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D or anti-D!!! Unblocking the dilemma of blocking-D phenomenon using acid elution

      Abstract

      Maternal IgG antibodies directed against fetal red cells can cause hemolytic disease in fetus and newborn manifesting as anemia and jaundice. Sometimes, these antibodies are so strong that they encapsulate the antigens on neonatal red blood cells and result in erroneous laboratory findings when tested. A requisition for double volume exchange transfusion was received for a term,3.1 kg female baby with neonatal jaundice at day 2 of life, born to a multiparous woman. The neonate was typed as AB RhD negative and the mother as A Rh D negative. The maternal sample tested positive for Indirect antiglobulin testing showing presence of Anti-D with IgG titer of 128. The direct antiglobulin testing for baby was strongly (4 +) positive. The strong DAT result with negative RhD typing for the neonate indicated towards the Blocking-D phenomenon. We attempted to resolve the Blocked-D case using acid elution, which revealed the presence of D antigen on the eluted neonate's red cells. The report emphasizes the importance of appropriate blood typing for neonates to provide prompt adequate care as a team by the departments of Neonatology and Transfusion Medicine.

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      References

        • Bowman J.M.
        The prevention of Rh immunization.
        Transfus. Med. Rev. 1988; 2: 129-150
        • De Haas M.
        • Thurik F.F.
        • Koelewijn J.M.
        • Van
        • der Schoot C.E.
        Haemolytic disease of the fetus and newborn.
        Vox Sang. 2015; 109: 99-113
        • Mollison P.L.
        • Engelfriet C.P.
        • Contreras M.
        Hemolytic disease of the fetus and the newborn.
        in: Mollison P.L. Engelfriet C.P. Contreras M. Blood Transfusion in Clinical Medicine. eleventh edn. Oxford Blackwell Science, Oxford, UK2005: 496-545
        • Harmening D.M.
        Modern Blood Banking & Transfusion Practices.
        seventh ed. F A Davis Company,, USA2018
        • Sulochna P.V.
        • Rajesh A.
        • Mathai J.
        • Satyabhama S.
        Blocked D phenomenon, a rare condition with Rh D haemolytic disease of newborn – a case report.
        Int. J. Lab. Hematol. 2008; 30: 244-247
        • Verma A.
        • Sachan D.
        • Vajpayee A.
        • Elhence P.
        • Dubey A.
        • Pradhan M.
        RhD blocking phenomenon implicated in an immunohaematological diagnostic dilemma in a case of RhD-haemolytic disease of the foetus.
        Blood Transfus. 2013; 11: 140-142
        • Jain A.
        • Kumawat V.
        • Marwaha N.
        Blocked D phenomenon and relevance of maternal serologic testing.
        Immunohematology. 2015; 31: 116-118
        • Lee E.
        • Redman M.
        • Owen I.
        Blocking of fetal K antigens on cord red blood cells by maternal anti-K.
        Transfus. Med. 2009; 19: 139-140
        • Mandal S.
        • Kaur D.
        • Negi G.
        • Basu S.
        • Chaturvedi J.
        • Maji M.
        • et al.
        Irregular erythrocyte antibodies among antenatal women and their neonatal outcome at a tertiary care hospital in Northern India.
        Postgrad. Med. J. 2021; (postgradmedj-2021-140497)
      1. Deka, D. Prophylaxis in India gone haywire: analysis of 200 cases. In: Proceedings of the All-India Conference of Obstetrics and Gynecology: AICOG; 2004; Available from internet: Use of Anti-D Immunoglobulin for Rh Prophylaxis. ICOG FOGSI recommendations for good clinical practice, 2009.

        • MacKenzie I.Z.
        • Bowell P.
        • Gregory H.
        • Pratt G.
        • Guest C.
        • Entwistle C.C.
        Routine antenatal Rhesus D immunoglobulin prophylaxis: the results of a prospective 10 year study.
        BJOG: Int. J. Obstet. Gynaecol. 1999.; 106: 492-497
        • Koby L.
        • Grunbaum A.
        • Benjamin A.
        • Koby R.
        • Abenhaim H.A.
        Anti-D in Rh (D)- negative pregnant women: are at-risk pregnancies and deliveries receiving appropriate prophylaxis?.
        J. Obstet. Gynaecol. Can. 2012; 34: 429-435
        • Adeyemi A.S.
        • Bello-Ajao H.T.
        Prevalence of Rhesus D-negative blood type and the challenges of Rhesus D immunoprophylaxis among obstetric population in Ogbomoso, Southwestern Nigeria.
        Ann. Trop. Med. Public Health. 2016; 9: 12
        • Naik A.
        • Bhattacharya P.
        • Datta S.S.
        Blocking phenomenon occurs in a neonate with a positive direct antiglobulin test due to maternal anti-D, anti-C antibodies: resolved by chloroquine diphosphate treatment.
        Indian J. Hematol. Blood Transfus. 2020; 36: 403-405
        • Subramanian R.
        Blocked D in RhD hemolytic disease of fetus and newborn.
        Glob. J. Transfus. Med. 2019; 4: 114-116
        • Katharia R.
        • Chaudhary R.K.
        Removal of antibodies from red cells: comparison of three elution methods.
        Asian J. Transfus. Sci. 2013; 7: 29-32