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Positive Cord DAT, RH= mom, Allo-D and Rhogam


JJSPLAYHOUSE
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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?

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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. 

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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.

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  • 2 weeks later...

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?

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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.

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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.   :coffeecup:

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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).

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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.   :coffeecup:

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.

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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.

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