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Red Blood Cell Alloimmunization Prevention Practices in Pregnancy at Tertiary Care Level Hospitals in Islamabad, Pakistan: a Cross-sectional Study

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Abstract

Red cell alloimmunization has been estimated to cause more than 100,000 babies’ death worldwide. Factors like physician’s knowledge, anti-D availability, and affordability are associated globally with the prevalence of rhesus disease. The purpose of this study was to find out factors and assess the current practices followed in Pakistan for the prevention of rhesus disease. This cross-sectional study was conducted at the two tertiary care hospitals in Islamabad from January to November 2022. The data was collected from 150 D− women and 30 physicians on a self-designed questionnaire. The British Committee for Standards in Hematology (BCSH) is used to provide practical guidelines to healthcare providers for the management of blood group incompatibilities in pregnancy. We compared the prevention practices followed in Pakistani hospitals with the BCSH guidelines. The antibody status was identified in only 18 (12%) pregnancies in the third trimester and no women received routine antenatal anti-D prophylaxis (RAADP) during pregnancy to prevent complications in pregnancy. The anti-D injection was administered to 33(22%) women when the potentially sensitive event occurred in pregnancy and 143 (95%) mothers received anti-D after the birth of rhesus-positive fetuses. According to physicians, 83% of families ca not afford anti-D injection and 67% believe the anti-D supply is limited in Pakistan. The rhesus-negative women were not receiving the standard prophylactic treatment as mentioned in guidelines and the reasons attributed to non-adherence were the physician’s poor knowledge, the low family income, along with the non-availability and non-affordability of anti-D injections.

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Data Availability

Upon special request, all the collected data can be made available.

Code Availability

Not applicable.

Abbreviations

RAADP :

Routine antinatal anti-D prophylaxis injection

BCSH :

British committee for standards in hematology

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Acknowledgements

We express our gratitude to all the women who participated in this study. Moreover, the authors like to thank the institutional review board committee of the federal government polyclinic hospital, Islamabad, and the Pakistan Institute of medical sciences, Islamabad, for providing the necessary permission to perform this study.

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None.

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Authors and Affiliations

  1. Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan

    Anam Fatima,  Fakhar-ud-din & Gul Majid Khan

  2. Department of Pharmacy, Faculty of Pharmacy, University of Lahore, Lahore, Pakistan

    Anam Fatima

  3. Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan

    Ali Ahmed

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Contributions

F.D., G.M., and A.A. conceptualize the idea. A.F., A.A., G.M., and F.D. worked on questionnaire, amd then, A.F. collected the data. A.F., F.D., and A.A. analyzed the data. A.F. write the first draft of manuscript, and then, F.D., G.M., and A.A. edited the manuscript and supervised the study. All authors read and approved the final version of manuscript.

Corresponding authors

Correspondence to Fakhar-ud-din, Gul Majid Khan or Ali Ahmed.

Ethics declarations

Ethics Approval

The study was ethically approved by the institutional review board committee at the Quaid-i-Azam University, Islamabad (letter diary number 2796), Pakistan Institute of Medical Sciences, Islamabad, and Federal Government Polyclinic Hospital, Islamabad.

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Written informed consent was obtained from all the participants included in the study.

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On behalf of all authors, corresponding author take all mentioned authors consent for publication.

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The authors declare no competing interests.

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Fatima, A., Fakhar-ud-din, Khan, G.M. et al. Red Blood Cell Alloimmunization Prevention Practices in Pregnancy at Tertiary Care Level Hospitals in Islamabad, Pakistan: a Cross-sectional Study. SN Compr. Clin. Med. 5, 284 (2023). https://doi.org/10.1007/s42399-023-01627-5

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