Utilization of anti-RhD in the emergency department after blunt trauma

In the United States, trauma occurs in 6% to 7% of pregnancies. Its severity may range from critical injuries where the mother's life is at risk, to apparently minor injuries, which might not be associated with any worrisome symptoms. One of the risks associated with a traumatic event is fetomaternal hemorrhage--the transfer of fetal blood cells into the maternal circulation. If the maternal blood type is rhesus negative and the fetus is rhesus positive, even a small amount of blood can cause the mother to develop antibodies against the fetal Rho D antigen, thus becoming sensitized. In subsequent pregnancies, this can lead to hemolytic disease of the fetus or newborn, which, if severe, is associated with total body edema, hepatosplenomegaly and heart failure, and intrauterine death. Although there are no published studies specific to the US population, poor awareness of the risk of sensitization following trauma and underutilization of anti-RhD in the emergency department has been reported in countries such as Canada and the United Kingdom. This article reminds caregivers of the risk of rhesus sensitization following blunt trauma, in order that they can administer anti-RhD appropriately and hemolytic disease of the fetus or newborn can be prevented.