preparation of maternal blood

[esther]

I have anti-kell antibodies (as well as anti Le and anti cw), which has previously caused severe hemolytic trouble. I have been strongly advised by the pediatrician to give blood in case of need. my previous baby had an exchange transfusion. I am not able to get cooperation from my local blood banks. They claim that there is the danger of GVH, which I believe not to be a problem now days, they promise me that there will definitely be maching blood, and they are right, however it seems to be preferable to give maternal blood in any case.

My questions are:

1) Is it really importants to give a newborn maternal blood?

2) How does one go about it when the blood banks are not interested in the idea?

any advice on the matter would be appreciated.

thanks

Esther

[Malcolm Needs ☆]

I have anti-kell antibodies (as well as anti Le and anti cw), which has previously caused severe hemolytic trouble. I have been strongly advised by the pediatrician to give blood in case of need. my previous baby had an exchange transfusion. I am not able to get cooperation from my local blood banks. They claim that there is the danger of GVH, which I believe not to be a problem now days, they promise me that there will definitely be maching blood, and they are right, however it seems to be preferable to give maternal blood in any case.

My questions are:

1) Is it really importants to give a newborn maternal blood?

2) How does one go about it when the blood banks are not interested in the idea?

any advice on the matter would be appreciated.

thanks

Esther

Hi Esther,

My own thoughts are that one would only use maternal blood for transfusion of a baby in extremis, when no other suitable blood is available. The danger of GvHD is a very real and present danger that can only be mitigated by irradiation of that blood.

If your antibodies are anti-Cw, anti-K and anti-Lea, the chances are that the problem antibody of the three is the anti-K, but Cw-, K-, Le(a-) blood from unrelated donors would be readily available, and I would choose this blood ahead of maternal blood every time.

Whilst your own red cells would be compatible (assuming that you are the same, or have a compatible ABO blood group as your baby, which is not necessarily the case) your blood would also have to be washed free of the "offending" antibodies in the plasma, prior to irradiation, and the more manipulation of the unit, however careful one can be, the more chance that there is of bacterial contamination.

The answers to your two questions, in my opinion are, therefore:

1. It is important to avoid giving your baby maternal blood, unless there is no alternative,

and

2. I think that you would be wise to accept the advice of the Blood Bank that is not interested.

[esther]

Thank you so much for your prompt reply.

I am aware of the irradiation which is why I though the GVH is not a problem, I was also told by the pediatrician about the washing. However, I was not aware of the bacterial contamination.

I'm extremely grateful for this information, since I was concerned about not giving my own blood.

With many thanks,

Esther

[Malcolm Needs ☆]

My pleasure.

The risk of bacterial contamination is, I must admit, extremely low, but it is, nevertheless a risk, and one that can be illiminated by using donor blood.

[L106]

Esther,

I think Malcolm has given you good advice. I would like to add that it is important that you communicate what you have told us to personnel in the Blood Bank/Transfusion Service Department of the hospital where you plan to deliver your baby. In case they are not already aware of your history, it would be very helpful (and a time-saver) if they have this information and your expected delivery date on file.

Donna

[jcdayaz]

Esther,

Please do not rely on the advice of your pediatrician in this case. It is most assuredly NOT wise for you to donate blood for your baby.

Consider this...if your baby does have an "issue" due to your antibodies, you don't want to potentially introduce more of those same antibodies into the baby's system. Yes, washing removes almost all of the plasma from a unit of blood--ALMOST being the key term here. Also, it is not standard practice for any Blood Bank I have ever worked in to wash cells. Now it is left to the reference labs--you are looking a huge time delay there. It is most certainly better to have your baby transfused with donor blood that is negative for the antigens that you have antibodies to.

[esther]

does this all mean that I cannot donate blood in general, or is it only a problem for my babies?

[esther]

thanks for your feedback. very much apprecaited.

I had been in touch with the head of the blood bank in my hospital before the previous birth, all they said was that there is the danger of the GVH, and they promise me there will be suitable blood available.

[esther]

thank you very much for your feedback. the main reasurance is that I'm doing the best for my baby. I'm much more reassured about not preparing blood.

[Malcolm Needs ☆]

does this all mean that I cannot donate blood in general, or is it only a problem for my babies?

The rules are quite complicated and differ from country to country.

If you are living the USA, as I think, this is probably best answered by one of the members of BBT from the USA. If I answered, I would be using the UK rules, and they will not apply.

[esther]

Thank you.

I shall try look into it locally.

[bbbirder]

Esther,

In the US you should still be able to be a blood donor for general use, your plasma (containing the antibodies) won't be used, but your red cells are fine. Check with your local blood center.

I would agree with all of the others that regular donor blood would be preferred for your baby (antigen matched would be readily available, no washing needed.)

Is your doctor following your anti-K titer?

[esther]

if washing is sufficient as a donor, why is it not sufficient for my baby?

my doctor is following the titer, however, it never seems accurate to indicate the real level. this I was told, is because the titer my lab gives is really meant for the antibodies of the Rh neg. blood issue.

thanks for your reply, it is very much apprecaited.

[Malcolm Needs ☆]

if washing is sufficient as a donor, why is it not sufficient for my baby?

my doctor is following the titer, however, it never seems accurate to indicate the real level. this I was told, is because the titer my lab gives is really meant for the antibodies of the Rh neg. blood issue.

thanks for your reply, it is very much apprecaited.

Washing a donor's red cells free of plasma (and, incidentally, most white cells and platelets) is not quite the same thing I'm afraid Esther.

Most donor's plasma will not contain (what are termed) atypical antibodies (in this case, your anti-Cw, anti-Lea and anti-K), but will only contain ABO antibodies (typical isoantibodies). We can wash the red cells free of most of the plasma, but not all (which is why we give ABO identical blood in as many cases as possible).

Your anti-K is probably high titre, if one of your earlier pregnancies resulted in a baby that had problems due to your antibodies. This means that if some of the plasma is left (even in a diluted form) it may still contain at least a residual amount of the antibody. Even this residual amount of antibody may (but not necessarily will) harm your baby.

It is really not worth taking the risk.

I'm sorry about the use of "technical jargon", but after a few years in the job, it becomes difficult to explain it in plain English!

:)

[esther]

thanks for your reply. It is quite clear even with all the technical language.

as regards giving ABO identical blood, my previous baby was given O+ while he (and I) are B+, could that be bacause B+ is not common enough or because my antibodies make the match harder to find?

[Malcolm Needs ☆]

Yes and no!

Certainly in the UK, any blood that is given to a newborn baby is group O (but it has been tested to make sure that the ABO isoantibodies are NOT strong) and this probably applies in the USA as well.

The reason for this is that the blood is usually required fairly urgently after the birth, and so there is not much time to "organise" an ABO identical donor (we have to have some on the shelf ready to go at all times). Group O blood can be given to almost everybody in the world, apart from incredibly rare people who have the Oh type (and I do mean incredibly rare).

The other thing is that, until the baby is born, we have little to no idea of the baby's ABO group, and under such circumstances, group O is the safest by far.

Although there is no doubt that group B individuals are rarer than either group O or group A (but commoner than group AB) there are plenty of group B people in the population who are Cw-, Le(a-) and K-.

[esther]

thank you so much for the information, it makes the whole picture much clearer.

it is reasuring to know that the hospital gave preferred blood and not just inferior blood out of desperation.

your feedback is very much apprecaited.

[Malcolm Needs ☆]

It's an absolute pleasure.

I often think that we are guilty of not fully explaining things to the patients.

[Kip Kuttner]

Esther,

If you are in the US, perhaps you could have any additional questions answered by speaking with the medical director at your local community blood bank. Most always, he or she will take some time to discuss this issue with you. It is not uncommon for me to receive calls like this, and I have a bit more time than many of the hospital blood bank doctors and technologists. Malcolm Needs has done a great job with his explanations though.