We currently have a 50 year old male in house that had an accident that damaged his foot 3 weeks ago. He arrived septic and has had to have an amputation.
His ABO/Rh gives a B pos with a 4+ anti-D. His gel screen and panel give 1+ results that match up with an anti-D (all others rules out). His autocontrol was positive at 1+ by IgG, neg for compliment. The eluate results matched the original antibody ID. Presently this patient's specimen is on its way to our reference lab. Previous history at another facility lists him as B Pos, screen negative. As far as we know, he has never been transfused.
What are the possibilities (for what appears to be an D auto antibody), and how should he be treated?
I was wondering if antibody titre is performed on a pregnant mother who previously had HDFN. According to the books, it mentions 'After the first affected pregnancy, the antibody titer is no longer useful'. Therefore does it mean that it doesn't matter what the antibody titre level is, and should be referred to fetal medicine specialist regardless? Or if there is more to this, I would be grateful for some enlightenment
I'm trying to find out the similarities and differences around the world (but particularly in Europe) for guidelines related to measuring fetomaternal haemorrhages and issue of anti-D.
I'm particularly interested in which countries issue anti-D and don't estimate the FMH, what formulas countries use for calculating doses, what tests different countries use, whether the FMH is measured in whole blood or packed cells, whether different countries use the 1.22 muiltiplier to account for the different sizes of red cells... Not a small list I know.
I've found a few international guidelines already so here are some useful links
UK guidelines for all Transfusion related things are here http://www.b-s-h.org.uk/guidelines/
Irish guideline on the use of Anti-D http://www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/antidprevrhd.pdf
Australian guideline on the use of anti-D https://www.ranzcog.edu.au/RANZCOG_SITE/media/DOCMAN-ARCHIVE/Guidelines for the use of Rh(D) Immunoglobulin (Anti-D) (C-Obs 6) Review November 2015.pdf
Australia/New Zealand guideline on measurement of FMH https://www.anzsbt.org.au/data/documents/guidlines/ANZSBTguide_Nov02a.pdf
Canadian guideline on the use of anti-D https://sogc.org/wp-content/uploads/2013/01/133E-CPG-September2003.pdf
Please add links to this forum
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.
How long does RHIG really persist? The package insert says one thing, but with Rh-loving methods such as solid phase, I feel like I see RHIG hang around a lot longer. I think this has implication for pregnant mothers who have suffered from trauma or miscarriage prior to their current pregnancy. Thoughts?