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The investigation of infants with RhD-negative mothers: can we safely omit the umbilical cord blood direct antiglobulin test?
  1. R M James1,3,
  2. W McGuire2,3,
  3. D P Smith3
  1. 1Epidemiology and Genetics Unit, Department of Health Sciences, York Hospital NHS Trust, York, UK
  2. 2Hull York Medical School, The University of York, Heslington, York, UK
  3. 3Department of Paediatrics, York District Hospital, York, UK
  1. Correspondence to Dr Rebecca Mathilda James, Department of Paediatrics, York District Hospital, Wigginton Road, York YO31 8HE, UK; beki.james{at}


Historically, the investigation of a neonate at risk of Rhesus D antigen (RhD)-associated haemolytic disease has included a direct antiglobulin test on umbilical cord blood. However, the introduction of routine antenatal anti-RhD prophylaxis has led to a significant number of false positive results and recent studies suggest that a positive cord blood direct antiglobulin test is poorly predictive of subsequent hyperbilirubinaemia. The British Committee for Standards in Haematology guidelines now recommend that a direct antiglobulin test should no longer be performed routinely on umbilical cord blood in infants born to RhD-negative mothers. We review the recent changes in antenatal management of RhD-negative mothers and their impact on the neonatal presentation of RhD-associated haemolytic disease of the newborn that underpin this recommendation. We conclude that there is convincing evidence to support the guidelines. Finally, we consider how babies born to RhD-negative mothers should be investigated and consider alternative strategies to detect neonatal hyperbilirubinaemia.

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.