Anti D antibodies in a D positive patient ! Input please !

[Malcolm Needs ☆]

To the extent of my experience, I have never seen/heard of Auto-Anti-D. I have seen multiple presentations of D variant patients forming Anti-D (although a farely rare phenomenon). If your patient is D variant, then it is not unexpected for him to form Anti-D. D, as we all know, is very immunogenic. If this is the case, we do not classify the Antibody as "Auto-Anti-D"--we would classify it as "D variant with Anti-D". We would not bother to have the D variant identified....we would simply transfuse Rh negative blood.

You do want to confirm/exclude the presence of WinRho infusion. WinRho would also explain your dilemma. The presence of WinRho has given me multiple problems!

Actually, auto-anti-D is more common than a lot of people think, and I would have no hesitation calling this one an auto-antibody.

We see at least six or seven a year in our reference laboratory here at Tooing in the UK, and the International Blood Group Reference Laboratory gets rather upset with us when we miss one and send it down to them for investigation as an alloanti-D in a possible partial D patient.

[jcdayaz]

Wow, seriously? Auto-anti-D? I've never encountered such a thing!

[Malcolm Needs ☆]

Yep, seriously!

You'll find that auto-anti-D is mentioned in Geoff Daniels book, Human Blood Groups, 2nd ed, Blackwell Science 2002, page 249, in Marion Reid and Christine Lomas-Francis' book, The Blood Group Antigen FactsBook, 2nd ed, Elsevier Academic Press 2004, page 122 and Lawrie Petz and George Garratty's book, Immune Hemolytic Anemias, 2nd ed, Churchill Livingstone 2004, page 385, to name but a few.

:)

[PAWHITTECAR]

There is a drug givin to increase platelet production that is called WinRho. Tis will cause an anti-D in patients taking it.

[Malcolm Needs ☆]

There is a drug givin to increase platelet production that is called WinRho. Tis will cause an anti-D in patients taking it.

WinRho doesn't cause anti-D in patients taking it. WinRho is anti-D!

[ahalim]

I would appreciate inputs from the members in the following scenario please !

Blood sample of a pregnant lady walking into the hospital for the first time is received in the Blood Bank and

the test for anti D typing shows 4+ reaction. But was not compatible with D positive blood.

Later on , antibody identification reveals anti D antibodies.

(For transfusion, "D negative" blood is given as "D positive" blood was incompatible.)

In my career for the first time, I am coming across such a situation .

How do we explain such a scenario of anti D antibodies in a "D positive " patient ? :eyepoppin

I have my explanation, but I would appreciate inputs from the members also please !

in anticipation,

and with wishes to all,

engeekay2003 :disbelief:disbelief:disbelief[/quote

ٍSalam

This patient could have partial D and received D + blood with the part missing and subsequently she made antibodies to this part! could be?

Edited November 30, 2009 by ahalim
spelling mistake

[jcdayaz]

This looks like a passively acquired anti-D due to rhogam. If she did not receive WinRHo(D) she probably got RhoGam. Yea, I know she's Rh+ and not a candidate for RhoGam, but obgyn offices make those mistakes all the time! We work closely with a hematology/oncology group and we see a lot of their rh+ patients with auto-anti-D due to WinRho(D). You call the office and half the time the nurses don't have a clue what you are talking about when you ask them if the patient received WinRho(D). Only when you speak to the treating physician (the one who ordered it) do you get straight answers (if you can figure that out). I'm willing to bet that your patients received WinRho(D), Rhogam or IVIG. A D variant is very possible but with a positive Direct Coombs, it's probably passively acquired. BTW, you can get passively acquired C and E with WinRho too!

Hope that helps.

Yes! My only experiences with WinRho have been samples that expressed D,C specificity. Maybe internationally a different product is used for ITP treatment? I don't know.

[jcdayaz]

WinRho doesn't cause anti-D in patients taking it. WinRho is anti-D!

Very true statement. However, why have I only ever seen it present as an Anti-D and Anti-C if it is only Anti-D?

I don't remember the specifics....but I know that whenever we have an Rh pos patient presenting with Anti-D, or Anti-D,C, the first thing we do is ascertain whether or not WinRho is a consideration.

I have only seen presentations of Anti-D,C.

[Malcolm Needs ☆]

Very true statement. However, why have I only ever seen it present as an Anti-D and Anti-C if it is only Anti-D?

I don't remember the specifics....but I know that whenever we have an Rh pos patient presenting with Anti-D, or Anti-D,C, the first thing we do is ascertain whether or not WinRho is a consideration.

I have only seen presentations of Anti-D,C.

Ah, I'm not saying it doesn't have other antibodies present too; I am just saying that the major specificitiy is anti-D.

[jcdayaz]

She may have ITP and is being treated with Rho(D) Immune Globulin. It is used only in Rh positive patients for ITP.

You have to LOVE WinRho(NOT)....It presents all sorts of issues... Good point you made here..

[Malcolm Needs ☆]

We had a case of a pregnant lady the other day that I was totally convinced was a partial DIII with anti-D in her plasma.

I was wrong.

Although it reacted with all of our anti-D sera (as would a partial DIII), when molecular studies were performed, it turned out to be a DOL with anti-D.

:redface: