Single dose of anti-D immunoglobulin for antenatal prophylaxis is smaller in the Netherlands than in the United Kingdom

Editor—Lee is right in correcting my editorial on dose schedules of anti-D immunoglobulin for antenatal prophylaxis.¹,² The Edinburgh consensus conference agreed on two main options—a dose of 500 IU at 28 and 34 weeks’ gestation or “alternatively a single larger dose early in the trimester,” but the size of the larger dose was not mentioned.³ It is usually accepted to be 1500 IU at 28-30 weeks, when a single dose is chosen instead of two smaller doses. In my editorial I unintentionally mentioned the Dutch policy of antenatal prophylaxis that was started this year. Anti-D immunoglobulin from volunteer Dutch blood donors (CLB Sanquin Blood Supply Foundation, Amsterdam) comes only in vials of 1000 IU (apart from a mini-dose of 375 IU, which is used for early abortion). This dose has been used in the Netherlands since the introduction of postnatal prophylaxis in 1969. To avoid a third dose of 1500 IU and undoubtedly the introduction of administrative failures, an antenatal programme was chosen that advocates the use of 1000 IU at 30 weeks of pregnancy. At birth the same dose is given. To my knowledge, this is the first policy of its kind, and it might be a way of saving the scarce resource of anti-D immunoglobulin from volunteer blood donors. A national evaluation programme was set up concomitantly to monitor the effects of the Dutch programme.