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We received Antenatal patient sample at 38 weeks gestation. Antibody screen was negative at 28 weeks ant patient blood group is A Rh D positive.  Now at 38 weeks patient Screening cell is positive with 2 lines(2+) therefore antibody identification was performed.  But panel shows negative with all 10 cell by IAT and papain.  My question is should we have to send sample to RCI for antibody conformation if blood is required for transfusion or we just can just provide ABO and D and Rh compatible blood IAT xmatch?

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Let me ask you a question, if I may?

How would you feel if the baby was born with clinically significant HDFN, and you didn't know the specificity of the maternal antibody, but the baby required an urgent exchange transfusion?  Not the mother, who I thing can be covered, but the baby?

Yes, you can probably give the mother IAT compatible blood, and it would be safe.  Always remember though, that maternal antibodies are actively transferred to their foetus, and so the concentration of the antibody in the foetus/new-born is higher than in the mother.

Send a sample to RCI PLEASE!

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Posted (edited)
2 hours ago, Malcolm Needs said:

Send a sample to RCI PLEASE

Thank you!!I just wanted to confirm.  

But guidelines suggest if maternal antibody develop after 28 weeks it wouldn't cause severe HDFN.

In this case I wasn't worried about baby but worried about mother. Panel was negative with both IAT and papain.  If we provide xmatch compatible blood to mother and IF mother  has transfusion reaction for some reason would we not be crucified? Because we haven't identified antibody.  Probably we wouldn't have leg to stand right? 

 

Edited by gagpinks
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13 hours ago, Ensis01 said:

If two of three screening cells positive at 2+ but panels are negative I would recheck everything 

Agreed. The initial results using the Screening Cells still need to be resolved. "Non-specific" probably won't be acceptable.

Please clarify - "Screening cell is positive with 2 lines(2+)". Does this mean that one, or two of the Screening Cells are reactive?

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15 hours ago, gagpinks said:

I am talking about non specific antibody.  

I agree that such an antibody formed late in pregnancy does not usually cause severe HDFN, BUT, you cannot state that it is a non-specific antibody.  It may well be an antibody directed against a low prevalence antigen that just happens, by coincidence, to be expressed on the screening cells, but not on the panel cells.  Once a person makes an antibody of such a specificity, they often make more than one specificity directed against more than one low prevalence antigen.  It could well be that such an antibody had been madee earlier in the pregnancy (or even an earlier pregnancy) and you may not be aware.

I agree with both Ensis01 and exlimey that more work needs to be done, just to be on the safe side.

By the way, I am aware of what the Guidelines say, having been one of the writers!

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This may seem like an odd question, but was the screen tested using a different method than the panel? 

I only ask this because there are some hospitals that run Antibody Screens using Gel then run the panels using Tube Testing. 

One cannot expect Gel vs Tube testing to give 'identical' results for several reasons.

Incubation Timing can also make a difference.

If only 1 cell in the Screen was positive and the entire panel was negative, I'd tend toward an Antibody to a Low Incidence Antigen.  But, this case had 2 positive screening cells, correct?

Other than sampling/dispensing error, I'm just trying to think of the reasons the Screen would not correlate with the panel.

 

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On 3/31/2022 at 6:49 AM, David Saikin said:

Could also be a low incidence or private ag that just happened to be on one of your screening cells.  We published a small paper in the mid-1980s on a private ag, which was discovered when the baby had a +DAT but mom's absc was negative.

I had an OB patient with an antibody to anti-Goa that we picked up on prenatal screening. One cell was positive on the screen and nothing showed up on 2 panels, Because it was an OB case, I sent it to the ref lab and they identified the culprit.

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