Guidance for Prenatal, Postnatal and Neonatal Immunohematology Testing in Canada: Consensus Recommendations from a...

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Immunohaematology

Background:

• Standardization of prenatal, postnatal, and neonatal immunohaematology testing and Rh(D) immunoglobulin (RhIG) administration is lacking.
• Variations in testing protocols across centers hinder optimal prevention of haemolytic disease of the fetus and newborn (HDFN).

Purpose of the Study:

• To establish Canadian consensus guidance for immunohaematologic testing and RhIG administration.
• To reduce the risk and improve the diagnosis of HDFN through standardized practices.

Main Methods:

• Delphi methodology involving a national, multidisciplinary expert panel.
• Iterative voting rounds using a 5-point Likert scale until consensus (Cronbach's alpha >0.95) was achieved.
• Inclusion of statements rated ≥4/5 by the panel.

Main Results:

• Forty-six experts participated, achieving 100% response rate over three survey rounds (Cronbach's alpha = 0.94).
• Consensus was reached on 44 out of 49 proposed statements.
• Guidance covers prenatal testing (21 statements), fetal-maternal hemorrhage (FMH) testing and RhIG administration (15 statements), and neonatal surveillance (8 statements).

Conclusions:

• The developed Canadian consensus guidance optimizes surveillance for pregnancies at risk of HDFN.
• Recommendations aim to standardize RhIG administration timing and dosing.
• The guidance supports safe, timely, and cost-effective care for HDFN prevention and management.