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Section 2a - Your blood group and pregnancy

This information is for you if you have had your antenatal booking with your community Midwife on or after the 13th May 2024.

 

This section explains the tests that can be done during pregnancy to:

  • find out your ABO blood group
  • find out your D group (sometimes known as RhD group/Rhesus D) group, and 
  • look for antibodies.

The people looking after you during your pregnancy need to know your blood group (type of blood) in case you ever need a blood transfusion. The screening test for blood group and red cell antibodies is very accurate. Sometimes you will need extra blood tests if antibodies are found.

This animation gives information on the screening tests you will be offered during pregnancy for you and your baby.

 

 

The test

This test can be done with other blood tests, usually early in pregnancy. It is offered to you again on the 28th week of pregnancy.

What your blood group test result will tell you your blood group will be one of the following four main groups.

  • Group O
  • Group A
  • Group B
  • Group AB

Within your blood group, you will either be D positive or D negative.

For example, your overall blood group might be written as ‘O RhD positive’.

About your blood

Your blood is made up of:

  • red blood cells
  • white blood cells, and
  • platelets

These are found in a liquid called plasma. Your blood group is identified by antigens and antibodies contained in your blood.

  • Antigens are protein molecules found on the surface of the red blood cells.
  • Antibodies are proteins found in the liquid part of the blood called plasma. Antibodies are part of your body's natural defence.

Red blood cells sometimes have another antigen known as D antigen.

  • If this is present, your blood group is known as D positive
  • If it is not present in your blood, your blood group is known as D negative
  • Most people, 85% (85 out of 100) will be D positive

What are red cell antibodies?

Red cell antibodies are part of your body's natural defence and fight against anything the body thinks is foreign. You may form antibodies if blood cells with a different blood group to yours, enter your blood stream. This can happen because of a blood transfusion or from your baby during pregnancy.

Red cell antibodies can pass from your bloodstream into your baby's blood, where anti-D antibodies may develop. Sometimes this can cause a rare condition called haemolytic disease of the fetus and newborn (HFDN), making your baby unwell. Babies with this rare condition usually need to be admitted to hospital.

What if you are D negative?

  • If your blood group is D negative and your baby's blood group is positive you may develop anti-D antibodies (if you are D positive, this problem does not usually happen).
  • If you are D negative, you will be offered a blood test at around the 16th week of pregnancy. This test is called cell free fetal DNA (cffDNA) and will tell you if your baby is D negative or D positive.

What is the cell free fetal DNA (cffDNA) test?

If you are D negative, the cell free fetal DNA test can predict if:

  • your baby is D negative (the same blood group as you), or
  • D positive.

This test will look at small amounts of your baby's DNA in your blood. DNA is the genetic information inside the body's cells. If you are D negative and your baby is D positive you will be offered anti-D immunoglobulin injections. This is referred to as anti-D in this information. This will greatly reduce HDFN developing.

What are anti-D injections?

Anti-D will help to stop antibodies being made if any f your baby's blood may have entered your blood stream, and so will reduce the chance of haemolytic disease of the newborn. Anti-D injections are made from plasma, which is the fluid part of blood that carries oxygen and blood cells around your body. The plasma used to make anti-D is collected from blood donors. You may need to be offered anti-D injections in future pregnancies.

Is anti-D safe?

Yes. Anti-D injections can cause some mild pain when they are injected into the muscle. Occasionally anti-D injections can cause allergic reactions. How it is produced is strictly controlled, so the risk of a known virus is being passed on to you from a donor is very low.

What are the advantages of having screening for my blood group and antibodies?

If you have this test, you will know your blood group and whether you are D positive or D negative.

It is less common to be D negative. If you are D negative, you will be offered a cell free fetal DNA test. If your baby is D negative, you would not be offered anti-D injections.

The test will also look for antibodies. It is important to know about these so that if you ever need a blood transfusion this could be given safely. Rarely, antibodies present in your blood carry a risk to your baby. If this happens you and your baby can be given specialist care.

What are the disadvantages of having screening for my blood group and antibodies?

Screening is a simple blood test. The only risk would be the same as having any blood test.

If you know that you are D negative

Contact your midwife or your hospital doctor (obstetrician) as soon as possible to remind them that you are D negative if you:

  • have vaginal bleeding after 12 weeks of pregnancy
  • have a miscarriage after 12 weeks of pregnancy, or
  • suffer an injury to your abdomen (for example, an injury from a seat belt in a car accident or by falling over)

If any of these things happen, your body may start to produce antibodies and you may need an anti-D injection.

Other reasons to be offered an anti-D injection

You should be offered an anti-D injection to reduce the risk of you producing antibodies.

This includes if:

  • you have chorionic villus sampling (CVS) or an amniocentesis (see section 7 for information on invasive tests)
  • you have a miscarriage
  • you have an ectopic pregnancy
  • your baby's blood group is not known, or
  • after your baby is delivered they are found to be D positive.