Testing Algorithm for Rh Immune Globulin Dosing in the Post-natal RhD-Negative Mother

  • Theresa NesterEmail author


Transfusion medicine physicians have advocated for testing all RhD negative newly delivered mothers with RhD positive babies for the presence of fetal maternal hemorrhage since 1980. Despite this fact, guidelines written for obstetrical groups have not been entirely aligned with the testing algorithm put forth by transfusion medicine groups. This discrepancy led to policies within individual institutions that leave out certain patient groups from the screening protocols, which in turn places the patient at risk for sensitization to D. The literature and controversy surrounding this topic is quite dated; a 2017 update finally aligns the testing recommendations.


Rh immune globulin RhD negative pregnant patient Rosette test Kleihauer-Betke test 


  1. 1.
    Wylie BJ, D’Alton ME. Fetomaternal hemorrhage. Obstet Gynecol. 2010;115:1039–51. Scholar
  2. 2.
    Ness PM, Baldwin ML, Niebyl JR. Clinical high-risk designation does not predict excess fetal-maternal hemorrhage. Am J Obstet Gynecol. 1987;156(1):154–8. Scholar
  3. 3.
    ACOG Practice Bulletin. Prevention of Rh D alloimmunization. Number 181, August 2017 (replaces educational bulletin Number 4, May 1999). Clinical management guidelines for obstetrician-gynecologists. American College of Obstetrics and Gynecology (1999). Int J Gynaecol Obstet. 2017;130:e57–70.Google Scholar
  4. 4.
    Stedman CM, Baudin JC, White CA, Cooper ES. Use of erythrocyte rosette test to screen for excessive fetomaternal hemorrhage in Rh-negative women. Am J Obstet Gynecol. 1986;154(6):1363–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Laboratory MedicineUniversity of Washington Medical CenterSeattleUSA
  2. 2.Integrated Transfusion Service Laboratories, Bloodworks NorthwestSeattleUSA

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