[Immunopreventive management of Rh-positive maltransfusions]

We report on a case of a Rh-positive mis-transfusion in a Rh-negative pregnant woman treated by human-immunoglobulin-G-anti-D (IgG-anti-D). A sensibilization that without a therapy was to be expected with a probability of 75 per cent did not take place. We discuss our observation in connection with information existing hitherto on similar events. Hereby a distinct dependence on an anti-D-dosis becomes evident in order to achieve a reliable immunosuppression in an appointed quantity of erythrocytes. A summarizing of literature at hand results in the fact that a reliable prevention of sensibilization may be achieved by a dosage of 20 microgramme IgG-anti-D each ml of a concentrate of erythrocytes respectively 10 microgramme each ml full blood. This means for a large foetomaternal as well as for false transfusions of adult blood. The dosage in the case, described by us, therefore by 1,9: 1 related to full blood was too low. We acted perfectly consciously as up to date there are no informations on a treatment by anti-D in this way during pregnancy and because an eventually Rh-positive child should not be injured at all. The clinical course after the anti-D-treatment has been examined by numerous authors. It showed even in a therapy by high doses of great quantities of erythrocytes but slight reactions. Severe disorders have not been described hitherto. We therefore ought to treat by sufficiently high doses and as soon as possible in order to allow the organism to contact with the intact antigen as brief as possible. Finally we present a proposition on diagnostics and therapy for the case of a Rh-mis-transfusion respectively a large glut in of foetal blood cells in order to avoid an immunization within the Rh-system.