Does anyone know of an article or a continuing education about determining if a patient has true anti-D or Rhogam? Obviously, patient history will determine this, but it would be nice to know that there is something else out that one can read to reinforce this. We typically use reaction strength as a clue; however, some of our new techs aren’t considering this so sometimes it is called what it isn’t. No good!

I don't think that I have ever come across anything and, in a way, I am not surprised.

The problem is that very low levels of anti-D, even after the proven administration of anti-D immunoglobulin, could be the beginnings of an immune response and a true alloanti-D. It is always difficult to determine the aetiology of the anti-D in terms of what will be accepted in a court of law, and herein lies the problem. If you specifically state that an anti-D is due to prophylaxis, as opposed to stating that it is probably due to prophylaxis, and then the anti-D strengthens and turns out to be an immune response, and if this results in an affected baby, you would not have a leg to stand on in court if you were to be sued.

This is, I think, why nobody has been brave (or foolhardy) enough to put such a thing in print.