Some Possible Explanations:

Always review the transfusion history of all component types, medication history, and the clinical history!! Start with this first.

1. Receipt of plasma with anti-D (RhIG, IVIG, etc.)–passive antibodies
2. Partial D with anti-D:
   1. Partial or mosaic D patient who received D positive RBCs and made anti-D directed against its missing epitopes
3. Anti-G:
   1. Not all anti-G is anti-C and anti-D:  It is really a separate specificity.  It is possible that anti-G may be made even though the patient is C-positive.
4. Anti-LW:
   1. However, it is unlikely to show such strong reactions

Can you think of other explanations?

3/10/20