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comment_78704

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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  • John C. Staley
    John C. Staley

    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 t

  • Mabel Adams
    Mabel Adams

    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 intere

  • David Saikin
    David Saikin

    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 sur

comment_78709
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. 

  • Author
comment_78710

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.

comment_78713

Can you give us anymore info on what was going on in 2016?  Also, what level of prenatal care had she received, if any?  :coffeecup:

  • 2 weeks later...
  • Author
comment_78816

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.

comment_78828

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.

  • Author
comment_78830

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?

  • Author
comment_78831
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.

comment_78844
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:

comment_78859

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).

  • Author
comment_78890
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.

  • Author
comment_78892
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.

comment_78907

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.

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