Related Experiment Video
Updated: Sep 9, 2025
Methylation Specific Multiplex Droplet PCR using Polymer Droplet Generator Device for Hematological Diagnostics
Published on: June 29, 2020
Guidance for Prenatal, Postnatal and Neonatal Immunohematology Testing in Canada: Consensus Recommendations from a
Lani Lieberman1, Catharine M Walsh2, Rebecca Barty3
1Laboratory Medicine Program, University Health Network, Toronto, ON; Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON.
Insights
Canadian experts developed consensus guidance for prenatal, postnatal, and neonatal immunohaematology testing and Rh(D) immunoglobulin administration to prevent haemolytic disease of the fetus and newborn (HDFN). This guidance aims to standardize care and improve HDFN diagnosis and prevention.
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.
Objectives:
Blood Group, antibody screen, fetal maternal hemorrhage tests and Rh(D) immunoglobulin (RhIG) administration are interventions during pregnancy that aid in the prevention of hemolytic disease of the fetus and newborn (HDFN). The timing, frequency, and nature of testing vary across centres due to limited data to inform standards development. Using Delphi methodology, this study aimed to establish guidance for Canadian practice related to prenatal, postnatal and neonatal immunohematologic testing, and RhIG administration, to reduce risk and improve diagnosis of HDFN.
Methods:
A national, multidisciplinary Delphi panel rated their agreement with potential guidance statements related to prenatal, postnatal and neonatal immunohematology testing on a 5-point Likert scale during iterative rounds of voting. After each round, responses were analyzed and statements were re-sent to the panel for further ratings until consensus was achieved, defined as Cronbach's α >0.95 or a maximum of 3 voting rounds. At the conclusion of the Delphi process, statements rated ≥4/5 were included.
Results:
In total, 46 experts voted on 49 proposed statements. Consensus was achieved after 3 survey rounds (Cronbach's α = 0.94), with a 100% response rate throughout. Overall, 44 statements reached consensus. Statements focused on prenatal immunohematology testing (N = 21 statements), maternal-fetal hemorrhage testing and RhIG administration during pregnancy (N = 15), and testing of neonates for surveillance of hyperbilirubinemia secondary to hemolytic disease of the newborn (N = 8).
Conclusions:
This Canadian consensus guidance aims to optimize the surveillance of pregnancies at risk of HDFN and the dosing and timing of RhIG administration. It provides actionable recommendations to harmonize practice and support safe, timely, and cost-effective care.
Related Concept Videos
01:19Rh Blood Group
01:15Blood Transfusion
Blood Transfusion Overview
A blood transfusion is a medical procedure used to replace blood lost due to injury, surgery, or to treat conditions such as anemia or cancer. During a transfusion, donor blood is...
01:22Development of Immunocompetence
The initial cells that migrate from the fetal thymus settle within the skin and epithelial tissues lining the mouth, digestive tract, and in females, the uterus and vagina. These cells, including skin-based dendritic cells, serve as antigen-presenting cells, playing a key role in T cell activation.
Subsequent T...