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RE: new BCSH guideline on the use of anti-D for the prevention of HDN


NAN47

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Hi all,

I have been reading over these new guidelines and am interested in people's thoughts on the following paragraph

There have been several cases in the UK where immune anti-D has been mistakenly assumed to be prophylactic without a validated method of measuring the strength of serological reaction or taking into account an accurate history (2010 SHOT Annual Report). It is important therefore that regardless of any prior administration of anti-D Ig, any anti-D detected at 28 weeks should be quantified and the results made available in the woman’s hand-held and hospital records.

At present we do not send patients sample away for quantitation if they have been recently given anti-D and presume that it is prophylactic anti-D that we are detecting, is this a common practice in other hospital blood banks?

Thanks

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Assumptions should NEVER be made on the strength of the reaction of the lady's plasma with D Positive red cells.

I have seen too many cases (and one is too many) where the lady's anti-D is really high in terms of IU/mL, but the strength of the reaction is actually quite weak, simply because the D antigens on the red cells are swamped by the amount of anti-D and the D antigens are blocked.

These Guidelines are designed to take into account such rare examples for the sake of the mother, father and baby/foetus, rather than to take into account the feelings of the Biomedical Scientist who may think that they can make such decisions on a misguided idea that they are experienced enough and will never make such a mistake.

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Thanks Malcolm, I completely agree that assumptions should never be made on such things and I will be sure to raise this issue, so basically what is being said is that if a positive antibody screen is detected at the 28 week screen for anti-D that this should be sent for quantification even if the patient has recently received Anti-D Ig for a sensitising event earlier in the pregnancy?

Thanks for your thoughts

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No, that isn't quite what I was trying to say. IF it is ABSOLUTELY certain that the lady has been given anti-D immunoglobulin prophylaxis AND the reactions are weak, then it can be accepted that the anti-D comes from that administration, BUT, if there is any doubt WHATSOEVER about the lady having had anti-D immunoglobulin prophylaxis, OR the reactions look too strong, then the anti-D should be sent in for quantification, just to be on the safe side.

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  • 2 years later...
On 15/02/2014 at 8:43 PM, NAN47 said:

Thanks Malcolm, I completely agree that assumptions should never be made on such things and I will be sure to raise this issue, so basically what is being said is that if a positive antibody screen is detected at the 28 week screen for anti-D that this should be sent for quantification even if the patient has recently received Anti-D Ig for a sensitising event earlier in the pregnancy?

Thanks for your thoughts

This is what I exactly understood. If antibody screen is positive at 28 weeks  and also if lady has sensitizing event prior to 28 weeks we always send sample to measure titre regardless of the strength of reaction. 

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