HDFN transfusion

[Yanxia]

We have encountered a case. The infant just 3 days old, her blood result is DAT pos ,elution shows anti-D, her serum no anti-D. We want to transfuse her with D pos cells, beacause in China D neg cells is rare. I don't know wether this is safe or not.

[Malcolm Needs ☆]

I would say that it is dangerous.

By definition, the anti-D must be maternal and, therefore, IgG. Much of the IgG will be extra vascular, and so will move in and out of the circulation. That which is in the circulation will, mostly, be on the baby's red cells (although this is a dynamic situation, because the anti-D will be continually associating with and dissociating from the red cells, as the reaction between antibody and antigen follows the Law of Mass Action).

If, and when you transfused D+ red cells, they will be coated with the maternal anti-D (either extra-vascular or that which dissociates from the baby's own red cells) and will be removed from the circulation by the reticulo-endothelium system. These red cells will break down and add to the pool of bilirubin in the baby's circulation, and make the baby more jaundiced.

:(:(

[Malcolm Needs ☆]

Continuation of my last post...

The point is, shily, whilst I realise that D Negative blood is extremely rare in China (whilst I was in China on a lecture tour in 2005, I was told D Negative donors join together in clubs because they are so rare - about 0.09% of the population, as I understand it), when D Negative blood is required, D Negative blood must be used, however rare it may be.

It is no use having D Negative donors if you do not use them when necessary.

[Yanxia]

Thank you,Malcolm. D neg blood in China about 0.3% of the population. The rate is higher in ethnic people( not han )

[Malcolm Needs ☆]

Thank you,Malcolm. D neg blood in China about 0.3% of the population. The rate is higher in ethnic people( not han )

Thanks shily.

A higher percentage than I thought, but I see that you are still not "swimming" in the stuff!

[SMW]

Depending on the ABO types of Mom and baby, you may want to consider the use of the maternal blood for the exchange. But if an exchange transfusion is required and D-negative blood is not available, it would be acceptable to use D-positive blood rather than delay the exchange. At this point it is the bilirubin that is the greatest risk to the neonate. This is analogous to other scenarios when the Mom has an IgG antibody to a high-incidence antigen and antigen-negative units are not (readily) available and "incompatible" units are used. Remember the purpose of an exchange is three-fold: to remove bilirubin, to remove potential biliburin (in the form of antibody coated cells) and then to provide cells which will have “normal†survival. Even with “incompatible†cells you will still be removing bilirubin and potential bilirubin in addition to some of the passive antibody. You may have to perform additional exchanges to keep the bilirubin below dangerous levels but this process will also remove the passive antibody to the point that the D-positive cells will survive normally and will no longer be contributing to the bilirubin load. Please let us know how things work out!

[Malcolm Needs ☆]

Yes, in extremis I would agree with this.

[Yanxia]

The infant transfused with D neg cells, and she is oK. Thanks! I can learn lot of things in this forum, but because English is not my mother language, there is some pherase I can't understand exactly , I will study and be better.

[Malcolm Needs ☆]

The infant transfused with D neg cells, and she is oK. Thanks! I can learn lot of things in this forum, but because English is not my mother language, there is some pherase I can't understand exactly , I will study and be better.

My goodness Yanxia, I certainly wouldn't worry about your English! I should be ashamed of the fact that I can speak no other language than English (and often people tell me that I am not much good at speaking that!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!).

:D