Rh positive patient with Anti-D

[Antrita]

We have just had our 2nd Rh positive patient with an Anti-D. The scary part was the night tech thought this was impossible and decided the man had an nonspecific warm autoantibody and was going to let them transfuse Rh positive blood if they needed it. The antibody Id panel was a perfect 3+ anti-D. Luckily he has not been transfused. I am sending his specimen to our reference lab for further work-up. Has anyone had similar experience and what did you do?

Antrita

[Malcolm Needs ☆]

We have just had our 2nd Rh positive patient with an Anti-D. The scary part was the night tech thought this was impossible and decided the man had an nonspecific warm autoantibody and was going to let them transfuse Rh positive blood if they needed it. The antibody Id panel was a perfect 3+ anti-D. Luckily he has not been transfused. I am sending his specimen to our reference lab for further work-up. Has anyone had similar experience and what did you do?

Antrita

Working in a Reference Laboratory in London, we see a few of these a year.

How strongly did the patient's red cells react with your routine anti-D reagents?

What is his ethnicity?

Was his DAT positive or negative?

If the reaction between your routine anti-D reagents was strong, and the patient has Black ethnicity, it could well be a Partial D III.

If your routine anti-D reagents detect Partial D VI, it could be that.

If the DAT was positive, it could be an auto-anti-D (or an auto-anti-LW mimicking an auto-anti-D).

I would be really interested in what your Reference Laboratory report. Will you let us know when you get the report please?

:confused::confused:

[vilma_mt]

I had a case quite awhile back.....Patient was typed Rh Pos was transfused and few days later developed Anti-D. Upon retesting and reading the tube immediate spin, patient was Rh Neg. Tube was incubated at room temp = 'pos' ; at 37C = 'pos'. DAT was negative. Was there previous transfusion? if yes I would re-test Rh type if specimen is still available. Extended incubation at room temp can detect weak D.

[Mary Ann]

We have just had our 2nd Rh positive patient with an Anti-D. The scary part was the night tech thought this was impossible and decided the man had an nonspecific warm autoantibody and was going to let them transfuse Rh positive blood if they needed it. The antibody Id panel was a perfect 3+ anti-D. Luckily he has not been transfused. I am sending his specimen to our reference lab for further work-up. Has anyone had similar experience and what did you do?

Antrita

Does this patient have thrombocytopenia? WinRho requires the patient to be Rh pos for treatment and prefer Rh pos blood products to be administered if patient's vitals are unstable and include the path's involvement. Is his Dr an oncologist? Thanks for sharing:tongue:

[kmh76]

We recently ran into this problem. We had an AB positive male patient with Anti D. It turned out the patient had received WinRho which can cause an Anti D in an Rh positive patient. We gave him Rh negative blood.

[Antrita]

It has been 2 years since we transfused 3 units of Rh positive blood. He does have a positive direct coombs so a auto anti-D is possible. We had a patient with an auto anti-e that when crossmatched with e positive cells the reactions were negative. This patient we have now had 3 + reactions with D positive cells. If it was an auto anti-d would the reactions be this strong? I will let you all know what the reference lab says, it will probably be a few days since we don't need them to find us units.

Thanks,

Antrita

[Antrita]

I forgot to mention that this patient does not have thrombocytopenia and has not had WinRho.

Antrita

[velliott]

I bet your patient has ITP and they gave them IVIG, which alot of times is contaminated with anti D. I had a similar experience and the tech also didn't understand.

[Malcolm Needs ☆]

It has been 2 years since we transfused 3 units of Rh positive blood. He does have a positive direct coombs so a auto anti-D is possible. We had a patient with an auto anti-e that when crossmatched with e positive cells the reactions were negative. This patient we have now had 3 + reactions with D positive cells. If it was an auto anti-d would the reactions be this strong? I will let you all know what the reference lab says, it will probably be a few days since we don't need them to find us units.

Thanks,

Antrita

If the DAT is positive, are you able to tell us the underlying pathology causing this (sorry, so many questions)? And his ethnicity?

Yes, the reaction could be 3+, and can go up to 5+, but this would be very,very rare.

Thanks for that information Antrita.

:):)

[L106]

We recently ran into this problem. We had an AB positive male patient with Anti D. It turned out the patient had received WinRho which can cause an Anti D in an Rh positive patient. We gave him Rh negative blood.

kmh -

I may not explain this very clearly, but it seems to be that when the WinRho binds to the patient's Rh Pos RBCs, the macrophages of the reticuloendothelial system concentrate of destroying the antibody-coated RBC complexes and spare the ITP patient's antibody-coated platelets.

Deciding what kind of donor blood to transfuse to a patient after treatment with WinRho depends on the patient's condition. I believe that it is usually recommended to give Rh Positive donor packed red cells (to encourage the action of the WinRho) unless the patient exhibits signs & symptoms of intravascular hemolysis and/or a serious anemia. (What's a "serious anemia"??? That's up to you & your Medical Director. <6 g/dL???)

[Antrita]

The patient's diagnosis is TIA vs Stroke with history of coronary bypass surgery and GI bleed. His hemoglobin has stabilized (10.0) so I don't think they are going to transfuse him. He is caucasian. He got 2 units of B positive here in 2008.

He is not being seen by a oncologist and his primary care is a family doctor. Since we don't need blood our reference lab is not working him up in a hurry but, as soon as I get something from them I will let you all know what they say.

Antrita