title: Anti-D Antibodies in Pregnant D Variant Antigen Carriers Initially Typed as RhD.
abstract: BACKGROUND
  To evaluate the incidence, the consequences, and the prevention strategy of anti-D alloimmunizations of D variant carriers in the obstetric population of Split-Dalmatia County, Croatia.
  
  
  METHODS
  RhD immunization events were evaluated retrospectively for the period between 1993 and 2012. Women were tested for RhD antigen and irregular antibodies. Those with anti-D antibody who were not serologically D- were genotyped for RHD. They were evaluated for their obstetric and transfusion history and their titer of anti-D. The neonates were evaluated for RhD status, direct antiglobulin test (DAT), hemoglobin and bilirubin levels, transfusion therapy as well as phototherapy and outcome.
  
  
  RESULTS
  Out of 104,884 live births 102,982 women were tested for RhD antigen. Anti-D immunization occurred in 184 women which accounts for 0.9% of individuals at risk of anti-D formation. 181 cases occurred in women serologically typed as D-. Three women were partial D carriers (DVa n = 2, DNB n = 1), initially typed RhD+, and recognized as D variant carriers after the immunization occurred. Anti-D titer varied from 1:1 to 1:16. Six children were RhD+, four had positive DAT, and two underwent phototherapy.
  
  
  CONCLUSIONS
  Anti-D immunization occurred in pregnant partial D carriers (DVa, DNB). RhD+ children had serologic markers of hemolytic disease of the fetus and newborn (HDFN), with no cases of severe HDFN.
authors.affiliation: Department of Transfusion Medicine, Split University Hospital Center, Split, Croatia, Zagreb, Croatia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Lukacevic Krstic
authors.affiliation: Department of Transfusion Medicine, Split University Hospital Center, Split, Croatia, Zagreb, Croatia.
authors.forename: Slavica
authors.initials: S
authors.lastname: Dajak
authors.affiliation: Croatian Institute of Transfusion Medicine, Zagreb, Croatia.
authors.forename: Jasna
authors.initials: J
authors.lastname: Bingulac-Popovic
authors.affiliation: Croatian Institute of Transfusion Medicine, Zagreb, Croatia.
authors.forename: Vesna
authors.initials: V
authors.lastname: Dogic
authors.affiliation: Department of Transfusion Medicine, Split University Hospital Center, Split, Croatia, Zagreb, Croatia.
authors.forename: Jela
authors.initials: J
authors.lastname: Mratinovic-Mikulandra
keywords: Anti-D antibodies; D antigen; D variants; HDFN; Pregnant women