Any IgG antibody is capable of causing HDFN if the fetal red cells possess the antigen and the antigen is well developed at birth. Anti-c and anti-K are the next most common anti-bodies to cause HDFN after anti-D.7 Less commonly reported antibodies including anti-E, anti-k, anti-Kp", anti-Kp, anti-Js', anti-Js", anti-Jk, anti-Fy, anti-Fyb, anti-S, anti-s, and anti-U. Antibodies to low-frequency antigens, such as Js and Kp, may not be detected when using screening or panel cells. If evidence of HDFN is present, testing paternal red cells with the mother's serum may demonstrate a positive reaction not detected with reagent red cells. Agglutination reaction with paternal cells would provide a clue to the presence of an antibody to a low-frequency antigen, and further testing with selected cells could be used to identify the spécificity.
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