{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T09:30:05Z","timestamp":1787131805359,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Massive fetomaternal hemorrhage can lead to significant fetal morbidity or mortality. RhD negative patients require appropriate treatment to prevent alloimmunization in subsequent pregnancies. Few cases with follow\u2010up into future pregnancies have been reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report and Results<\/jats:title>\n                    <jats:p>30\u2010year\u2010old gravida 3 para 1 presented at 40\u2009weeks and 2\u2009days gestation for late term evaluation. Ultrasonography identified an intrauterine fetal demise. The patient was O RhD negative and had previously received Rh immunoglobin (RhIG) at 26\u2009weeks of gestation. The patient was induced and delivered a 3,450 gram stillborn fetus. Kleihauer\u2010Betke testing performed and revealed massive fetomaternal hemorrhage with a result of 5.4\u20136.0%. The calculated fetomaternal hemorrhage was estimated to be 281.6\u2009mL (approaching the total estimated fetal blood volume of 293\u2009mL). The patient received 3 vials of intramuscular RhIG (300\u2009\u03bcg\/vial), 2 vials of intravenous RhIG (1,000\u2009\u03bcg\/vial), and 1 vial of intravenous RhIG (300\u2009\u03bcg\/vial) for a total RhIG dose of 3,200\u2009\u03bcg, over a 3\u2010day period, with no adverse clinical sequelae. Serological investigations for anti\u2010D antibodies remained positive until 6\u2009months and were inconclusive at 8 months postpartum. At 10\u2009months postpartum, she was 9\u2009weeks pregnant and no anti\u2010D antibodies were detected. With this subsequent pregnancy, she was treated with routine RhIG and delivered a healthy RhD positive neonate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adequate dosing of RhIG can be achieved to prevent alloimmunization, even in massive fetomaternal hemorrhages. After large doses of RhIG, anti\u2010D antibodies may persist for several months and do not necessarily indicate maternal alloimmunization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/trf.70318","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T09:18:48Z","timestamp":1787131128000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Massive fetomaternal hemorrhage and successful prevention of maternal\n                    <scp>RhD<\/scp>\n                    alloimmunization: A case report"],"prefix":"10.1111","author":[{"given":"Sajjad","family":"Hassan","sequence":"first","affiliation":[{"name":"Department of Pathology University of Massachusetts Chan Medical School\u2014Baystate  Springfield Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Essa","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology University of Massachusetts Chan Medical School\u2014Baystate  Springfield Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Orr","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology University of Massachusetts Chan Medical School\u2014Baystate  Springfield Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corina N.","family":"Schoen","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology University of Massachusetts Chan Medical School\u2014Baystate  Springfield Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chester","family":"Andrzejewski","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Massachusetts Chan Medical School\u2014Baystate  Springfield Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1990.30490273444.x"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002528"},{"issue":"3","key":"e_1_2_11_4_1","first-page":"323","article-title":"Massive fetomaternal hemorrhage: Manitoba experience","volume":"83","author":"Almeida V","year":"1994","journal-title":"Obstet Gynecol"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0009922819870254"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000093881"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.1971.tb04424.x"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0887-7963(88)70039-5"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197505082921906"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000020.pub3"},{"issue":"9","key":"e_1_2_11_11_1","first-page":"385","article-title":"Prevention of Rh immunization after massive Rh\u2010positive transfusion","volume":"99","author":"Bowman JM","year":"1968","journal-title":"Can Med Assoc J"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqad011"},{"issue":"5","key":"e_1_2_11_13_1","article-title":"A case of massive fetomaternal hemorrhage","volume":"64","author":"Warren E","year":"2023","journal-title":"J Miss State Med Assoc"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1159\/000263583"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000236150"},{"key":"e_1_2_11_16_1","volume-title":"Technical Manual","author":"Delaney M","year":"2017"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01481043"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000157115.05754.3c"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.16710"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000271212.66040.70"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0028-1103150"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2004.00243.x"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.5858\/133.3.465"},{"issue":"5","key":"e_1_2_11_24_1","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1111\/trf.18202","article-title":"Why do people still make anti\u2010D over 50\u2009years after the introduction of rho(D) immune globulin? 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