JJSPLAYHOUSE Posted October 23, 2019 Share Posted October 23, 2019 Hi! I had a positive cord DAT. The mom had a hx of allo-D, couldn't be completely ruled out in the past and has not been tested recently, BUT she also received rhogam recently. Is it necessary to perform an elution? In this case, wouldn't it be redundant? I was wondering what you guys normally do. I performed, and charged for the elution anyway, but they only treat via bilirubin levels. What your thoughts? Link to comment Share on other sites More sharing options...
David Saikin Posted October 23, 2019 Share Posted October 23, 2019 1 hour ago, JJSPLAYHOUSE said: The mom had a hx of allo-D, couldn't be completely ruled out in the past How do you know it was alloanti-D if it was not ruled out? If she had a history of alloanti-D why did she receive RhIg? Anti-D tends to stay around for quite a while, in my experience. Are you sure you weren't detecting residual RhIg initially? To do or not do elution - you should follow your policy. Carrie Easley 1 Link to comment Share on other sites More sharing options...
JJSPLAYHOUSE Posted October 23, 2019 Author Share Posted October 23, 2019 I wondered the same thing, but the allo-D was added back in 2016 and this is the first time we've seen her since then. I would've thought it was rhogam as well but I don't think they could track a rhogam injection during that time and that's the reason for calling the ABID allo-D instead of passive. Link to comment Share on other sites More sharing options...
John C. Staley Posted October 24, 2019 Share Posted October 24, 2019 Can you give us anymore info on what was going on in 2016? Also, what level of prenatal care had she received, if any? Link to comment Share on other sites More sharing options...
JJSPLAYHOUSE Posted November 4, 2019 Author Share Posted November 4, 2019 We don't have to much information from the 2016 registration, but the current pregnancy had consistent prenatal care. All we know from the pregnancy in 2016 is that the antibody screen was positive with a anti-D pattern but no record of rhogam given. Link to comment Share on other sites More sharing options...
John C. Staley Posted November 5, 2019 Share Posted November 5, 2019 Did the "consistent prenatal care" include an antibody screen at some point?? I've seen anti-D drop below detectable levels but not that quickly and not in a young person. If this pregnancy had a negative antibody screen I would question the results from 2016. Link to comment Share on other sites More sharing options...
JJSPLAYHOUSE Posted November 5, 2019 Author Share Posted November 5, 2019 No, there was not an antibody screen done during prenatal care, typically they only order the screens during delivery. Most OBs order ABS for first time rhogam recipients during prenatal care. This looks like the third pregnancy. She's been in the ER a couple of times. But I don't understand why she's getting rhogam if allo-D has been present since after the first pregnancy. Will it still be needed? Link to comment Share on other sites More sharing options...
JJSPLAYHOUSE Posted November 5, 2019 Author Share Posted November 5, 2019 55 minutes ago, John C. Staley said: Did the "consistent prenatal care" include an antibody screen at some point?? I've seen anti-D drop below detectable levels but not that quickly and not in a young person. If this pregnancy had a negative antibody screen I would question the results from 2016. I actually just found out that she had a negative ABS on 5/24/16, fetal screen bleed of 45 mL and one rhogam shot was injected. Next ABS was 6/23/16 where Allo-D was entered because it could not be ruled out. Link to comment Share on other sites More sharing options...
John C. Staley Posted November 6, 2019 Share Posted November 6, 2019 On 11/5/2019 at 8:33 AM, JJSPLAYHOUSE said: I actually just found out that she had a negative ABS on 5/24/16, fetal screen bleed of 45 mL and one rhogam shot was injected. Next ABS was 6/23/16 where Allo-D was entered because it could not be ruled out. Based on on of this I would be inclined to believe she never had an allo anti-D. I am tempted to climb on my soap box and spout a heated diatribe on the prenatal practice but I think I'll skip that this time. JJSPLAYHOUSE and David Saikin 2 Link to comment Share on other sites More sharing options...
David Saikin Posted November 7, 2019 Share Posted November 7, 2019 I have to agree w John on this based on results you state. It seems she should have received at least 3 RhIg doses after that delivery. RhIg dose covers 30mL whole blood bleed, so there is the need for 2 doses. In my experience we always give +1. Doesn't sound like very good prenatal care especially if you have documented anti-D in the past (and not due to RhIg). JJSPLAYHOUSE 1 Link to comment Share on other sites More sharing options...
JJSPLAYHOUSE Posted November 11, 2019 Author Share Posted November 11, 2019 On 11/6/2019 at 11:56 AM, John C. Staley said: Based on on of this I would be inclined to believe she never had an allo anti-D. I am tempted to climb on my soap box and spout a heated diatribe on the prenatal practice but I think I'll skip that this time. I completely agree! I spoke with the physician to see if we can get her redrawn during one of her check ups to clear some of this chaos. Thank you soo much for your help. Link to comment Share on other sites More sharing options...
JJSPLAYHOUSE Posted November 11, 2019 Author Share Posted November 11, 2019 On 11/7/2019 at 9:38 AM, David Saikin said: I have to agree w John on this based on results you state. It seems she should have received at least 3 RhIg doses after that delivery. RhIg dose covers 30mL whole blood bleed, so there is the need for 2 doses. In my experience we always give +1. Doesn't sound like very good prenatal care especially if you have documented anti-D in the past (and not due to RhIg). Exactly! Prenatal care has always, and probably will always, be insufficient. Thanks for your help. Link to comment Share on other sites More sharing options...
Mabel Adams Posted November 12, 2019 Share Posted November 12, 2019 To the elution question: if the results of the test will never alter the patient's treatment, it is hard to justify having the policy to always do the test, even if the results are academically interesting to understand causes and what is really going on. John C. Staley and AMcCord 2 Link to comment Share on other sites More sharing options...
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