Newly detected anti-D

[RichU]

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

[John C. Staley]

Any testing between 2014 and now?  Were any units transfused in 2012 or 2014?  I assume if either these questions are you would have mentioned it but I don't like working on assumptions.

[carolyn swickard]

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.

[Malcolm Needs ☆]

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.

[John C. Staley]

17 hours ago, Malcolm Needs said:

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

I was going in the same direction as well.  

Edited October 2, 2021 by John C. Staley
forgot my coffee cup!

[exlimey]

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.

[RichU]

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

[David Saikin]

On 10/1/2021 at 4:33 PM, Malcolm Needs said:

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

me too

[galvania]

Did he not receive any blood products then in 2016?

 

[galvania]

And a bit more 'way out' - has he received any plasma for Covid that might have contained the anti-D?

[SbbPerson ☆]

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? 

 

[SbbPerson ☆]

6 hours ago, galvania said:

And a bit more 'way out' - has he received any plasma for Covid that might have contained the anti-D?

I doubt that would be likely, since I think a positive antibody screen disqualifies donors. But maybe I am wrong. 

[Malcolm Needs ☆]

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

[RichU]

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