Oh Rh (D)-Negative in vitro fertilization pregnancy: Obstacles surmounted

We report a rare case of Oh (D)-negative female with in vitro fertilization (IVF) pregnancy. Blood grouping was reported as O Rh (D) negative elsewhere and was referred at 28 weeks gestation for anti-D titration to our center. Blood grouping repeated at our laboratory was Oh Rh (D) negative. Owing to the absence of H antigen-negative cells, we did anti-H adsorption studies on the patient serum to look for underlying red cell alloantibodies, which were absent. The Ig (G) anti-H titer was 256, but there were no signs of fetal anemia as seen on the fetal middle cerebral artery (MCA) peak systolic volume studies also. The patient was on follow-up with anti-H titers and fetal MCA-Doppler studies every 2 weeks. The patient was started on oral iron and erythropoietin as hemoglobin was 8.5 g% which then improved to 11.5 g% after two doses of erythropoietin. Owing to risk of bleeding due to low-lying placenta, the treating obstetrician wanted to keep two units of red cell concentrate ready before elective lower segment cesarean section. Hence, close family members of the patient were screened for Oh phenotype, but none of them were found to be of Oh phenotype. Hence, autologous predeposit with fetal monitoring was considered but not implemented owing to legal and patient concerns. Pregnancy was uneventful and a healthy female baby was delivered at term. The baby did not have any signs of hemolytic disease of newborn. Blood grouping of baby was O positive and direct antiglobulin test done at the referring center was negative