfusion Procedures:
detail.aspx?ID=1864
LTHT Policy for the Positive Identification of Patients, Leeds Teaching Hospitals NHS Trust, http://nwwlhp.leedsth.nhs.uk/common/guidelines/detail.aspx?ID=528
Handbook of Transfusion Medicine, Blood Transfusion Services of the United Kingdom, Fourth Edition, ed. DBL McClelland, 2007.

Approved By

Hospital Transfusion Executive Committee

Document history

LHP version 1.0

Related information

Not supplied

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