This is the first in a series of linked posts that I hope will serve as signposts to resources for those who wish to learn more about anti-D. I want to offer links to documents and resources that offer a variety of perspectives and levels of information, because I believe that women and families need to consider decisions from as many angles as possible and that professionals can offer the best help when they can explain issues from a variety of perspectives rather than just their own. This first post will be vital to some and unecessary to others; it links to a few resources that give a basic explanation of the issues for those new to the area – or a starting point for your essay or dissertation if that’s why you’re visiting! – and a handful of the documents written by organisations who have an interest in this area as well as to product information.
First of all, let me save you the trouble of having to type anything into wikipedia by adding the link to the relevant page here, but mainly so that it gives me a chance to express my view that, while I appreciate that it is ever-evolving, the entry on this page tends to reflect North American terms, pharmaceutical products, policies and attitudes towards women. I don’t personally view wikipedia as a reliable data source for much more than checking out the past and current composition of rock bands and the location of obscure islands that I may one day need to visit, but please don’t let me stop you going ahead and making your own informed choice about that! 😀
As with many pharmaceutical and medical products, much of the information out there is written by marketing departments geared towards letting you know how fabulous, necessary, effective and safe their product is, and I am sure you will bear that in mind as you surf. Some of the information sources that I found while checking links for this page (including some written by midwives, I am sorry to say) are rather shocking in relation to the language and rather absolute statements that they use, so do use your discretion! (In fact, while writing this page, I was moved to write this post about language, which you may like to read in conjunction with it.) As far as statements such as ‘anti-D is perfectly safe for you and your baby’ are concerned, I think it important to point out that even the nice people at the companies who make anti-D and who spend lots of time and effort ensuring it is as virus-free as possible would not say that it is perfectly safe. It is as safe as their combined valiant efforts and modern technology can make it, but no blood product is ever going to be perfectly safe, and no scientist would make such a ridiculously absolute claim.
Let’s start with some of the overviews of this area. These are quite variable in their level of assumed scientific knowledge, so I’ve provided a variety. One of the better UK ones is that provided by NHS Choices, which has links to a few other relevant pages on their website, and those on medscape and from BioProducts Laboratory may also be of value. None of these ever seem to detail that women have much of a choice in this area, or that this is about anything except happy mums, happy babies and, on occasion, happy dancing blood cells, but I have said my piece on language and will save the further questioning for later! Another overview which also includes a few comments from women is that offered by mumsnet and an overview published in the RCM Journal for midwives and students can be found here.
If you’d like to go a bit further and begin considering the evidence and UK guidelines in a bit more depth, you might also want to look at the RCOG Green Top guideline on anti-D which sits alongside a brief overview about its context and development, and/or the NICE antenatal anti-D guidance and the NICE antenatal anti-D patient [sic] information leaflet. Later posts will look at the evidence in more detail and consider the systematic reviews and the wider picture.
For anyone who would like product information, a few starting points would be the NHS Choices product information page on anti-D (please note there are several different formulations and each has a different page, but the menu there is quite clear), the information page on D-GAM from BioProducts Laboratory and the Rhophylac patient [sic] information leaflet. There is information on the gamut of variously named US preparations on medscape. Although it’s not as up-to-date as some of the others, the EMA guideline can be downloaded from here and the NZ Medsafe drugs list is also useful, but you may find it helpful to use CTRL-F to find what you’re looking for, as the page is really long and the links aren’t static enough to put on here individually!
Next in this series: the Cochrane reviews!
Read more in my book: Anti-D in Midwifery: panacea or paradox?