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The page below is a sample from the LabCE course Overview Of Major Antigens of the Rh Blood Group System. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Hemolytic Transfusion Reaction (HTR)

Based on the high immunogenicity of the antigens of the Rh system, particularly D, the determination of an individual's Rh type and detection of unexpected Rh antibodies are major components in the quest to provide safe transfusions and manage future pregnancies.
When individuals encounter red cells that possess antigens they lack, circulating antibody may appear after as long as 120 days after the initial exposure (primary response) and within 2 to 7 days of subsequent exposure (secondary, anamnestic response). In addition, it is not unusual for a person with a single Rh antibody to produce additional Rh antibodies if further stimulated by transfusion or pregnancy. Given that Rh antibodies do not fix complement, the effects of the adverse event is extravascular destruction of antibody-coated red cells. A transfusion reaction mediated by these antibodies may present with unexplained fever, mild bilirubin elevation, a decrease in hemoglobin and haptoglobin, a positive direct antiglobulin test (DAT), and a positive antibody screening test.
In the event of a positive DAT, elution studies should be performed to assist in defining the antibody specificity causing the reaction. If antibody is detected in screening tests and/or through elution studies, the patient must receive units that lack the corresponding antigen for all subsequent transfusions. A complete and accurate antibody history and communication with the care team is critical to the patient's future treatment.
Harmening, DM,: Modern Blood Banking & Transfusion Practices, 6th ed. FA Davis, Philadelphia, PA, 2012, p 162.
Blaney, KD and Howard, PR: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 3rd ed. Elsevier, St. Louis, MO, 2013, p 119-120, 232.