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Found 7 results

  1. Our facility is evaluating making a change to our process for Weak D testing for patients with a positive DAT. For years, if we were required to do a Weak D, but the patient had a positive DAT, we used to cancel the Weak D as invalid. Another hospital in our system mentioned that they tended to perform the Weak D, but then only cancel as invalid if the Weak D is positive. We are thinking about changing to this process, as we now have to result many babies as "Rh Unknown" and give their mothers Rhogam. Per our Anti-D's package insert: "Red blood cells coated with alloantibodies or autoantibodies of the same or similar specificity as the reagent (i.e. cells that are DAT positive) may give weak reactions. This is due to decreased availability of antigen sites because of antigen blocking or steric hinderance. In extreme cases false-negative results may occur." I'm worried about the "extreme cases" where a false negative could occur, but I cannot see this being common. Also, would you think that if the cells were coated with that much antibody, that we would see any other odd reactivity in the ABO/Rh? What do other facilities do? Thank you in advance, Susan
  2. We have recently switched from using the Ortho ProVue to the BioRad tango Optimo. With this, we have encountered some issues. The tango does not pick up Du on the routine ABO/Rh strip. The ProVue ABO/Rh card does. So, we have had a lot of discrepant Rh types since we have started using the tango. We use the Quotient D Blend as our serologic reagent, which does pick up Du at immediate spin, as well as Du & D6 at IAT. In the last week we have had two OB patients type as Rh negative both on the tango and at immediate spin with the Quotient D blend. On one patient, the nurse called and stated that the patient had a history of being Rh Positive in their prenatal workup that was done at another lab. On the other patient, their Rh type was not questioned until their Fetal Bleed Screen was performed and was macroscopically positive. Both were testing through IAT with the Quotient D blend and with the Ortho ABO/Rh gel card (manual method) and were found to be Rh positive. I feel like when we run into these patients with discrepant types, we are chasing our tails testing by 3 methods to confirm their Rh type and am wondering if there is a better way/process? What does your facility do for routine D testing? What about Du testing? We typically only perform Du testing on Rh negative babies born to Rh negative mothers and of course when an investigation is needed like the above situations. Any wisdom is great appreciated! TIA!
  3. In your hospital, do you give rhogam to weakly D positive mothers without differentiating whether the mother is weak D or partial D?
  4. What are other people's institutions practices on the following. If you have a patient with an anti-D do you need to go ahead and carry out the D antigen typing on the patients rbcs through the IAT phase(weak D testing)? The AABB 18TH ed. Technical Manual states on pg. 327 "When the D type of a patient is determined, a weak D test is not necessary except to assess the red cells of an infant whose mother is at risk of D immunization." It then goes on to say under Identification of Antibodies to Red Cell Antigens pg.401 "Determining the phenotype of the autologous red cells is an important part of antibody identification." We use MTS gel for as our primary method for blood type determination and it states that Most weak D antigen expressions will be detected(which means not all), however partial DVI epitope variant of the D antigen will not be detected with this monoclonal reagent. Not that it really changes how we transfuse the patient but just curious to others procedures/thoughts. Thanks in advance.
  5. Mother is O negative, baby is A negative. The DAT on the baby is positive, so the Weak D is inconclusive. According to the limitations of the FMH screen, if you have a weak d (which we don't know if it is or isn't because of the positive DAT) you must use a test to detect feto-maternal hemorrhage other than the screen. We send out a KB for this determination. However, the limitations also state that "in cases of ABO incompatibility between mother and child, the mother's natural ABO antibodies may destroy any fetal cells in the maternal blood specimen before testing is performed. This is true for any method of detecting fetal cells in the maternal blood." So my question is would you send this ABO incompatible specimen out for a KB or would you just issue the mother one vial of Rhogam and not worry about the KB since nothing may be detected? This was an uncomplicated vaginal delivery.
  6. We started using the Provue in 2013. Currently when testing prenatal and maternal patients to determine if a patient is a candidate for RhIg immune globulin or Rhogam, we perform tube and weak D testing. Considering the AABB Std that weak D testing is not required, we looked at dropping it all together (except cords and neonatal testing), The Provue ABD gel card package insert says it will detect nearly all forms of D antigen so we are considering using the Provue result exclusively. A quick survey of other labs with Provues in our area shows most are still using weak D testing to various degrees. If you use a Provue, did you drop weak D testing? Or do you only perform weak D if there is a +1 or +2 reaction in gel as some facilities are doing? thanks.
  7. I realize the topic of Rh-discrepancies has been oft-discussed on these forums but I wanted to get an idea of what kinds of different policies are out there. A recent incident has brought this issue to a higher level of attention and we are looking at revising our current policy but before we do so, we'd like to find out how many other institutions have adopted something similar so we could feel comfortable that we'd fall under the umbrella of 'Generally Accepted Practice Standard.' A prenatal patient was typed at an outside facility on a Galileo and found to be Rh-negative. When the patient came in to deliver they were considered Rh-positive on the Ortho ProVue (2+ reaction). We had no previous history on the patient so a second specimen was drawn and was also Rh-positive on the Ortho ProVue. (2+ reaction). Our current policy says for women of childbearing age perform tube testing when anti-D is 1+ on ProVue. If tube testing is negative report Rh negative and if any degree positive report Rh positive with a comment that RhIg is at physician's discretion. I don't think this is sufficient; I think we should look at 2+ gel reactions. I'm also concerned with the report of Rh-positive and a comment about RhIg administration. From a physician perspective, how do we know they are even seeing this comment to make the decision to administer RhIg? (the comments issue has been a long topic of debate through all sections of the laboratory, certain lab results show up in the EMR as SEE COMMENT specifically because of this) Partly based on recommendations from http://www.ncbi.nlm.nih.gov/pubmed/18067505. There are definitely problems associated with changing the policy; how do we handle patients who we have previously typed as Rh-positive, change their blood type? Is it inappropriate to get positive anti-D results but report Rh-negative, will the techs or physicians be confused? Are we wasting our time/energy on something that isn't really worth it? We're very curious to see how other institutions have handled this with the new anti-D reagents and testing platforms that are out there today.
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