Pharmacology · Immunoglobulins and antitoxins
Anti-D immunoglobulin (Rho(D)) !
Human IgG against the RhD antigen. In an RhD-negative mother it clears RhD-positive fetal red cells before she forms antibodies.
Updated 2026-11-01
Also called: Rho(D) immune globulin, Anti-Rh immunoglobulin
Mechanism of action
When red cells from an RhD-positive fetus enter the circulation of an RhD-negative mother, she can form anti-D antibodies and memory. In later pregnancies these IgG antibodies cross the placenta and destroy fetal red cells (haemolytic disease of the fetus and newborn). Administered anti-D coats and clears the fetal cells before the mother's B cells are activated, so no memory is left.
- RhD+ fetal red cells enter the blood of the RhD− mother
- Anti-D coats them and the spleen removes them
- The mother does not activate B cells or form anti-D memory
- Later pregnancies have no antibodies to harm the fetus
Pharmacokinetics
- Distribution
- Human IgG circulating in the mother's plasma
- Onset and duration
- Works only if given before the mother is sensitised; once sensitised, it is of no use
Indications
- Routine antenatal prophylaxis in an RhD-negative pregnant woman without anti-D antibodies whose fetus is RhD positive or of unknown group
- After sensitising events: birth of an RhD-positive baby, miscarriage or abortion, ectopic pregnancy, invasive procedures, external version, abdominal trauma or bleeding
Adverse effects
Common
- Discomfort at the injection site
- Occasional low-grade fever
Contraindications
- Mother already sensitised (with her own anti-D antibodies): prophylaxis is no longer useful
- RhD-positive person
- Not given to the newborn
Key interactions
- Live virus vaccines
- Immunoglobulins can reduce the response to live vaccines; timing is coordinated
What is monitored
- Mother's blood group, RhD type and antibody screen before giving
- Newborn's blood group after birth
- Brief observation after injection for allergic reaction
Administration and safety
- Given to the mother, never to the baby
- It is a blood product: record product and batch for traceability
- Give as soon as possible after a sensitising event
Nursing care
- Confirm RhD-negative group and absence of anti-D antibodies before giving
- Ask about bleeding or blows to the abdomen during pregnancy and report them
- Watch for a few minutes after the injection for allergic reaction
- Explain that it is made from donor plasma and what it is for
Pregnancy and breastfeeding
Used in pregnancy and after birth in the RhD-negative mother to protect future pregnancies.
Test yourself
Think of the answer, then tap the question to see it.
Why is anti-D useless in a mother who already has anti-D antibodies?
Prophylaxis works by preventing sensitisation; once the mother has antibodies and memory, clearing fetal cells does not change that response.
Who receives anti-D: the mother or the newborn?
Only the RhD-negative mother; it is not given to the newborn.
Which events in pregnancy can sensitise an RhD-negative mother?
Bleeding or abdominal trauma, invasive procedures such as amniocentesis, and miscarriage or ectopic pregnancy, as well as the birth of an RhD-positive baby.
Related drugs
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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Farmacología básica y clínica (Katzung), ch. 55 (McGraw Hill, 2025); Information on the use of Anti-D Prophylaxis in Pregnancy (Harrogate and District NHS Foundation Trust, 2025); Haemolytic disease of the fetus and newborn (HDFN) (NHS, 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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