Rhogam & Positive Antibody Screens

[sgtdmski]

When I was back in the Army and at Fort Sill, I was assigned as the Blood Bank NCOIC (noncommissioned officer in charge). We had several Rh negative women of child bearing age who would receive Rhogam. As part of our procedure we were required to do a Type and Screen on each of the OB patients when they were admitted. Often times the Rh negative mothers who had received Rhogam would have a positive antibody screen. We used to do a Little r panel on these patients. Little r was a second antibody screen panel. If this panel was negative we reported the antibody screen as negative and commented that patient had received Rhogam. I believed that we used either a Gamma (which is now immuncor) or an Orthro test kit for this.

Is anybody familiar with this procedure or product and does anyone use this in their Blood Bank???

I am currently a traveller and the last several labs I have worked at do not do this procedure and instead require a complete Antibody ID.

Thanks

Dave

[Lcsmrz]

Sgt Dave:

Thank you for your service to our country ...

The R Set (we call it a minipanel) is used to exclude all antibodies other than Anti-D. Ortho Panel A has 3-4 cells marked with an "@" in the righthand column that can be used for this purpose, although some sites just do a complete panel. It's at the discretion of the BB Supv and Medical Director.

We report it an "Anti-RhIg" with a comment that the identified Anti-D was consistent with a patient who recently received RhIg.

[geekay]

Thanks sir...

very informative...

we do a complete identification procedure though !

I am sure , it will definitely come handy to many !

best wishes ...

[sgtdmski]

Sgt Dave:

Thank you for your service to our country ...

The R Set (we call it a minipanel) is used to exclude all antibodies other than Anti-D. Ortho Panel A has 3-4 cells marked with an "@" in the righthand column that can be used for this purpose, although some sites just do a complete panel. It's at the discretion of the BB Supv and Medical Director.

We report it an "Anti-RhIg" with a comment that the identified Anti-D was consistent with a patient who recently received RhIg.

I appreciate the info on the Panel A. We use the Immuncor 20 cell panel and cells 11 - 13 are all negative for D. I was just hoping to find a little r set because we are transitioning to the 10 cell panel. I guess they just don't offer it anymore.

[csjuarez]

I believe that r-set was discontinued a few years ago -- we had been getting it at the lab I worked at in Saudi Arabia, but had to make changes when it was no longer available.

We currently are using gel, so also use the indicated (@) Rh-negative cells from the Ortho Panel A (or Ortho Panel C) in these cases rather than do a complete panel rule out.

I think, though, that the Immucor Panel-10 also has a set of 3-4 cells marked to use as an Rh negative screen/mini-panel.

[NedB]

When you know the Patient has gotten Rhogam is just like when you know the Patient previously tested Positve for some other identified antibody. Select cells to rule out all other significant alloantibodies, choosing as many homozgously expressed cells as possible. I choose not to use the cells Ortho designates with the symbol @ because that combination does not give me enough homozygous cells; but I can usually select four to five cells which cover all the others; so this becomes a super-screen. The homozygous K is always the challenge.

[irshadaad]

WE IN KING FAHAD ARMED FORCES HOSPITAL JEDDAH KSA........PERFORM A REGULAR DIAED 11 CELL PENAL ON FINDING ANTI -D WE ASK THE CONCERNED DOCTORS IF PT.HAD HISTORY OF RECIEVING PROPHELECTIC ANTI-D IF YES WE DONT GO ANY FURTHER...OTHERVISE we look for other antibodies or consider it anti-d and carry on titration

[galvania]

If you have access to DiaMed products, there is a minipanel called the ID Diascreen Prophylaxis, designed especially for this. It contains 6 cells, the first one is an R1R2, and there are 5 other cells, all D negative but which contain all the other important antigens

[TimOz]

Australia has an "RhD Neg screening subset" that is contained in the regular 11 cell Ab Identification panel we commonly use. On this panel the first 5 cells are RhD Neg and the next 3 cells form a "mini-panel" that has all of the clinically relevant antigens required and with the correct zygosities.

The bad news - it cannot be exported, so you can't have it, unless you are Australian.

[janet]

We too use the @ marked cells and report as "Pasiive Anti-D. RhIg given__date___".

Doesn't a full panel just confuse staff? The passive D's aren't very strong and rarely react with all D+ cells - someone not on 'the ball' could work all evening trying to figure things out!!!

[Mary**]

I agree wirh you. We do the same.

[David Saikin]

When we have an OB pt who has rec'd RhIg, we run a minipanel. We no longer get the Ortho A panel which basically had an r minipanel defined. Now I designate a group of cells from one of our current panels, which may be run to r/o other specificities. In these instances I am not concerned with anti-Kpa,-Jsa, or -Lua. Some of my techs still will run an entire panel, but it is not necessary for the antenatal RhIg recipient.

[Malcolm Needs ☆]

In the UK, the Guidelines state that, as long as it is known for certain that a pregnant lady has been given ant-D immunoglobulin, no further antibody testing is required after 28 weeks gestation (unless, of course, she has a fall or something).

Similarly though, if we are tracking an antibody, such as anti-c, through a pregnancy, we would only run a mini panel of 6 cells, including one known c+, with the other 5 covering all the other clinically significant antigens (including an R1Rz to cover the E antigen), and would only perform a full panel if the lady's plasma reacted with 1 or more of the 5 cell samples that we would expect to be negative. We would, of course, also quantify they anti-c.

[beverleyj]

This is how we report them. As long as they have received Rhogam in the past 3 months.

[BrianD]

our lab currently reflexively runs a complete ID panel tho' given our saturation (6 hospitals, and 20-somethin' clinics) we know who has been dosed with RhIg most of the time. the current argument is regarding reporting a positive ab screen. the ab screen in our procedure manual is "for the detection of unexpected antibodies directed against red cell antigens." those of us who are older would prefer to report the ab screen as negative since we expect the passively acquired ant-D to be there since we put it there in the first place. the younger folks just roll their eyes at us older folks as being unnecessarily nit-picky but complain loudest about the patient being forever disqualified from eligibility for electronic crossmatches and must have AHGXMs since the patient has a positive ab screen in the permanent record.

[Malcolm Needs ☆]

Hi BrianD,

Is there any way that you could put on the computer that the anti-D has been caused by prophylactic anti-D immunoglobulin, so that these ladies are not excluded from electronic issue in the future?

[BrianD]

Hi BrianD,

Is there any way that you could put on the computer that the anti-D has been caused by prophylactic anti-D immunoglobulin, so that these ladies are not excluded from electronic issue in the future?

i'd expect there is, M. but ***********************************************************************************

***********************************************. :explosion

oops, my frustrations with the IS types are showing.:pcproblem

Edited January 12, 2011 by BrianD
removal of extreme snark about IS

[Malcolm Needs ☆]

I know EXACTLY what you mean.

:angered::angered:

[John Hansen]

We report the screen as positive, do a mini or full panel (up to the technologist) and report that the anti-D is most likely due to RhoGam. I think this is to cover our butts if the anti-D was actually from mom. As far as the computer goes, we have a different result code for RhoGam anti-D, and we will deactivate the antibody as soon as we have a negative screen again.

[L106]

Hi BrianD,

Is there any way that you could put on the computer that the anti-D has been caused by prophylactic anti-D immunoglobulin, so that these ladies are not excluded from electronic issue in the future?

This is exactly what we do. We would report out "Passive Anti-D", and our computer can be programmed to lump it in with the "Not-Clinically-Significant" group.

[BrianD]

This is exactly what we do. We would report out "Passive Anti-D", and our computer can be programmed to lump it in with the "Not-Clinically-Significant" group.

i keep putting the capability to remove the lock out on electronic crossmatches for the patient once the passively acquired anti D (RhIg) titers down and the patient reverts back to a negative ab screen on my "quarterly wish list" but apparently revising the truth-tables is akin to redacting the Bible 'round here. one day.........