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Auto-anti-D blocking D determinants on red cells in pregnancy
G Kuśnierz-Alejska1, I Bugajna, H Seyfried
1Department of Serology, Institute of Haematology, Warszawa, Poland.
Materia Medica Polona. Polish Journal of Medicine and Pharmacy
|January 1, 1990
Summary
A pregnant woman developed a positive direct antiglobulin test from an IgG1 anti-D autoantibody. This autoantibody temporarily blocked D antigen expression, causing mild hemolytic disease in her infant.
Area of Science:
- Immunology
- Hematology
- Obstetrics
Background:
- Autoimmune hemolytic anemia (AIHA) can complicate pregnancy.
- Rh typing is crucial during pregnancy for managing potential alloimmunization.
- D variants can present diagnostic challenges in blood banking.
Observation:
- A pregnant woman presented with a positive direct antiglobulin test (DAT).
- The DAT was positive due to an IgG1 autoantibody with anti-D specificity.
- During peak autoantibody activity, D epitopes were completely blocked, hindering Rh typing.
Findings:
- The autoanti-D antibody caused a benign form of hemolytic disease of the newborn (HDN) in the infant.
- Autoantibody production was transient, ceasing after delivery.
- The patient and her siblings possess a D variant (Category V), explaining the complete epitope blocking by the autoantibody.
Implications:
- This case highlights a rare cause of DAT positivity in pregnancy.
- Understanding D variants is essential for accurate RhD blood typing, especially in cases of autoantibodies.
- Transient autoantibody production in pregnancy requires careful monitoring for fetal well-being.