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Antibody Exclusion Protocols (RhIg)

Laboratories use different protocols to confirm anti-D from RhIg administration and simultaneously exclude other antibodies in pregnant females at delivery.

The following are sample protocols (not all inclusive) with comments. All protocols assume,

  • That the patient has received RhIg (this needs to be confirmed);
  • That the antibody screen is positive (2+ or less);
  • Reactions only occurred in the IAT phase;
  • Reactions occurred only with D+ screen cells.

In other words, the following protocols assume that the antibody looks like a relatively weak IgG anti-D consistent with RhIg administration.

1. Mini-panel

Probably the most common protocol is to perform a mini-panel to exclude other antibodies and report "probable passive anti-D due to RhIg administration"; "passive anti-D consistent with recent RhIg administration" or similar.

Some commercial panels indicate which panel cells are useful to rule out other antibodies in the presence of anti-D. A mini-panel of 5-7 carefully selected red cells is typically all that is needed.

2. Full panel: Some labs do a full antibody identification panel to confirm anti-D and exclude other antibodies. This protocol is acceptable, but may be 'overkill' given that the same results can be achieved with fewer red cells.