Johnquigley

Dear All Can I pick your brain about something. Under the UK Guidelines, there is no requirement to perform a post-partum antibody screen on the mother, and no requirement to perform a DAT on the baby if the mother had no antibodies during her pregnancy (or in the past), and the mother was given routine anti-D immunoglobulin prophylaxis during her pregnancy. We are introducing RAADP in The National Maternity Hospital this year and we are wondering how did labs in the UK approach dropping the DAT on the cord. We use BioRAD 6 well ID-Cards (DiaClon ABO/D + DAT): A, B, DVI-, DVI-, ctl, DAT As we sometimes (not often) see one D well negative and the other D well positive we would prefer to stick to the 2 D well ID-card. Our problem is that we cannot source a BioRAD ID-card that has this minus the DAT well. What do BioRAD users in the UK do? Any advice would be greatly appreciated. Best wishes John

Hi All Under the BCSH Guidelines there is no requirement to run a DAT on the baby if the mother had no antibodies during her pregnancy, and the mother received RAADP. I am wondering for those of you who use DiaMed ID-cards for newborn grouping, what card do you use to group the baby?

Apologies Mum is O RhD Negative (that was a typo!!) Twin 1 = Ror Twin 2= R2r Twin-Twin transfusion usually not possible with dichorionic diamnionotic, primarily only seen with monochorionic. Just to note Twin 2 was grouped pre 1st IUT at 27 weeks when the Anti-D levels were not near as high as when Twin 1 was grouped in the neonatal period at 34+3 weeks gestation, Twin 1 Grouped as A but weak reactions against the anti-D reagents, we assumed that this could be the blocking effect- where high anti-D levels result in blocking of D antigen sites resulting in false negative or weakened RhD group. Elusion demonstrated that it was Rh D+ve IgG and IgM were coating the baby red cells , DCT strong positive (4+), IgG 4+ IgM 2+ ? Origin of IgM. On RhD antigen density Issit & Anstee quote the following: R2r has 14,000 to 16,500 D antigen sites Ror has 12,000 to 20,000 D antigen sites Initially I assumed it may have been due to the fact the twin was Ror until I discovered the no of antigen types in Ror and R2r

Mrs X Para 2+1 with dichorionic diamniotic twins. Anti-D+G present Anti-D quantitation levels at 13+2 and 29+3 weeks were 21IU/mL-1 and 330IU/mL-1 respectively. Mum O RhD Positive rr, Dad A Rh D Positive R2Ro Twin 1: A RhD Positive DAT 4+, did not go over 1.5MoMs on middle cerebral artery Doppler peak systolic velocity surveillance and did NOT require IUT. Postnatally only required top up Tx’s Twin 2: O RhD Positive R2r DAT 4+. required three intrauterine transfusions. Postnatally required Exchange Tx, IVIg and phototx and serial top-ups Although both twins in this case were RhD positive only one was severely affected. What are the possible reasons / theories to explain this disparity? According to Mollison there are 3 circumstances the fetus may be unaffected or only mildly affected despite a strong positive result in a cellular bioassay. These are: 1. Fetus Rh D Negative 2. Presence of Fc receptor blocking antibodies 3. Diminished transport of maternal IgG to the fetus Are there any other suggestions theories or advice?

Thanks Malcolm looking forward to the new guidelines.

Dear All I am writing a paper and I am finding difficulty sourcing a reference for the following statement I am making in the paper. I know I have read it somewhere but for some reason I cannot find it now Background: once an Intrauterine transfusion has happened, the transfusion procedure itself is known to increase antibody levels. Therefore carrying out serial quantitations post IUT are unnecessary as the patient will be closely monitored by MCA Doppler US. Best wishes John

I'm in Ireland and work in the National maternity hospital, we implemented a massive haemorrhage protocol in 2012. If you want any advice don't hesitate to send a PM Best wishes

I've only just discovered it myself recently too. It's a great website. Great podcasts too

Done. Best of luck, keep us updated on the survey results.

Both are very good books