Post rhogam Anti-D

[Antrita]

We have a new maternal hemorrhage protocol. Included in this protocol is a type and screen on any patient with a previous c-section. Of course we are now finding Anti-D on everyone that had Rhogam during their pregnancy. This is not making us very happy. Our policy is to automatically set-up 2 units of blood. Also, once a patient has a positive antibody screen, there history is marked and we always do an AHG crossmatch on their units even if the antibody screen is now negative. I have 2 questions,

1. We use gel and there is a modified antibody ID for patients you know have an anti-D. Does anyone use this?

2. We would like to remove this antibody from their history if they return with a negative antibody screen. does anyone do this?

Thanks

Antrita

[clmergen]

1. The one hospital in our system doing gel does do the modified Gel panel for patients with Anti-D.

2. We footnote the AB as being due to Rh Immune Globulin and then ignore it in the future. Previous place I worked at gave it its own AB name (which I can't remember) so that it could be ignored. I think our current procedure even says that if Anti-D is due to Rh Immune Globulin then we do Immediate Spin crossmatches.

[JOANBALONE]

Perhaps you can result this antibody as clinically insignificant. This may allow you to do immediate spin or electronic crossmatch. I would only consider this antibody clinically insignificant if the patient's history includes recent RhIG administration.

[swede]

We result these antibodies as "probably passive anti-D" and comment with the date of the last Rhogam injection. We still use the electronic crossmatch since the antibody is not clinically significant.

[knittie5]

we label ours passive anti D, and deactivate the ab after the ab screen is negative.

[mprandealr]

Where we have evidence of the patient receiving prophylactic anti-D and is the likely cause of the positive antibody screen, we will rule out all other clinically signisficant antibodies using a short panel.

We record the reults as psoitive antibody screen; Anti-D from prophylaxis.

Whilst the patient is demonstarting a positve antibody screen due to the Anti-D from prophylaxis we will crossmatch if necesary.

When the patient no longer exhibits a positive antibody screen the patient reverts to electonically suitable, if other criteria are met for electronic issue or computer crossmatch.

We have a new maternal hemorrhage protocol. Included in this protocol is a type and screen on any patient with a previous c-section. Of course we are now finding Anti-D on everyone that had Rhogam during their pregnancy. This is not making us very happy. Our policy is to automatically set-up 2 units of blood. Also, once a patient has a positive antibody screen, there history is marked and we always do an AHG crossmatch on their units even if the antibody screen is now negative. I have 2 questions,

1. We use gel and there is a modified antibody ID for patients you know have an anti-D. Does anyone use this?

2. We would like to remove this antibody from their history if they return with a negative antibody screen. does anyone do this?

Thanks

Antrita

[richardsonj]

First, I just want to tell you that I feel your pain! Our OB department recently adopted a new policy to do a TS on EVERY OB admission so we too are seeing all kinds of Anti-D. We too set up 2 units of blood on these patients for delivery. We result the antibody as Anti-D and put in history that it is probably due to Rhogam given on (date). When the screen is negative in the future, we then just treat the patient as if they always had a negative screen. We also use gel, but do not do the D-modified protocol.

[adiescast]

We have a separate antibody code for anti-D due to RhIg injection. It is treated as not clinically significant and does not require antigen matched Coombs crossmatched blood and does not trigger our requirement for 2 units to be crossmatched at delivery. We do not remove the designation from the patient's permanent file.

[macarton]

We are a gel user and do T&S on every OB on admission. We use the panel cells indicated for screening, usually 5,6,7 & sometimes 8 to do our screening. The Labor Room has an order set that orders it in our LIS. We have a disclaimer comment that it's not checked for Rhogam D. If the infant has a positive DAT, we work up to make sure Mom doesn't have a real D. Mary

[Antrita]

Thank you everyone,

This will give my pathologist his pick of how he wants to address this problem. With all the changes that have been going on in my department, I don't know what I would do without all of your help.

Antrita

[adiescast]

I forgot to mention that the patient has to have a negative screen this pregnancy and documented injection of RhIg to have their antibody designated as Anti-D due to RhIg. If we have the negative screen and a claim of injection with no date, or no history and documented injection, we designate the antibody as "possibly due to RhIg" and monitor it.

Edited September 17, 2009 by adiescast
spelling, of course!

[lhawth]

We primarily do gel but also have tube tesing as a backup/alternate method. When a patient is known to have received RhIg recently, we automatically set up what we call the "r set" from the tube panel or do manual gel on the "r set" of the gel. (These cells are denoted on the panels with the @ symbol. and constitute a screening cell set that detects antibodies other than anti-D). If anti-D known be passive from RhIg is detected on the routine screens, we enter the results of the r set as negative and treat the passive anti-D as insignificant. The entry of the comment "r set" negative makes it clear to all that passive anti-D was detectable. No units are set up and if transfusion is ordered we only do immediate spin.

Hope this info is helpful...

[BankerGirl]

I have also struggled with what to do with anti-D results on nearly all of our Rh neg moms since changing to gel. One suggestion I received was to do the antibody screens in tube so we do not detect the antibodies in the first place, but I have been loath to do this, as this may be perceived as inconsistent (using a less sensitive method selectively). However, we have also been getting several positive screens (with non-OB patients) that we waste hours working up, only to find that they do not identify anything in gel, and are negative using our tube panels. In these cases we report the tube results, so isn't this sort of the same end result?

My questions to you experienced gel users are as follows:

1. Has anyone used this type of selective method for different patient populations?

2. If so, what have your inspectors said about it?

3. For those of you who have said you use a different code for anti-D due to RhIG, have you had any feedback from inspectors? I really would prefer not to perform AHG crossmatches on every pregnant Rh negative patient!:cries:

[mprandealr]

My answer to your questions to are as follows:

1. We use 3 cell screens on ALL antibody screens.

Positive screens are identified as;

No history; Full ID panel and identification: discuss with midwives for evidence of rANP. Without writeen evidence then is identified as anti-D and satys agianst that patient.

Recent prophylactic anti-D history; O rr 2 cell screen

On our computer system we still leave the original result as positive antibody screen and then add the comment on the report as; Result consistent with rANP anti-D

2. Our MHRA inspectors have been ok with this.

3 We perform IAT IgG crossmatches on pregnant Rh negative patient where the anti-D is still detected as per BCSH guidlines. If no longer detected we electoically issue Rh Neg, K Neg

[macarton]

We use the ortho panel cells 5-8 for doing our ABS on labor room admissions (we do a T&S on all admitted). We have a order set only for L&D that they can order this test on Rh negative OB's. We use the gel for it and have a disclaimer that it was not tested for Anti D. If the newborn has a positive DAT, then we do an elution on he cord. We have used the gel method since 1995 and have not had an issue during CAP or JC inspections.