SRTECH Posted August 29, 2011 Share Posted August 29, 2011 Patient had a Type and Screen(TS) done in June 2011 by A Reference Lab. ABSC was negative, ABORH=AB negative. Patient given RhIG on 8/10 by Doctor's office. TS done on by us on 8/26 gave 4+ reactions in gel for both screen cells. Titer was 1:32, Fetal Screen was negative on 8/28. Per AABB Technical manual 17th edition "Administration of RhIG during pregnancy may produce a positive antibody screen in the mother, but the titer is rarely greater than 4."Is this Anti-D or Passively Acquired D?Thanks for your anticipated response! Link to comment Share on other sites More sharing options...
John C. Staley Posted August 29, 2011 Share Posted August 29, 2011 No way of knowing for the next few months. The RhIG anti-D will go away in a few months, maybe up to 6 months. If the patient developed her own anti-D it will still be there well past 6 months. Link to comment Share on other sites More sharing options...
David Saikin Posted August 29, 2011 Share Posted August 29, 2011 Do you use gel? Titer will be greater in gel vs tube. When I am in doubt I recommend repeat TS 3-4 months after last dose of RhIg. Link to comment Share on other sites More sharing options...
SRTECH Posted August 29, 2011 Author Share Posted August 29, 2011 Thanks you David and John for your responses.Titer was done in Tube. I did reccommend that the patient be given postpartum RhIG andI will also reccommend that a TS be repeated in the future (3-6 months).Thanks a million! Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted August 30, 2011 Share Posted August 30, 2011 How much anti-D immunoglobulin do you give?A titre of 32 sounds high to me. Link to comment Share on other sites More sharing options...
John C. Staley Posted August 30, 2011 Share Posted August 30, 2011 Malcolm, the other question should also be, did you do a saline titer or was some form of enhancement involved? Enhancement will, of course, inflate the titer value rendering it useless for this discussion. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted August 30, 2011 Share Posted August 30, 2011 Very true John. Link to comment Share on other sites More sharing options...
SRTECH Posted August 31, 2011 Author Share Posted August 31, 2011 (edited) 300 ug of RhIG was given. We always perform saline titers. We have never used enhancementfor any of our titers. (well I haven't and hopefully the MT who performed the titer did not since we do not have a SOP for this ) :disbelief Edited August 31, 2011 by SRTECH incomplete post Link to comment Share on other sites More sharing options...
Eagle Eye Posted August 31, 2011 Share Posted August 31, 2011 Even 4+ reaction in gel is kind of strong for RHIG. Sometime we get a specimen after giving full dose of RhIg (very next day) and I haven't seen reaction stronger than 2+ (rarely 3+) in gel. This may be allo anti-D, considering titer of 32 or may be patient developed allo anti-D and RHiG was given so titer is elevated... Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted August 31, 2011 Share Posted August 31, 2011 Even 4+ reaction in gel is kind of strong for RHIG. Sometime we get a specimen after giving full dose of RhIg (very next day) and I haven't seen reaction stronger than 2+ (rarely 3+) in gel. This may be allo anti-D, considering titer of 32 or may be patient developed allo anti-D and RHiG was given so titer is elevated...I totally agree. Link to comment Share on other sites More sharing options...
Shelby56 Posted August 31, 2011 Share Posted August 31, 2011 Hi all-I have a related question but not titers- do you perform AHG crossmatching for these patients if need transfusion until anti-D no longer present (if passive)? We have a big debate here about that.... Link to comment Share on other sites More sharing options...
jbrun Posted September 1, 2011 Share Posted September 1, 2011 (edited) We have a doc who's been notorious for giving RhIG a couple weeks prior to patient's due date and subsequent delivery. We have encountered 4+ rxns (tube) in these folks with previous negative ab screens. However we have never titered them out and attributed the reactivity to the RhIg. We have seen some of the same patients again at a later time with negative ab screens, so from our experience I'd say it is possible. I can not give you specific numbers though, just my recollections.And in answer to your question Shelby56, we indeed perform AHG crossmatchs. Edited September 1, 2011 by jbrun Link to comment Share on other sites More sharing options...
adiescast Posted September 2, 2011 Share Posted September 2, 2011 Several years ago I noted an increase in the strength of RhIg tested post injection. I wondered at the time if the RhIg formulation had been changed, but I was never able to confirm that. We see stronger reactions, higher titers, and longer half life than we used to see.This all occurred without a change in our techniques.To Shelby56: we do AHG crossmatches on any patient with a passively acquired antibody until the antibody is no longer detectable. Link to comment Share on other sites More sharing options...
dcubed Posted September 7, 2011 Share Posted September 7, 2011 I wonder if patient got more than 1 injection of Rhig? You did the right thing by giving a dose of Rhig postpartum. When in doubt, give the Rhig. Link to comment Share on other sites More sharing options...
Mabel Adams Posted September 17, 2011 Share Posted September 17, 2011 I wonder how high a titer could get if they gave more than one dose of RhIG over a few weeks. It does seem suspicious for allo anti-D. Link to comment Share on other sites More sharing options...
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