{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T14:12:54Z","timestamp":1764943974475,"version":"3.46.0"},"reference-count":13,"publisher":"SMC Media","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction:\u00a0The D antigen is highly immunogenic, and alloanti-D antibodies in maternal blood may cause haemolytic disease of the foetus and newborn. Prophylactic administration of anti-D immunoglobulin (Ig) to D-negative pregnant women significantly reduces the risk of alloimmunisation. However, absorption after intramuscular (IM) injection may be impaired in obese women. Case description:\u00a0We report the case of a 27-year-old D-negative pregnant woman body mass index (BMI) 35 kg\/m2\u00a0who received three IM injections of anti-D Ig during pregnancy and after caesarean section. Despite confirmed administration, her indirect antiglobulin tests (IATs) remained negative or only borderline positive. Investigations excluded weak\/partial D variants, foetomaternal haemorrhage, chimerism, and other causes. Due to her high BMI, we hypothesised that the injections were administered into subcutaneous fat, resulting in minimal absorption. After intravenous administration of anti-D Ig, the IAT became strongly positive, confirming correct drug delivery. Conclusion:\u00a0This case highlights the importance of considering maternal BMI in the administration of anti-D Ig. In obese women, inadequate IM administration may compromise prophylaxis. Intravenous administration or the use of alternative injection sites should be considered.<\/jats:p>","DOI":"10.12890\/2025_005868","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T16:35:21Z","timestamp":1764002121000},"source":"Crossref","is-referenced-by-count":0,"title":["Inadequate absorption of intramuscular anti-D immunoglobulin in a pregnant woman with a high body mass index"],"prefix":"10.12890","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9377-0211","authenticated-orcid":false,"given":"Ivica","family":"Mari\u0107","sequence":"first","affiliation":[{"name":"Slovenian Institute for Transfusion Medicine, Ljubljana, Slovenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klara","family":"\u017deleznik","sequence":"first","affiliation":[{"name":"Slovenian Institute for Transfusion Medicine, Ljubljana, Slovenia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"10.12890\/2025_005868_ref1","unstructured":"Kennedy MS, Delaney M, Scrape S. Perinatal issues in transfusion medicine. In: Fung MK, Grossman BJ, Hillyer CD, Westhoff CM. Technical manual, 18th ed. Bethesda: AABB, 2014. p. 561-570"},{"key":"10.12890\/2025_005868_ref2","doi-asserted-by":"crossref","unstructured":"Brinc D, Lazarus AH. Mechanisms of anti-D action in the prevention of haemolytic disease of the newborn. ASH Education Book January 1, 2009 vol. 2009 no. 1 185-191.","DOI":"10.1182\/asheducation-2009.1.185"},{"key":"10.12890\/2025_005868_ref3","unstructured":"Pravilnik o transfuzijskih preiskavah in postopkih ob transfuziji (Low about blood transfusion investigations and procedures with transfusion). Uradni list RS, st. 9\/2007, 2007 (The Official Gazette of the Republic of Slovenia, no. 9\/2007, 2007)."},{"key":"10.12890\/2025_005868_ref4","unstructured":"Rhophylac: Summary of Product Characteristics [Internet]; [cited 2025 Sep 15]. Available from: Health Professional Information Leaflet."},{"key":"10.12890\/2025_005868_ref5","unstructured":"Rhesonativ: Summary of Product Characteristics [Internet]; [cited 2025 Sep 15]. Available from: Rhesonativ 625 IU per ml solution for injection ENG SmPC_09001bee807a752b.pdf"},{"key":"10.12890\/2025_005868_ref6","doi-asserted-by":"crossref","unstructured":"Chan VO, Colville J, Persaud T, Buckley O, Hamilton S, Torreggiani WC. Intramuscular injections into the buttocks: are they truly intramuscular? Eur J Radiol 2006;58:480-484. doi: 10.1016\/j.ejrad.2006.01.008","DOI":"10.1016\/j.ejrad.2006.01.008"},{"key":"10.12890\/2025_005868_ref7","doi-asserted-by":"crossref","unstructured":"Zaybak A, G\u00fcnes UY, Tamsel S, Khorshid L, Esser I. Does obesity prevent the needle from reaching muscle in intramuscular injections? J Adv Nurs 2007;58:552-556. doi: 10.1111\/j.1365-2648.2007.04264.x","DOI":"10.1111\/j.1365-2648.2007.04264.x"},{"key":"10.12890\/2025_005868_ref8","doi-asserted-by":"crossref","unstructured":"Qureshi H, Massey E, Kirwan D, Davies T, Robson S, White J, et al. BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn. Transfus Med 2014;24:8-20. doi: 10.1111\/tme.12091","DOI":"10.1111\/tme.12091"},{"key":"10.12890\/2025_005868_ref9","doi-asserted-by":"crossref","unstructured":"Bichler J, Sch\u00f6ndorfer G, Pabst G, Andresen I. Pharmacokinetics of anti-D IgG in pregnant RhD-negative women. BJOG 2003;110:39-45","DOI":"10.1046\/j.1471-0528.2003.02158.x"},{"key":"10.12890\/2025_005868_ref10","doi-asserted-by":"crossref","unstructured":"MacKenzie IZ, Roseman F, Findlay J, Thompson K, Jackson E, Scott J, et al. The kinetics of routine antenatal prophylactic intramuscular injections of polyclonal anti-D immunoglobulin. BJOG 2006;113:97-101. doi: 10.1111\/j.1471-0528.2005.00789.x","DOI":"10.1111\/j.1471-0528.2005.00789.x"},{"key":"10.12890\/2025_005868_ref11","doi-asserted-by":"crossref","unstructured":"Woelfer B, Schuchter K, Janisiw M, Hafner E, Philipp K, Panzer S. Postdelivery levels of anti-D IgG prophylaxis in D- mothers depend on maternal body weight. Transfusion 2004;44:512-517. doi: 10.1111\/j.1537-2995.2004.03287.x","DOI":"10.1111\/j.1537-2995.2004.03287.x"},{"key":"10.12890\/2025_005868_ref12","doi-asserted-by":"crossref","unstructured":"Ngan CBM, Kaur R, Jackson DE. Does high body mass index (>25 kg\/m2) or weight (>80 kg) reduce the effectiveness of anti-D prophylaxis in Rh(D)-negative pregnant women? A systematic review and meta-analysis. Vox Sang 2024;119:902-911. doi: 10.1111\/vox.13693","DOI":"10.1111\/vox.13693"},{"key":"10.12890\/2025_005868_ref13","unstructured":"Expert Panel Consensus Position Statement regarding the Use of Rh(D) Immunoglobulin in Patients with a Body Mass Index > 30 [Internet]; [cited 2025 Sep 15]. Available from: Use of Rh(D) Immunoglobulin in Patients with High BMI (Australian Red Cross Blood Service and NBA Consensus Position Statement)"}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/5868\/4969","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/5868\/4970","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/5868\/4970","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T14:09:19Z","timestamp":1764943759000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/5868"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,24]]},"references-count":13,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.12890\/2025_005868","relation":{"has-manifestation":[{"id-type":"other","id":"1-132-5868-g4969","asserted-by":"subject"},{"id-type":"other","id":"1-132-5868-g4970","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-132","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"type":"electronic","value":"2284-2594"}],"subject":[],"published":{"date-parts":[[2025,11,24]]}}}