{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T16:34:33Z","timestamp":1788798873076,"version":"build-2803163510"},"reference-count":14,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Laboratory Analysis"],"published-print":{"date-parts":[[2022,4]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>Hemolytic disease of the fetus and newborn (HDFN) is a potentially fatal complication in Rh\u2010incompatible pregnancies and rarely occurs in the sensitizing pregnancy. Distinguishing RhIG from true anti\u2010D identified is challenging. A case of severe HDFN in which a sample drawn at 28\u00a0weeks showed anti\u2010D antibody (3+ strength) attributed to RhIG is described. RBC antibody testing early in pregnancy was negative. At birth, the infant was severely anemic and maternal anti\u2010D titer was 1:256. This case represents a clinically significant anti\u2010D in the sensitizing pregnancy that was missed due to confusion with RhIG.<\/jats:p><\/jats:sec>Methods<\/jats:title>To determine if agglutination strength could be helpful, a retrospective chart\u2010review using both electronic and paper medical records was performed on 348\u00a0samples identified as RhIG and 52 true anti\u2010D samples. The agglutination strength of antibody was recorded for each sample.<\/jats:p><\/jats:sec>Results<\/jats:title>For RhIG, there was an even distribution between the weak to moderate agglutination strength (w+, 1+, and 2+) results (35%, 26%, and 33%, respectively) and just 6% had a 3+ strength. Agglutination strength in patients with high titer (\u22651:16) anti\u2010D showed they often (44.4%) have 1+ or 2+ agglutination reactivity.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>These results show that agglutination strength alone does not provide reliable evidence to distinguish RhIG from high titer anti\u2010D antibodies. We recommend that in cases where there is any uncertainty about whether the anti\u2010D reactivity is due to RhIG, titers should be performed to rule out clinically significant anti\u2010D antibody.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcla.24323","type":"journal-article","created":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T06:11:58Z","timestamp":1646374318000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Hemolytic disease of the fetus and newborn in the sensitizing pregnancy where anti\u2010D was incorrectly identified as RhIG"],"prefix":"10.1002","volume":"36","author":[{"given":"Mackenzie L.","family":"Walhof","sequence":"first","affiliation":[{"name":"DeGowin Blood Center Department of Pathology University of Iowa Hospitals & Clinics Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Leon","sequence":"additional","affiliation":[{"name":"DeGowin Blood Center Department of Pathology University of Iowa Hospitals & Clinics Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea L.","family":"Greiner","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Iowa Hospitals & Clinics Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James R.","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Iowa Hospitals & Clinics Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3964-5466","authenticated-orcid":false,"given":"Charles Michael","family":"Knudson","sequence":"additional","affiliation":[{"name":"DeGowin Blood Center Department of Pathology University of Iowa Hospitals & Clinics Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2016.05.008"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2005.076794"},{"key":"e_1_2_8_4_1","first-page":"25","article-title":"Obstetric management in Rh alloimmunizated pregnancy","volume":"3","author":"Cacciatore A","year":"2009","journal-title":"J Prenat Med"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31817d453c"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/vox.12302"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.21307\/immunohematology-2019-681"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3148.1999.009001093.x"},{"key":"e_1_2_8_9_1","first-page":"9","article-title":"Pathogenesis of Rh immunization in primigravidas. 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