Rhesus immune globulin fails to prevent immunization after rhesus incompatible blood transfusion

The transfusion of rhesus positive (D+) red blood cells to a rhesus negative (D−) person usually induces the development of an irregular anti-D antibody in the recipient. This can lead to a hemolytic reaction in subsequent transfusions, and, in women of childbearing age, can lead to fetal erythroblastosis in any future pregnancy. The recommended interventions to avoid the immunization of the recipient include the administration of intravenous rhesus immune globulin within 72 h after the transfusion. We report the case of a D− woman who received one unit of D+ red blood cells and a total of 40 units of D− red blood cells after severe trauma. In spite of treatment with rhesus immune globulin, the patient developed anti-D antibodies.