PRAMS (Prevention of Alloimmunization in Mothers of Saskatchewan) Program

What is Alloimmunization?

Red blood cells are oxygen carrying cells in the body that have many proteins on their surface. These proteins are called red cell antigens.
Red cells antigens are inherited from the parents, the birthing person and partner/donor.
An antibody is a protein that is produced by the body’s immune system when it ‘sees’ antigens which are different from its own antigens or proteins. These antibodies try to remove the foreign antigens from the body.
If you are exposed to red cells that carry antigens different from your own red cells, your immune system may form antibodies. This is called alloimmunization. Exposure to red cells different from your own usually happens if you get a transfusion or in pregnancy.
In pregnancy, there can be mixing of the fetus’s blood with the birthing person’s blood. Sometimes, the fetus carries antigens on their red blood cells that are different from the birthing person’s red cell antigens. The birthing person can then form antibodies against the fetus red cells.

Image created by Dr. Tehseen Property of Saskatchewan Health Authority

More information is available in Patient Information and Education Resource (PIER) pamphlets:

What is Hemolytic Disease of the Fetus and Newborn (HDFN)?

If the birthing person has an antibody against antigens on the fetus’s red blood cells, these can cross the placenta into the fetus and break down the red blood cells. This is called hemolysis and can lead to hemolytic disease of the fetus and newborn (HDFN).
Fetuses and newborns that develop HDFN can have low hemoglobin (anemia) or jaundice, which may require treatment during pregnancy and after birth. If not treated, the anemia and jaundice can cause long term health problems involving the brain and heart.

How do I know if I am at risk?

Your health care provider will order a test for your blood group (ABO), Rhesus type (Rh) and to determine if you have red cell antibodies. This test is usually done at the first prenatal visit (8-12 weeks)
If you have a red cell antibody, your healthcare provider will tell you how often to get blood work for antibody testing and if other tests, investigations such as fetal ultrasounds, or referrals are needed.
The PRAMS nurse coordinators will aid your healthcare provider and you with follow up and referrals as needed.

Can HDFN be prevented?

Many red cell antibodies can cause HDFN. However antibody against the Rh antigen can cause severe anemia and jaundice in fetus and newborn.

If you are an Rh negative birthing person, we can prevent your immune system from making anti-D by giving a medication called Rh immune globulin (WinRho ®).
Rh immune globulin is obtained from blood of healthy donors and greatly reduces the chance that your body will form anti-D.
It is given to all Rh negative birthing persons between 26-28 weeks of pregnancy and after birth if the newborn is RhD positive.
It may also be given at other times in the pregnancy when there is a risk that the birthing person may be exposed to fetal blood; such as with bleeding or spotting and miscarriage.

More information is available in the Patient Information and Education Resource (PIER) pamphlets:

PRAMS Coordinators who are Registered Nurses are available and can be contacted at prams@saskhealthauthority.ca