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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

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

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 | 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 | 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

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

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

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

Letter to Editor | 18-October-2020

Letters to the Editors Re: Gel technology for RhIG dosage

Stephen Apfalroth

Immunohematology, Volume 16 , ISSUE 4, 161–161

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

Case report | 09-November-2020

Quantitating fetomaternal hemorrhages of D+ red cells using an FITC-conjugated IgG monoclonal anti-D by flow cytometry: a case report

patient who presented with a large fetal bleed (approx. 80mL) as determined using the Kleihauer method. We compared the efficacy of the direct FC technique to the rosetting and Kleihauer tests in estimating the quantity of Rh immunoglobulin (RhIg) to be administered to the mother to suppress Rh alloimmunization. Both the Kleihauer and the direct FC gave precise estimates of 80mL for the size of bleed, whereas the rosetting test failed to be as precise. The former tests predicted that a 10,000 iu dose

Anatole Lubenko, John Raymond Collier, Mark Williams, Damien Hindmarch, Sally Rosemary Wilson, Julie Pluck

Immunohematology, Volume 13 , ISSUE 1, 12–14

Article | 15-April-2020

Update on HDFN: new information on long-standing controversies

Hemolytic disease of the fetus and newborn (HDFN) results from maternal IgG antibodies that cross the placenta to the fetal circulation during gestation and cause RBC destruction and complications before birth (HDF), or anemia and hyperbilirubinemia after birth (HDN), or both. In its most severe form,HDF produces hydrops fetalis,which is characterized by total body edema,hepatosplenomegaly,and heart failure and can lead to intrauterine death. Before discovery of Rh immunoglobulin (RhIG), HDFN

Anne F. Eder

Immunohematology, Volume 22 , ISSUE 4, 188–195

Case report | 26-October-2020

Case report: passively acquired anti-D in a D+ pregnant patient

Marie P. Holub, Kirk D. Kitchen, Eugene Mensinger

Immunohematology, Volume 15 , ISSUE 2, 69–70

Report | 16-March-2020

D+ platelet transfusions in D– patients: cause for concern?

prophylactic Rh immunoglobulin (RhIG), results in D alloimmunization. The transfusion records of all patients who received platelet transfusions from December 2004 to March 2007 were reviewed. Transfusion recipients were evaluated with pretransfusion ABO and D typings, and an antibody screen. Recipients were reevaluated in the same manner before subsequent transfusions. Transfusion records of 114 D– patients were analyzed. Overall, 104 patients received D+ platelets; 67 had repeat antibody screening

Angela N. Bartley, John B. Carpenter, Mary P. Berg

Immunohematology, Volume 25 , ISSUE 1, 5–8

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

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

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