Blocked D phenomenon and relevance of maternal serologic testing

Immunohematology. 2015;31(3):116-8.

Abstract

A blood requisition for double-volume exchange transfusion was received for a 2-day-old male child born to a 29-year-old multiparous female (P2002) referred to our institute having neonatal jaundice with encephalopathy; no maternal sample was received. the neonatal blood sample was typed as group A, D-, and the direct antiglobulin test (DAT) was strongly positive (4+) using the gel method. Mono-specific DAT showed the presence of IgG antibodies on neonatal red blood cells (RBCs). Acid elution and gentle heat elution (at 56°C) confirmed the presence of anti-D on neonatal RBCs. The baby received two exchange transfusions with group O, D-, packed RBCs compatible with his own serum. Later, on day 3, the neonate's mother was typed as group AB, D-, and her serum revealed the presence of alloanti-D, -C, and -S reactive in the anti-human globulin phase. The anti-D titer was 1024. this report highlights the "blocking" phenomenon caused by maternal anti-D in a case of hemolytic disease of fetus and newborn with a positive DAT.

Publication types

  • Case Reports

MeSH terms

  • Blood Transfusion / methods
  • Coombs Test / methods*
  • Erythroblastosis, Fetal / blood
  • Erythroblastosis, Fetal / diagnosis
  • Erythroblastosis, Fetal / immunology
  • Erythrocytes / immunology*
  • Female
  • Humans
  • Infant, Newborn
  • Male
  • Pregnancy
  • Rho(D) Immune Globulin / blood
  • Rho(D) Immune Globulin / immunology*

Substances

  • RHO(D) antibody
  • Rho(D) Immune Globulin