How do you handle prenatal patients with anti-C and Anti-G.

[BBCLS]

We can not identify anti-G in our hospital. How do you handle prenatal samples. Do you always have it identified and titered?

[Malcolm Needs ☆]

We would expect to have samples like this submitted to our Reference Laboratory, but whether or not they are all submitted is anyone's guess!

[MikeB]

Some further questions:

 

1. How often are titers being performed and what cell(s) are selected?

 

2. Once Anti-G is identified, is the presence of Anti-D/Anti-C ruled out on each subsequent sample submitted (eg, samples for titers?)

[Malcolm Needs ☆]

1. From our point-of-view, titres are done for the first sample, and then at 28 weeks gestation IF the 28 week titre is less than 32. If the titre is 32 or greater, we will also titre at 34 weeks gestation.

2. Yes, unless we are told that anti-D immunoglobulin prophylaxis has been administered (although we are much more concerned about maternal anti-D than about maternal anti-C). If there is an anti-D present, we would suggest that the pregnancy is monitored by MCA Doppler/ultrasound, as finding D+, G- red cells is so difficult that we would have to titre/quantify using D+, G+ red cells, and that would almost certainly give a falsely high result for one or the other.

[vk008]

When someone is found at booking to have anti-C+D which is later confirmed to actually be anti-C and anti-G, the patient would be in line to receive Anti-D prophylaxis. Ideally (!) the repeat sample at 28/40 would be taken before administration of prophylaxis. Do the RCI reports recommend determining the RhD type of the partner (where possible) in case there is a bleed in the meantime to prevent having to do the extra testing if Anti-D is later detected?

[Malcolm Needs ☆]

We certainly do at my Reference Laboratory.