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Passive Anti-D following RhIg Administration

A scenario where anti-D is detected at delivery in a female who received RhIg during pregnancy raises the question, is the anti-D active or passive?

Distinguishing between passive and immune anti-D is important clinically:

  • If passive anti-D is misinterpreted as active, RhIg prophylaxis may be omitted, leading to D sensitization.
  • If active anti-D is misinterpreted as passive, appropriate antibody investigation may be curtailed putting the fetus at risk of developing HDFN.

When this occurs, two main serologic questions need to be answered:

  1. Are the reactions due to passive anti-D from RhIg or due to active anti-D?
  2. Are there other antibodies that need to be excluded?