Abstract
Background
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.
Case report
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.
Conclusion
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.
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