Help- Rh(null)

[globe]

A 23- y old pregnant female has positive Antiglublin test

,Auto control is negative ,direct antigloblin test is negative

blood Group is A negative Du:negative, her Rh phenotype

showing Rh(null){E,C,c,e=negative} .The Antibody Identification test performed on Diamed Classic Id-Gel

station as well as through Immucor Kit through conventional tube method all the pannel cells showing (4+) positive reaction ,Is that Anti-Rh29 antibody?

or the else? What should I do to Identify as well,as Physician ordered the "Titration" test also. Pls Help

[David Saikin]

You will have to send this to a reference facility. We had an anti-Rh17, same type of antibody scenario, except not pregnant BUT needed transfusion. You could probably titer this but with what cell/cells I am not certain. Better off sending it away. If the newborn needs a transfusion, you should have made prearrangements - probably have to get blood from rare donor file (which means it will only be good for 24 hours) unless you can find a compatible (Rh null) donor . . . GOOD LUCK - you don't want to follow this patient, she should be going to a major center.

[Marilyn Plett]

I agree. A reference lab should identify your antibody. But even a reference lab may not be able to supply a donor. Test ALL family members. If you're lucky, one will be compatible. The mom may be able to donate autologous blood which can be frozen. We had a pregnant mom with anti-Rh17. The obstetrician was able to perform 6-8 intrauterine transfusions with maternal blood only. He gave mom iron, EPO, and folate to stimulate RBC production. The obstetrician specialized in high-risk pregnancies. Your patient definitely needs a specialist.

[Yanxia]

I am not sure what kind of test we should do to identify the antibody. I just want to say my idea. First ,we should do absorb and elute test with anti-D,anti-E,anti-C,anti-c, anti-e to identify the cell have not those antigens. The next we should use Rhnull and cell to test the serum of the patient to identify it just don't react with this kind of Rh cells.

[dalene]

Hi, I see you are located in Pakistan. Those of us working outside North America and Europe have no easy access to reference labs to assist us. Since you are using DiaMed, speak to your DiaMed rep, he should be able to send a sample to Switzerland for testing. If you have access to BGRL in London, UK they can also work up the sample for you. Good luck.

[marilynm]

You might see what the Rh type is of the father of the baby, and if he is ABO compatible with the mother you could perform a titration using his cells. Just a suggestion. Save some of the sample to compare with the next one, if she is not ready to deliver yet. She should be managed by a physician familiar with high risk pregancies.

Marilyn Plett certainly had good suggestions for getting family (siblings) tested and the mother to donate.

Marilynm