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Positive cord blood DAT


Okie

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Hello,

We received a cord blood with a positive DAT (2+).  The baby and Mom are both O Pos.  No reactions were seen with either the acid or Lui eluates. Mom's antibody screen and panel were negative.  Her poly and IgG DAT were weakly positive, eluate nonreactive.  Her list of drugs did not indicate medications could be the cause.  The baby's bilirubin is normal.  We did not obtain a specimen from the father.  Has anyone seen this before?  Possibly a warm auto?

Thanks.

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It could be a maternal warm auto-antibody, as these rarely cause clinically significant haemolytic disease of the foetus and newborn, but equally, it could also be the result of an allo-antibody the mother has produced against a low prevalence antigen expressed on the baby's red cells, the gene for which was inherited from the father.  I know that you said that the baby's bilirubin is normal (which mitigates against it being HDFN), but not all such antibodies are clinically significant, and certainly not all lead to clinically significant HDFN.

It's a pity you couldn't get a sample of dad's red cells to test against the baby's eluate, but that is so often the case!

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Although the baby seems to be doing well, it would indeed be nice if the father's cells were available to test with the eluate (and Mom's serum). Or you could have a reference lab take a look for antiboduies to low-incidence antigens. Identifying the antibody might also be helpful in managing future pregnancies which probably would have a 50% chance of the same serologic scenario. I would think that no clinical signs of HDFN are no guarentee that the next child would fare as well. And if nothing else, the ex-blood banker in me would just want to know what the darn thing is!

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I agree with every word you say Phil, EXCEPT that, as the baby is fine, trying to identify an antibody directed against a low-prevalence antigen is like hitting your head against a brick wall, over and over and over again!  One has to remember that it is not just the specificities within the 701 series (assuming that it is not a novel specificity all together), but most of the "larger" Blood Group Systems also contain low-prevalence antigens (just look at the Diego Blood Group System, as an example); you could spend many "happy" hours testing the plasma, and still get nowhere.

So, the serologist in me says "YES", the pragmatist in me shouts "NO"!!!!!!!

The thing is, the next pregnancy, if there is one, should, without doubt, be closely monitored (probably by MCA Doppler, or something similar), but, if either an IUT or an exchange transfusion (or a top-up transfusion, come to that) is required, finding compatible blood would be easy, even without knowing the actual antibody specificity.

:eek::eek::eek::eek::eek:

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On ‎5‎/‎17‎/‎2016 at 0:48 PM, Malcolm Needs said:

I agree with every word you say Phil, EXCEPT that, as the baby is fine, trying to identify an antibody directed against a low-prevalence antigen is like hitting your head against a brick wall, over and over and over again!  One has to remember that it is not just the specificities within the 701 series (assuming that it is not a novel specificity all together), but most of the "larger" Blood Group Systems also contain low-prevalence antigens (just look at the Diego Blood Group System, as an example); you could spend many "happy" hours testing the plasma, and still get nowhere.

So, the serologist in me says "YES", the pragmatist in me shouts "NO"!!!!!!!

The thing is, the next pregnancy, if there is one, should, without doubt, be closely monitored (probably by MCA Doppler, or something similar), but, if either an IUT or an exchange transfusion (or a top-up transfusion, come to that) is required, finding compatible blood would be easy, even without knowing the actual antibody specificity.

:eek::eek::eek::eek::eek:

When we run into scenarios like this we will routinely test against the more common low incidence antigens (e.g. Jsa, Kpa, Cw). I think it makes all of the techs feel better.

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