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Newly detected anti-D


RichU
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Hi Guys,

Has anyone seen the following scenario before and , if so, how common is it? 

2002 male O neg patient transfused 4 units of Oneg and 6 O pos.

2012 and 2014 antibody screen negative. Now using the same methodology (DiaMed IAT), we have a strong anti-D. No D positive units transfused since 2002.

Why is anti-D now apparent 20 years after the transfusion of D pos cells but not 10 years ago?

Cheers,

RichU

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What about RH pos plasma products or platelets?  Though they don't tend to cause an anti-D, they can "spike" one that dropped below detectable levels, I believe.  And that far back, if any platelet concentrates were given, they would have had more RBC exposure than they do now with platelet pheresis units.  Just a thought.

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1 hour ago, carolyn swickard said:

What about RH pos plasma products or platelets?  Though they don't tend to cause an anti-D, they can "spike" one that dropped below detectable levels, I believe.  And that far back, if any platelet concentrates were given, they would have had more RBC exposure than they do now with platelet pheresis units.  Just a thought.

I was thinking the same - and I have seen this scenario.

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I'm in line with the above answers. A current diagnosis would be useful, especially to give us an idea if the aforementioned blood products (platelets, plasma) may be in play. There has to be some kind of  more recent stimulus.

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Thanks for your input.

Patient came in this time for Laparotomy.

The only other product we have issued is Beriplex (prothrombin complex to reverse Warfarin) in 2016 when he had an AAA. (Antibody screen neg)

Cheers

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On 10/1/2021 at 2:10 PM, carolyn swickard said:

What about RH pos plasma products or platelets?  Though they don't tend to cause an anti-D, they can "spike" one that dropped below detectable levels, I believe.  And that far back, if any platelet concentrates were given, they would have had more RBC exposure than they do now with platelet pheresis units.  Just a thought.

 

In plasma products, what exactly would "spike" the formation of Anti-D?  Residual D-positive RBCs or platelets? 

 

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17 minutes ago, diplomatic_scarf said:

 

In plasma products, what exactly would "spike" the formation of Anti-D?  Residual D-positive RBCs or platelets? 

 

In some plasma components, it would undoubtedly be residual D positive red cells, as long as the component has not been frozen, as the freezing and thawing process would disrupt the  structure of the membrane (although some people have theorised that the D antigen on disrupted red cell membranes may still cause sensitisation [I don't believe it]).  However, once anti-D has been produced by a person, it takes minute amounts of D positive red cells to cause a strong secondary production (see around and about slide 60 of the attached lecture - which I know is about HDFN, but the sensitisation is the same).

In Depth Lecture on Alloimmune Haemolytic Disease of the Foetus and Newborn HDFN.pptx

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No products/components since 2016 (see  my previous post) TO OUR KNOWLEDGE.

Being a small island nation, patients quite often get treatment in the UK which we don't know about and vice versa - very helpful. So he may have had D pos platelets. I think it unlikely he had D pos red cells for a planned procedure.

We did XM 4 units (O neg) in 2016 but none were required.

Thanks all

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