Failure of Anti-D Immunoglobulin to Remove Fetal Red Cells from Maternal Circulation

Abstract

A Rhesus negative female was found post delivery to have circulating cells of fetal origin. The neonate was typed as D-positive. In spite of more than conventionally adequate doses of anti-D immunoglobulin given to the mother, the fetal cell count in the maternal circulation remained unchanged. Further investigation showed the fetus to be a Du variant and to exhibit a diminished reaction with the batch of anti-D immunoglobulin used.

Prenatal management of women who have partial Rh (D) antigen

“…The partial D category IV a individuals lack epitopes 1,2,3,9; the partial D category IV b individuals lack epitopes 1,2,3,4,9; the partial D category V a individuals lack epitopes 1,5; and the partial D category VI lack epitopes 1,2,5,6,7,8 (Table 1). Interestingly, anti‐D immune globulin, administered to Rh (D) negative mothers, failed to reduce the fetal cell count in her circulation shortly after the birth of an infant with a weak partial D phenotype 29 .…”