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# 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

- Class: [Immunoglobulins and antitoxins](https://durgical.com/en/pharmacology/classes/immunoglobulins-and-antitoxins/)
- Target: RhD antigen on fetal red cells
- ATC code: J06BB01
- WHO Model List of Essential Medicines

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

### Serious (rare, important)

- Allergic reaction (very rare)

## 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.

## Memory aid

Anti-D = "wipe the footprints before the mother memorises them": it clears fetal cells before memory forms.

## 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.

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## Related drugs

- [Normal human immunoglobulin (IVIG)](https://durgical.com/en/pharmacology/normal-human-immunoglobulin/)

[← Back to the class: Immunoglobulins and antitoxins](https://durgical.com/en/pharmacology/classes/immunoglobulins-and-antitoxins/)

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](https://www.hdft.nhs.uk/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)](https://www.nhs.uk/conditions/rhesus-disease/) (NHS, 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=J06BB01) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/anti-d-immunoglobulin/