Anti-D due to Rhig

[lef5501]

Does anyone have a computer code for "Anti-D due to Rhig" or do you just use your regular Anti-D code? I know of a few hospitals that differentiate between the two, but I'm not sure I want to be the one responsible for saying if that D is definitely due to Rhig or not. We have been getting quite a few Anti-D's on C/S samples, post delivery samples, etc where we know the woman received rhogam recently, but I'm not sure I want my people to be responsible for putting in a result that will go to a patient's chart that says that the Anti-D is due to Rhig. Just wondering what other facilities are resulting, or if it even matters, since the docs give the post delivery rhogam anyway. (whether the D is present or not)

[donellda]

We have a code for anti-D due to Rhogam. We usually check our computer to see if the patient had a recent injection of Rhogam at our facility or we call the floor to check with the patient. The code is set up so that it does not go into the patients antigen/antibody file but it stays as a permanent comment in the patients blood bank administrative data file until we remove it.

[David Saikin]

We use an "anti-D due to RhIg" code in our BB Computer. We result this as anti-D, possibly due to RhIg administration on _ _ _ and also recommend a repeat antibody screen in 8 -10 weeks in order to differentiate passive vs active immunity.

[Melanie]

We enter the ABS as "pos" with a comment that states:

"Passive Anti-D due to Rhogam"

This is used for patient's who receive Winrho or rhogam. There is no official antibody identification entered in the file.

[Patty]

We ask for a midterm RHIG history on OB patients that develop Anti-D. If RHIG is administered in past 2 months we suggest that the Anti-D may be passive. If the patient later returns for a crossmatch we would be required to do the AHG Xmatch vs the Immediate spin due to the anitibody history even if the screen is currently neg. As time goes on we will have allot of these patients who will eventually come back for surgies/anemias. How can I present this to my pathologist so we can go back to Immediate Spin crossmatches on these patients? Wouldn't the Anti-D still be there if it was a true Anti-D? Does the titer of Anti-D ever drop below detection if it was antigen stimulated? We would give Rh neg blood to them anyway based on their blood type except for extreme circumstances.

[Olivia]

We report Passive Anti-D due to Rhogam administration, and we have a separate computer code for that.

[John C. Staley]

We tend to waffle a little. Our code is RHD and it results: Anti-D most likely due to recent RhIG injection.

We used to be more definitative and say that it was due to the RhIG but we had one OB doc come unhinged over that. She said there was no way we could be certain that the anti-D was due to the RhIG and after giving it some thought I was forced to agree.

[GilTphoto]

We also use different codes for passive and immune anti-D. If you have records of RhIG being given, and the anti-D reacts weakly (< 2+) in IAT only, we call it passively aquired anti-D. BUT, if it reacts at IS or 37C, or 3+ - 4+, then we titer it. If the titer is greater than 1:4, we call it immune anti-D. Passive anti-D rarely titers greater than 1:4.

[CABMT]

We also use a separate computer code for passive vs apparent alloimmune anti-D. For patients that return years later with a negative antibody screen (and negative prior to the RhIG injection), we remove the antibody from their history caution window, thereby allowing us to do an electronic crossmatch. We would always give Rh negative blood anyway except in a dire emergency.

[Lady_Jeni]

We very rarely saw reactions due to RhoGam injections in the tubes, unless it was given within the past couple of weeks. When we switched to using the gel system for antibody screens and identifications, we started picking up more RhoGam. We have a separate code for passive anti-D that is entered into the patient history. If we have no history of RhoGam injection, we call the doctor to see if the patient received RhoGam somewhere else (we have a lot of hospital hoppers), and then call that hospital BB to confirm. If we can confirm that RhoGam was given, we use the passive anti-D code and footnote when and where RhoGam was issued. In cases where we can get no confirmation of RhoGam injection, we call it anti-D.

[macarton]

We use the Rh negative cells indicated by Ortho on their panel C if we have an Rh negative OB in L&D for doing admission T&S since we had so much trouble with the gel method picking up the shots. I have a test profile built in Meditech that L&D will order for any Rh negative Moms. There is a canned comment that it was not screened for D on the report. If the infant has a positive DAT then we do an elution as part of our HDN workup.

[bevydawn]

We have two separate anti-D's in our LIS. One is just a regular anti-D for those that have a true antibody and then we have "anti-D with Rhogam" which the doctors can translate to the patient has an anti-D but they have also received Rhogam. This way we are not calling it a true anti-D nor are we saying definitively that it is due to the Rhogam. We then require a footnote to be added documenting when the last vial of rhogam was administered. Once the anti-D is no longer demonstrating, the "anti-D with Rhogam" will allow us to treat this patient as a negative history and allow electronic crossmatch. The plain old response of anti-D will not allow that for those which are true antibodies.

[Liz0316]

We use a code that translates to "weak anti D due to residual RhIg"

There are 2 "tricks" you can use to determine if the anti D is due to RhIg or if you are seeing an active, immune D.

First - RhIg is IgG anti D. Therefore if you run a panel at all phases, the RhIg will only be demonstrable at the AHG phase. A developing or immune anti D will (or should) be demonstrable at 37, if not IS.

Second - passive anti D will not titer as high as an immune response. A low titer is indicative of a passively acquired antibody, a higher titer is most likely an immune response.

Now, I realize these are crude methods, but this info, along with patient history should solve your dilemma.