@article {4128,
	title = {Clinically significant hemolytic disease of the newborn secondary to passive transfer of anti-D from maternal RhIG.},
	journal = {//Transfusion},
	volume = {54},
	year = {2014},
	month = {2014},
	pages = {2863 - 2866},
	publisher = {(1)Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center and Monroe Carell Jr. Children{\textquoteright}s Hospital at Vanderbilt, Nashville, Tennessee,(2)Department of Medicine, Vanderbilt University Medical Center and Monroe Carell J},
	address = {(C) 2014 John Wiley \& Sons, Ltd},
	abstract = {<p>BACKGROUND: RhIG is used worldwide to reduce the incidence of alloimmunization to D during pregnancy. We report a case of clinically significant neonatal hemolysis mediated by maternally administered RhIG., CASE REPORT: A 25-year-old, O-, primigravid mother with a negative antenatal antibody screen delivered a 6-lb 4-oz, blood group A, D+ baby girl at 36.5 weeks\&$\#$39; gestation. Prenatal care included a dose of intramuscular RhIG at 28 weeks\&$\#$39; gestation. At delivery, the newborn was markedly jaundiced with a total bilirubin of 6.3 mg/dL, which reached more than 20 mg/dL after 6 days. The newborn\&$\#$39;s lactate dehydrogenase (LDH) was 485 U/L (normal, \&lt;226 U/L) and further laboratory studies revealed reticulocytosis (17.2\%; normal range, 0.36\%-1.9\%) and a hemoglobin (Hb) of 14.3 g/dL (normal for age range, 13.4-19.8 g/dL) that decreased to 11.5 g/dL (normal for age range, 13.5-22.6 g/dL) by Day-of-life 7. Although the maternal antibody screen was negative, the newborn\&$\#$39;s direct antiglobulin test (DAT) was positive for immunoglobulin (Ig)G, with an anti-D identified by elution studies. The possibility of hemolytic disease of the newborn (HDN) due to anti-A was considered, but ultimately ruled out by the absence of anti-A1 in the eluate. The newborn\&$\#$39;s hyperbilirubinemia was adequately managed with phototherapy. Analysis of the mother\&$\#$39;s plasma 10 days postpartum revealed an anti-D titer of 8. Two months after birth, the child\&$\#$39;s laboratory studies, DAT, antibody screen, and peripheral smear were unremarkable., CONCLUSION: In the context of neonatal anemia, elevated LDH, and reticulocytosis, a positive IgG DAT with anti-D identified in the eluate suggests RhIG-mediated HDN. This appears to be a rarely reported event., (C) 2014 John Wiley \&amp; Sons, Ltd</p>},
	keywords = {*Erythroblastosis, *Isoantibodies, Adult, Erythroblastosis, Female, Fetal/bl [Blood], Fetal/et [Etiology], Fetal/pc [Prevention \& Control], Fetal/th [Therapy], Humans, Hyperbilirubinemia/bl [Blood], Infant, L-Lactate Dehydrogenase/bl [Blood], Newborn, Pregnancy, Prenatal Care},
	isbn = {0041-1132},
	author = {Cohen, Daniel and Johnson, Mary and Liang, Wayne and McDaniel, Heather and Young, Pampee}
}
