Journal article
Hemolytic disease of the fetus and newborn in the sensitizing pregnancy where anti-D was incorrectly identified as RhIG
Journal of clinical laboratory analysis, Vol.36(4), pp.e24323-n/a
04/2022
DOI: 10.1002/jcla.24323
PMCID: PMC8993642
PMID: 35243688
Abstract
Hemolytic disease of the fetus and newborn (HDFN) is a potentially fatal complication in Rh-incompatible pregnancies and rarely occurs in the sensitizing pregnancy. Distinguishing RhIG from true anti-D identified is challenging. A case of severe HDFN in which a sample drawn at 28 weeks showed anti-D antibody (3+ strength) attributed to RhIG is described. RBC antibody testing early in pregnancy was negative. At birth, the infant was severely anemic and maternal anti-D titer was 1:256. This case represents a clinically significant anti-D in the sensitizing pregnancy that was missed due to confusion with RhIG.
To determine if agglutination strength could be helpful, a retrospective chart-review using both electronic and paper medical records was performed on 348 samples identified as RhIG and 52 true anti-D samples. The agglutination strength of antibody was recorded for each sample.
For RhIG, there was an even distribution between the weak to moderate agglutination strength (w+, 1+, and 2+) results (35%, 26%, and 33%, respectively) and just 6% had a 3+ strength. Agglutination strength in patients with high titer (≥1:16) anti-D showed they often (44.4%) have 1+ or 2+ agglutination reactivity.
These results show that agglutination strength alone does not provide reliable evidence to distinguish RhIG from high titer anti-D antibodies. We recommend that in cases where there is any uncertainty about whether the anti-D reactivity is due to RhIG, titers should be performed to rule out clinically significant anti-D antibody.
Details
- Title: Subtitle
- Hemolytic disease of the fetus and newborn in the sensitizing pregnancy where anti-D was incorrectly identified as RhIG
- Creators
- Mackenzie L Walhof - University of IowaJudith Leon - University of IowaAndrea L Greiner - University of IowaJames R Scott - University of IowaCharles Michael Knudson - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Journal of clinical laboratory analysis, Vol.36(4), pp.e24323-n/a
- DOI
- 10.1002/jcla.24323
- PMID
- 35243688
- PMCID
- PMC8993642
- NLM abbreviation
- J Clin Lab Anal
- ISSN
- 0887-8013
- eISSN
- 1098-2825
- Language
- English
- Date published
- 04/2022
- Academic Unit
- Pathology; Radiation Oncology; Obstetrics and Gynecology
- Record Identifier
- 9984318323002771
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