Background Particularly for the less haemolytic antibodies, there is limited evidence to aid management. New Scottish guidelines are in production. To provide evidence for their development, we sought to study over the last 3 years, in a DGH with 4000 deliveries/yr, how effective our existing local management has been and what impact new draft guidelines would have had.

Aims To identify babies affected by haemolytic disease of the newborn and to establish whether new guidelines could have changed pregnancy or neonatal management. To estimate extra demands on services made by the proposed new guideline.

Methods All women with red cell antibodies were identified over a three year period. Numbers of ultrasound appointments required and neonatal outcomes were noted and applied to existing management and the proposed guideline.

Results There were 101 women identified of which 12 had anti-D; 6 anti-c; 6 anti-K; 7 others had titres over 1/32 and 2 others which doubled. Had the new guideline been in place this would have equated to 111 extra ultrasound appointments. With the existing guideline, one baby affected by anti-Jka fetal anaemia required top up transfusion that was not anticipated but would have been with the new guideline.

Conclusions The new guideline suggests more close screening and intervention than our existing management. The data supports the proposed management for anti-D, c and K but we suggest that MCAPSV screening only should be undertaken for other antibodies if titre >1/64 with no place for extra scans in other situations