Lifeblood now offers RhD non-invasive prenatal testing (NIPT)

The administration of antenatal RhD immunoglobulin (Ig) prophylaxis at 28- and 34-weeks' gestation has been the standard of care for all RhD-negative mothers in Australia, regardless of the RhD blood group of the fetus.  

The updated Guideline for the prophylactic use of RhD Ig in pregnancy care (NBA 2021, published on MAGICapp in 2024) includes recommendations for testing of maternal blood to determine fetal RhD genotype in all RhD-negative pregnant women to enable targeted antenatal RhD immunoprophylaxis. To support the advancement of RhD NIPT, clinical care pathway templates are available to develop local health service flow pathways.  

To support services wanting to introduce targeted RhD Ig prophylaxis as part of their pregnancy care pathway (where MBS eligible), our Brisbane Red Cell Reference Laboratory is now offering RhD NIPT for RhD-negative mothers from 15-weeks' gestation to predict fetal RhD status.  

This NATA-accredited test is a molecular blood group genotyping assay using cell-free fetal DNA (cffDNA) from the mother’s blood to predict the baby’s RhD phenotype. This means that around one-third of women who are predicted to be carrying an RhD negative fetus could safely avoid routine antenatal RhD Ig prophylaxis.  

Refer to your local health service/jurisdictional guidelines and care pathways regarding use of RhD NIPT for targeted antenatal prophylaxis. The current pathway of universal anti-D prophylaxis may not yet have changed while the logistics of implementation of RhD NIPT are being explored and planned. 

Vale James Harrison OAM

Lifeblood established the RhD program in 1967 to produce sufficient RhD Ig prophylaxis in Australia.

It involves collecting plasma from a small group of RhD negative blood donors who were alloimmunised due to previous transfusions or stimulated to produce elevated levels of anti-D antibodies.

James Harrison OAM (pictured) was one of the most valued and impressive donors who helped pioneer our RhD program at Lifeblood. Having donated for 60 years and helped save the babies of more than 2 million Australian women, he was often referred to as 'The Man with the Golden Arm'.

The world’s most prolific blood and plasma donor, James Harrison OAM, passed away earlier this year.

Guideline for the investigation and management of red cell antibodies in pregnancy

The British Society for Haematology (BSH) has recently published these new guidelines with the updated name to mirror the complementary UK Royal College of Obstetricians and Gynaecologists (RCOG) clinical guidance document, 'The management of women with red cell antibodies during pregnancy'. The BSH guideline is intended to incorporate the necessary scope of the 2014 RCOG Green-top guidelines.

While retaining the essential format and structure of the previous version (2016), it's worth noting that the numbering of sections has been updated, and two new sections have been added: 'Requirements for Blood' (Section 8) and 'Obstetric Considerations' (Section 10).

The main focus of the BSH guideline remains the antibodies anti-D, -c and -K which have significant risks for the fetus or neonate, including anaemia, jaundice, and perinatal loss. However, many other antibodies can cause anaemia or jaundice predominantly in the neonatal period (with occasional case reports of the fetus being severely affected) and/or pose challenges for laboratory screening and the timely provision of blood for the mother or baby.

Why do people still make anti-D over 50 years after the introduction of Rho(D) immune globulin?

A large retrospective descriptive study by the Biomedical Excellence for Safer Transfusion (BEST) Collaborative describes the epidemiology of RhD alloimmunisation in high and high-middle income countries following the development and implementation of RhIg as the standard of care.

RhD negative adult patients born between 1965–2005 with anti-D alloantibodies identified for the first time during the study period of 2018–2022 were included in the analysis. Data was extracted from laboratory and electronic medical records (EMRs) across 30 institutions in 5 countries (United States, Canada, United Kingdom, New Zealand, Brazil).

Understanding the anti-D immune response

The Walter and Eliza Hall Institute of Medical Research (WEHI) team and Lifeblood researchers are working together to investigate the immune response produced by our anti-D donors. The ultimate goal is to create a new therapy, which could meet the needs of expectant mums but also reduce the need to boost and bleed anti-D donors.

Upcoming events and webinars