Prenatal Testing and Prevention of Alloimmunization in Mothers of Saskatchewan (PRAMS) Program
In expectant mothers, it is standard of care for maternal blood group with Rh determination and antibody screen testing (ABO/Rh type and Ab Screen) to be performed to evaluate for fetal risk of hemolytic disease of the fetus and newborn (HDFN). Current clinical practice guidelines recommend that all expectant patients be typed and undergo a screen for alloantibodies at their first prenatal visit, with results of initial testing guiding the need for further investigations.
Prenatal transfusion medicine testing (ABO/Rh Type and Ab Screen) is currently provided to residents of Saskatchewan through Canadian Blood Services (CBS) in Vancouver. This testing will transition to the Laboratories of the Saskatchewan Health Authority on February 3, 2020. This allows us to provide care closer to home for our patients, improving the turn-around time and the information flow of test results electronically. These changes will impact your practice and improve the delivery of care for your patients.
Transmissible disease ordering and testing processes will remain unchanged.
Prenatal Transfusion Medicine Testing changes effective February 3, 2020
Facts you need to know:
- Test results will be available in e-Health and EMRs, as opposed to the current experience of receiving paper faxes from CBS.
- A new requisition will be in use effective February 3, 2020 titled Saskatchewan Health Authority, Prenatal Request for Testing. The new requisition will be pushed out to Accuro users and will be available for download from MedAccess in late January. Paper-based offices may access the new requisition under the FORMS section below.
- Antibody titer reporting will change. SHA laboratories use automated testing for antibody titers, which is considerably more sensitive than manual testing methods used by CBS. This will impact titer interpretation and the identification of critical thresholds for patients. The new critical threshold for referral to specialist care will be 64, rather than 16.
Test Centers
Routine Testing
Serving the former Cypress, Five Hills, Regina Qu’Appelle, Sun Country and Sunrise Health Regions:
Transfusion Medicine Laboratory
Regina General Hospital
1440 – 14th Ave.
Regina, SK S4P 0W5
Phone: 306-766-4474
Fax: 306-766-4004
Serving the former Athabasca, Kelsey Trail, Mamawetan Churchill River and Prince Albert Parkland Health Regions:
Transfusion Medicine Laboratory
Victoria Hospital
1200 24th St. West
Prince Albert, SK S6V 4B2
Phone: 306-765-6146
Fax: 306-765-6163
Serving the former Heartland, Keewatin, Prairie North and Saskatoon Health Regions
Transfusion Medicine Laboratory:
St. Paul’s Hospital
1702 20th St. West
Saskatoon, SK S7M 0Z9
Phone: 306-655-5168
Fax: 306-655-5101
Provincial Reference Testing
Transfusion Medicine Laboratory
Royal University Hospital
Room G502, 103 Hospital Dr.
Saskatoon, SK S7N 0W8
Phone: 306-655-2179
Fax: 306-655-2222
Resources
Forms
*** For the Accuro template, please access the Accuro Forms Editor and search for “SHA Request for Prenatal Testing (SK)”
| Document Name | Date of Original Publication | Date Revised |
|---|
| Packaging Change for WinRho | November 28, 2023 | November 28, 2023 | Download |
| PRAMS Program Rhlg Administration Report Form | September 7, 2022 | June 7, 2023 | Download |
| PRAMS Utilization of Rh Immune Globulin (RhIg) Non-SoftBank Report Form | February 5, 2020 | November 20, 2020 | Download |
| Request for Fetal-Maternal-Hemorrhage/Cord Blood Testing | June 10, 2021 | July 31, 2023 | Download |
| Request for Prenatal Testing | January 8, 2020 | January 10, 2020 | Download |
| Rhlg Monograph Information | March 9, 2023 | March 9, 2023 | Download |
| SHA Request for Prenatal Testing Med Access Template | January 28, 2020 | January 28, 2020 | Download |
Correspondence
| Document Name | Date of Original Publication | Date Revised |
|---|
| CBS Customer Letter 2020-04 - Transfer of Routine Saskatchewan Prenatal ABO-Rh and Antibody Testing from Canadian Blood Services Vancouver to Saskatchewan Hospitals | February 12, 2020 | June 29, 2020 | Download |
| Cell-free Fetal Genotyping (cffDNA) for Red Blood Cell Antigens from Maternal Plasma | June 3, 2024 | June 3, 2024 | Download |
| Memo Changes in recommendations for Rhlg administration in early pregnancy (8-12 weeks GA) | January 20, 2025 | January 20, 2025 | Download |
| Memo Red Blood Cell Antigen Cell-free Fetal DNA (cffDNA) Testing Indications and Request Process | April 5, 2023 | April 5, 2023 | Download |
| Memo Rh Immunoglobulin (Rhlg; WinRho®) Information Resources and Confirmation of Administration Forms for Healthcare Providers | April 5, 2023 | April 5, 2023 | Download |
| Physician and Patient education about early pregnancy Rhlg | January 8, 2025 | January 8, 2025 | Download |
| Prenatal Testing Memo to All Healthcare Practitioners Ordering Prenatal Blood Testing | February 12, 2020 | February 13, 2020 | Download |
| Prenatal Testing Memo to All Healthcare Practitioners Ordering Prenatal Blood Testing in Lloydminster Hospital and Onion Lake, Saskatchewan | February 12, 2020 | February 13, 2020 | Download |
| SHA Memo Changes in recommendations for RhIg administration in early pregnancy (8-12 weeks GA) | January 8, 2025 | January 8, 2025 | Download |
| SHA Memo Identification Requirements for Prenatal Patient Test Samples: Complete Name and Unique Patient Identifier | May 29, 2024 | May 29, 2024 | Download |
Patient Teaching Information
| Document Name | Date of Original Publication | Date Revised |
|---|
| Antibodies Against Red Blood Cells in Pregnancy (CS-PIER-0047) | August 20, 2024 | August 21, 2024 | Download |
| Hemolytic Disease of the Newborn (HDN) | October 13, 2022 | October 13, 2022 | Download |
| Rh (D) factor, Red Blood Cell Antibodies and Rh Immune Globulin: Following a Pregnancy Loss (CS-PIER-0048) | October 13, 2022 | August 20, 2024 | Download |
| Rh (D) factor, Red Blood Cell Antibodies and Rh Immune globulin: Information for Rh Negative Women | October 13, 2022 | May 5, 2023 | Download |
| Ukrainian Translation - Rh (D) factor, Red Blood Cell Antibodies and Rh Immune Globulin: following a Pregnancy loss | October 13, 2022 | August 20, 2024 | Download |
| Ukrainian Translation Antibodies against Red Blood Cells in Pregnancy | October 13, 2022 | November 23, 2022 | Download |
Algorithms
| Document Name | Date of Original Publication | Date Revised |
|---|
| Algorithm 1- Prenatal patient with negative antibody screen. RHD Positive or negative. | July 27, 2020 | February 3, 2025 | Download |
| Algorithm 2a - Testing and titration of RBC antibodies associated with severe HDFN | September 2, 2020 | February 3, 2025 | Download |
| Algorithm 2b - Testing and titration of RBC antibodies associated with low risk or mild HDFN | September 2, 2020 | February 3, 2025 | Download |
| Algorithm 2c - Prenatal transfusion testing for patients with HISTORICAL clinically significant RBC antibodies | February 3, 2025 | February 3, 2025 | Download |
| Algorithm 2d - Prenatal transfusion testing for non-specific antibodies, autoantibodies and antibodies that do not cause HDFN | February 3, 2025 | February 3, 2025 | Download |
| Algorithm 3a - Prenatal Transfusion Testing for Rh-Negative Pregnancies | September 2, 2020 | February 3, 2025 | Download |
| Algorithm 3b - Testing to differentiate between passive versus immune anti-D in Rh-negative pregnancies | September 2, 2020 | February 3, 2025 | Download |
| Algorithm 5 - Recommendations for Postnatal Follow-up of Infants and Newborns with HDFN | September 4, 2020 | September 4, 2020 | Download |
| Algorithms 4a-4c Management of Prenatal Transfusion Testing for Regina and Prince Albert | July 28, 2020 | September 3, 2020 | Download |
Posters
| Document Name | Date of Original Publication | Date Revised |
|---|
| Cord Blood Specimen Labelling and Testing Process Flow for Saskatchewan | January 31, 2023 | January 31, 2023 | Download |
Presentations
| Document Name | Date of Original Publication | Date Revised |
|---|
| Prevention and Management of Alloimmunization in Pregnancy | November 10, 2022 | November 10, 2022 | Download |
Contact Information
For questions, please contact:
PRAMS Provincial Program PRAMS@saskhealthauthority.ca or e-fax 306-974-3777.
Links of Interest
- Due Date Calculator
- Provincial form for post-natal testing: cords, FMH, etc. – Referral Request for Transfusion Medicine Testing/RBC Crossmatch
- Rh Immune Globulin (WinRho®)
- Antibodies Against Red Blood Cells – Alloimmunized Pregnant Women (CS-PIER-0047)
- RhIG Teaching with a Pregnancy Loss (CS-PIER-0048)