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  • Immunohematology


Article | 03-November-2020

Detection of anti-D following antepartum injections of Rh immune globulin

Antepartum prophylaxis using Rh immune globulin (RhIG) at 28 weeks of gestation is routine in unsensitized Rh-negative women. As various sources state that anti-D may be detected up to 6 months after administration, we reviewed the medical and laboratory records of all Rh-negative women who delivered at our institution during 1995. For 385 evaluable women, only 137 (35.6%) had anti-D demonstrable in their sera at delivery; 97.8 percent of these delivered within 75 days after administration of

Melanie S. Kennedy, Jamie McNanie, Abdul Waheed

Immunohematology, Volume 14 , ISSUE 4, 138–140

Article | 14-October-2020

Serologic aspects of treating immune thrombocytopenic purpura using intravenous Rh immune globulin

In patients with immune thrombocytopenic purpura (ITP), IgG autoantibody-coated platelets are phagocytized by mononuclear macrophages, primarily in the spleen. Intravenous Rh immune globulin (IV RhIG) has been used since 1983 to treat D+, nonsplenectomized patients with ITP. The beneficial therapeutic effect of IV RhIG is attributed to competitive inhibition of phagocytosis of IgG-coated platelets by IgG anti-D-coated D+ red blood cells (reticuloendothelial or Fc receptor blockade). Following

Can M. Savasman, S. Gerald Sandler

Immunohematology, Volume 17 , ISSUE 4, 106–110

Article | 14-October-2020

Intravenous Rh immune globulin prevents alloimmunization in D– granulocyte recipients but obscures the detection of an alloanti-K

Rh immune globulin (RhIG) has been used to prevent alloimmunization in D– recipients of apheresis platelet transfusions from D+ donors that may contain up to 5 mL of D+ red blood cells (RBCs). Granulocyte concentrates contain approximately 30 mL of RBCs and it has been necessary to give D– recipients granulocyte transfusions from D+ donors. Intravenous RhIG has not yet been demonstrated to be effective in preventing D alloimmunization with granulocyte transfusions. Four D&ndash

D.F. Stroncek, J.L. Procter, L. Moses, C. Bolan, G.J. Pomper, C. Conry-Cantilens, H.L. Malech, H.G. Klein, S.F. Leitman

Immunohematology, Volume 17 , ISSUE 2, 37–41

Article | 14-December-2020

Microcomputer software simulating problems in Rh immune globulin prophylaxis and hemolytic disease of the newborn

Our purpose was to develop educational software that would simulate laboratory investigation of problems in Rh immune globulin prophylaxis and hemolytic disease of the newborn. An interactive, branching style program was developed using a 256K Penonal Computer (International Business Machines, Boca Raton, FL). The software has been used in over 125 institutions for preprofessional and continuing professional education.

Patrick K. Hardman, Jill T. Hardman, PeggyJ. Brown, Deborah A. Borek, Malcolm L. Beck

Immunohematology, Volume 7 , ISSUE 1, 12–15

Article | 15-February-2021

Rh immune globulin: an interfering substance in compatibility testing

Introduction Rh immune globulin (RhIG) is administered routinely to Rh-negative,* pregnant women to prevent hemolytic disease of the fetus and newborn (HDFN), to Rh-negative patients who have received Rh-positive blood components, and to patients as a treatment for immune thrombocytopenic purpura (ITP). The result of RhIG administration may be the presence of anti-D in the plasma of antepartum and postpartum Rh-negative women, occasionally in their newborns, and in patients with ITP. The number

T.S. Casina, S.G. Sandler, S.M. Autenrieth

Immunohematology, Volume 35 , ISSUE 2, 51–60

Review | 14-March-2020

Laboratory methods for Rh immunoprophylaxis: a review

The recommended dose of Rh immune globulin for postpartum Rh immunoprophylaxis is based on an estimation of the volume of the fetomaternal hemorrhage, if any, measured as the percent of fetal RBCs in a sample of the D– mother’s blood. Laboratory methods for distinguishing fetal from maternal RBCs have been based on their different blood types (D+ versus D–) or predominant hemoglobin content (hemoglobin F versus hemoglobin A). We conducted a review of the medical literature

S. Gerald Sandler, Srividya Sathiyamoorthy

Immunohematology, Volume 26 , ISSUE 3, 92–103

Report | 09-October-2019

Laboratory management of perinatal patients with apparently "new" anti-D

Despite the existence of long-standing, well-organized programs for Rh immune globulin (RhIG) prophylaxis, immune anti-D continues to be detected in the D– perinatal population. Between 2006 and 2008, 91 prenatal patients, found to have a previously unidentified anti-D, were followed up with a survey to their treating physician and with additional serologic testing where possible. The physician survey requested pregnancy and RhIG history information, including recent or distant potential

Judith L. Hannon, Gwen Clarke

Immunohematology, Volume 32 , ISSUE 3, 108–111

Article | 03-November-2020

Immunoprophylaxis using intravenous Rh immune globulin should be standard practice when selected D-negative patients are transfused with D-positive random donor platelets

two pregnancies more than 40 years ago, prior to the availability of immunoprophylaxis by Rh immune globulin (RhIG). Although studies have shown that as many as 19 percent of D– people may develop anti-D following transfusion of platelets from D+ donors, there is no specific standard requiring immunoprophylaxis with RhIG to prevent Rh alloimmunization after transfusion of random donor platelet concentrates from D+ donors. In contrast, vigorous efforts are routine for preventing Rh

Clinton A. Ewing, Dawn H. Rumsey, Albert F. Langeberg, S. Gerald Sandler

Immunohematology, Volume 14 , ISSUE 4, 133–137

Article | 22-November-2020

Development of a flow cytometric test for the detection of D-positive fetal cells after fetomaternal hemorrhage and a survey of the prevalence in D-negative women

A sensitive test for the presence of D-positive fetal red blood cells (RBCs) in the maternal circulation of D-negative women has been developed. It was used to investigate the possibility that the occasional failure in preventing alloimmunization might be due to the administration of inadequate amounts of prophylactic anti-D Rh immune globulin. The standard dose in Australia contains 125µg of antibody, and can suppress immunization by an estimated 6 mL of packed D-positive RBCs. A

Margaret Nelson, Hazel Popp, Kathy Horky, Cecily Forsyth, John Gibson

Immunohematology, Volume 10 , ISSUE 2, 55–59

Article | 29-December-2020

Evaluating the need for Rh immune globulin in some unusual situations  

Marjory Stroup-Walter

Immunohematology, Volume 4 , ISSUE 2, 31–33

Article | 06-December-2020

Alloimmunization by blood group antigens from bone allografts

. Therefore, young, Rh-negative bone allograft recipients at risk (especially women) should receive Rh-negative bone allografts. Alternatively, they should receive Rh immune globulin at the time of transplanting if the allograft is from an Rh-positive donor. Bone allografts processed to deplete the hemopoietic marrow and red cells should minimize the risk of blood group antibody sensitization.

C. Elizabeth Musclow, Glen Dietz, Robert S. Bell, Madeleine Beaudry-Clouatre

Immunohematology, Volume 8 , ISSUE 4, 102–104

Article | 03-November-2020

Comparison of gel technology and red cell affinity column technology in antibody detection

anti-D due to Rh immune globulin but missed one anti-Jka. ReACT missed one anti-D and one anti-Jkb. MTS-Gel detected one anti-I and one anti-H whereas ReACT detected two antiH but not anti-I. No false positive reactions were found by either method. Sensitivity based on this study for MTS-Gel is 93.3% and ReACT is 86.7%. Advantages for MTS-Gel included the small volume needed for testing, and the reaction was stable for 48 hours; for ReACT, there was less spin time and no special pipette was needed

Sauvai I. Chanfong, Sherri Hill

Immunohematology, Volume 14 , ISSUE 4, 152–154

Review | 15-May-2020

Review: immune thrombocytopenic purpura: an update for immunohematologists

S. Gerald Sandler

Immunohematology, Volume 20 , ISSUE 2, 112–117

Article | 31-March-2021

Transfusion support during childbirth for a woman with anti-U and the RHD*weak D type 4.0 allele

Hemolytic disease of the fetus and newborn is reliably prevented by proper management, based on antenatal D typing and screening for red blood cell (RBC) antibodies. Many hospital laboratories do not determine the RHD genotype of pregnant women with a serologic weak D phenotype, because these women are often managed as D–.1 However, Rh immune globulin (RhIG) and provision of D– RBC units are unnecessary if D+ RBCs can safely be transfused. An Interorganizational Work Group on RHD Genotyping

Q. Yin, K. Srivastava, D.G. Brust, W.A. Flegel

Immunohematology, Volume 37 , ISSUE 1, 1–4

Article | 18-October-2020

A gel technology system to determine postpartum RhIG dosage

Failures of Rh immune globulin (RhIG) prophylaxis occur when the dose is too small. We report a test using a gel technology (GT) method to replace the Kleihauer–Betke (K–B) test to assess fetomaternal hemorrhage (FMH) and assist in determining the minimum necessary dose of RhIG. Cord blood (O, D+) was mixed with adult blood (O D–) to mimic an FMH of 10 mL, 20 mL, 28 mL, and 40 mL. Test samples were incubated with anti-D at known concentrations and centrifuged. The supernatant

John R. Fernandes, Ronny Chan, Ahmed S. Coovadia, Marciano D. Reis, Peter H. Pinkerton

Immunohematology, Volume 16 , ISSUE 3, 115–119

Case report | 09-October-2019

Two cases of the variant RHD*DAU5 allele associated with maternal alloanti-D  

Rh is a complex blood group system with diverse genotypes that may encode weak and partial D variants. Standard serologic analysis may identify clinically significant D variants as D+; nevertheless, individuals with these D variants should be managed as D– patients to prevent antibody formation to absent D epitopes. Variant identification is necessary during pregnancy to allow for timely and appropriate Rh immune globulin (RhIG) prophylaxis for hemolytic disease of the fetus and newborn

Jennifer A. Duncan, Susan Nahirniak, Rodrigo Onell, Gwen Clarke

Immunohematology, Volume 33 , ISSUE 2, 60–63

Article | 17-February-2021

Identifying obstetrics patients in whom RHD genotyping can be used to assess risk of D alloimmunization

and women of childbearing potential from developing alloanti-D, thus reducing the risk of HDFN in future pregnancies. They are transfused with D− blood, and administration of Rh immune globulin (RhIG) is recommended at appropriate times throughout the pregnancy and after delivery. Nevertheless, this approach is imperfect. Less than 100 percent specificity means that there is unnecessary administration of RhIG and unnecessary use of rare D− RBCs for transfusion. Less than 100 percent sensitivity

T.N. Horn, J. Keller, M.A. Keller, L. Klinger

Immunohematology, Volume 36 , ISSUE 4, 146–151

Report | 01-December-2019

Prevalence of clinically significant red blood cell alloantibodies in pregnant women at a large tertiary-care facility

More than 50 red blood cell (RBC) alloantibodies are known to cause hemolytic disease of the fetus and newborn (HDFN). Although Rh immune globulin (RhIG) prophylaxis has significantly reduced the incidence of pregnancies complicated by anti-D, the need to detect and monitor maternal alloantibodies capable of causing HDFN is still a concern. The prevalence and specificity of these alloantibodies were determined. In this retrospective study, the prevalence and specificities of unexpected RBC

Heather M. Smith, Rosetta S. Shirey, Sandra K. Thoman, Jay B. Jackson

Immunohematology, Volume 29 , ISSUE 4, 127–130

Report | 01-December-2019

Comparison of estimation of volume of fetomaternal hemorrhage using KleihauerBetke test and microcolumn gel method in D-negative nonisoimmunized mothers

7.9–10.4 mL, p < 0.001). Microcolumn gel method is an effective screening test. Technologies like KB and flow cytometry are better options for detecting a large volume of FMH. Antepartum hemorrhage and cesarean delivery are risk factors for FMH. The 300-µg dose appears to be excessive immunoprophylaxis in the majority of cases. We need to analyze the relative cost-effectiveness of universal administration of 300 µg of Rh immune globulin vs. FMH quantitation with subsequent

Kshitija Mittal, Neelam Marwaha, Praveen Kumar, Subhash C. Saha, Beenu Thakral

Immunohematology, Volume 29 , ISSUE 3, 105–109

Article | 28-April-2020

Reactivity of FDA-approved anti-D reagents with partial D red blood cells

Individuals whose RBCs are characterized as having a partial D phenotype may make anti-D if exposed to normal D+ RBCs;thus it is desirable that they be typed as D– should they require blood transfusion or Rh immune globulin (RhIG) prophylaxis. Further, use of different anti-D reagents by blood centers and transfusion services can account for FDA-reportable errors. For this study,antiD reagents for use in tube tests were obtained from three U.S. manufacturers. They included three examples

W. John Judd, Marilyn Moulds, Gloria Schlanser

Immunohematology, Volume 21 , ISSUE 4, 146–148

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