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PubMed1989

The Rh-negative donor.

By typing fully for Rh, donor samples found to be D-negative but C-positive and/or E-positive on the Kontron Groupamatic G2000, the incidence of Ccddee (r'r) was found to be 0.44%, ccddEe (r"r) 0.50% and Du 0.30%. A total of 15,000 samples typed on the Groupamatic as D-, C- and E-negative were tested by an antiglobulin technique for Du, but none was found to be positive. A new strategy was therefore adopted for routine Rh typing of donations that includes typing first-time donors on the Groupamatic for C, D and E antigens; those that type as D-negative, C-positive and/or E-positive are further tested but no routine Du testing of D-, C- and E-negative donations is performed. Donations are labelled according to their D type, and the once used terminology 'Rh-positive donor, Rh-negative recipient' is no longer used except for those rare Rh D-positive donors belonging to the D category VI of Tippett & Sanger (1962).

Blood Banks↗
PubMed1991

'Partial D' women with anti-D alloimmunization in pregnancy.

We report five women with Rh 'partial D' who were found to have anti-D during pregnancy. Two patients were category IVa, their red cells typing as Go(a+); one was category VI; and two had a 'partial Du' which could not be categorized. The maternal anti-D concentration increased during four of the eight pregnancies studied, but none reached significant levels. Three of six D-positive cord blood samples had a positive direct antiglobulin test (DAGT). Although one baby became jaundiced, no treatment was required. The policy in the Oxford Region for the management of patients with a weak expression of D is outlined.

England↗
PubMed1995

A case of unexplained mild Rh (D) haemolytic disease in utero.

This report describes the case of a patient with a history of HDN complicated by fetal losses, in which the alloantibody in this particular pregnancy did not appear to cause HDN in utero. No protective HLA-DR antibodies could be demonstrated, and transport of IgG across the placenta appeared to be normal. The infant's red cells possessed a normal D antigen and his mononuclear phagocyte system appeared unimpaired. However, the number of molecules of IgG bound in vivo per fetal red cell was below the level usually associated with significant haemolysis and HDN.

Adult↗
PubMed1995

Anti-D quantification by flow cytometry: an alternative to the AutoAnalyser?

A flow cytometry method for quantifying levels of anti-D is described. The method is based on the indirect antiglobulin test and uses an FITC Fab anti-human IgG reagent for detection of bound anti-D. A standard curve is generated from the fluorescence measured by flow cytometry using the British Standard anti-D preparation 73/515. The fluorescence obtained from test samples by flow cytometry is converted into IU/mL anti-D, using the standard curve. In a limited study with 42 serum samples the assay showed good correlation with results obtained using the AutoAnalyser for sera with anti-D levels less than 100 IU/mL. The method is simple to perform and has potential as a replacement for the AutoAnalyser.

Autoanalysis↗
PubMed1996

A pharmacokinetic/pharmacodynamic model for the action of anti-D immunoglobulin in effecting circulatory clearance of Rh D+ red cells.

A dynamic model of the action of anti-D immunoglobulin in effecting clearance of Rh D-positive red cells from the circulation of D-negative subjects is presented. The pharmacokinetics of the redistribution of anti-D between injection site, intravascular and extravascular spaces following either intramuscular or intravenous administration is included, also the reaction of anti-D with D-positive red cells in the intravascular space and subsequent circulatory clearance of antibody-coated cells. Numerical computer modelling methods have been used to obtain solutions of the model, using kinetic rate constants which have been derived from previously published experimental data. Selected solutions are presented, chosen for their relevance to (i) clinical situations in which anti-D is used to prevent Rh D immunization of D-negative subjects and (ii) determination of some of the properties of anti-D antibodies which are important for effecting circulatory clearance of D-positive red cells.

Computer Simulation↗
PubMed1986

Frozen recovered red cell boosting of female donors for anti-D-production.

A selected group of women previously immunized in pregnancy by the Rh(D) antigen were boosted with 0.5 ml of Rh(D)-positive frozen recovered red cells from an accredited donor panel. The response was prompt and sustained and increased the anti-D content by almost 10-fold. In spite of the reduced rate of clinical immunisation to the Rh(D) antigen, it was possible to recruit females with anti-D, acquired in pregnancy, for secondary boosting and a programme is recommended which maximizes efficiency and safety.

Adult↗
PubMed1990

Alloimmunization to RhD by platelet transfusions in autologous bone marrow transplant recipients.

Platelet transfusions from RhD-positive (D-positive) donors are often given to RhD-negative (D-negative) cancer patients. The low observed rate of alloimmunization has been attributed to disease and therapy-related immunosuppression. We have studied the occurrence of alloimmunization in 16 D-negative patients who did not have detectable anti-D prior to autologous bone marrow transplantation for malignant disease. All received D-positive platelets, but no other D-positive blood product. Three patients (19%) developed anti-D at 13, 24 and 83 days, respectively, after first receiving D-positive platelets, and after a total dose of 53, 65 and 119 D-positive platelet unit equivalents, respectively. Two of them also developed anti-C. The 13 patients in whom anti-D was not detected were also heavily transfused with D-positive platelets (mean +/- SD = 136 +/- 82 platelet unit equivalents). In 6 of them, the last recorded antibody screen was less than 3 months after the first D-positive platelets, and may not exclude a primary immune response. Thus, despite profound immunosuppression associated with autologous marrow transplantation, alloimmune responses to D-positive red cells in platelet concentrates can occur in some D-negative recipients.

Adolescent↗
PubMed1993

Protection against Rh D-haemolytic disease of the newborn by a diminished transport of maternal IgG to the fetus.

IgG present in the circulation of newborn infants is predominantly of maternal origin. In cases of severe Rh D alloimmunization, the maternal anti-D anti-bodies may lead to Rh D-haemolytic disease of the newborn. However, an impaired placental transport of maternal IgG could be associated with the protection of the fetus/newborn against haemolytic disease as shown in this case report.

Biological Transport↗