Kurniawan Samantha, Gerhardy Laura, Hull Sue, Janus Melanie, Dhondy Nina, Clarke Lisa
Department of Haematology, Liverpool Hospital, Sydney, Australia.
Australian Red Cross Lifeblood, Sydney, Australia.
Obstet Med. 2025 Jun 12:1753495X251346056. doi: 10.1177/1753495X251346056.
Anti-D is usually alloimmune and develops in exposed RhD-negative individuals with potential for haemolytic disease of the fetus and newborn (HDFN). However, autoimmune anti-D is rare with limited understanding of its haemolytic risk to the fetus and mother.
A 30-year-old woman previously typed as B RhD positive was found to have an autoimmune anti-D on antenatal screening in her third pregnancy. RHD genotyping confirmed RhD positivity without D variants. Anti-D titres remained elevated at 1:512 throughout pregnancy with normal Doppler monitoring and no maternal haemolysis. The neonate was born at 38 weeks and 3 days of gestation with no evidence of haemolysis.
Autoimmune anti-D in pregnancy is rare and requires a multidisciplinary approach to management. Strategies include RHD genotyping to exclude D variants, close monitoring for HDFN, and careful selection of Rh phenotype matched blood for transfusion if required to avoid alloimmunisation for future pregnancies.
抗-D通常是同种免疫性的，在暴露于RhD阴性且有胎儿及新生儿溶血病（HDFN）风险的个体中产生。然而，自身免疫性抗-D很罕见，对其对胎儿和母亲的溶血风险了解有限。
一名先前血型为B RhD阳性的30岁女性在第三次怀孕的产前筛查中被发现有自身免疫性抗-D。RHD基因分型证实为RhD阳性且无D变异体。整个孕期抗-D效价持续升高至1:512，多普勒监测正常，且无母体溶血。新生儿于妊娠38周零3天出生，无溶血迹象。
孕期自身免疫性抗-D罕见，需要多学科方法进行管理。策略包括进行RHD基因分型以排除D变异体，密切监测HDFN，以及在需要时仔细选择Rh表型匹配的血液进行输血，以避免未来妊娠发生同种免疫。
