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A pregnant lady in her first prenancy  develop Anti-Inb at that time her titre was 8.  As far as I know anti-Inb doesn't cause HDFN but  it can cause HTR. In her first prenancy  we kept ready 2 unit of  ABO ,D Rh and K matched compatible blood. No blood required in first prenancy. But now in her second pregnancy her titre gone upto 64 at 28 weeks .   If  blood required  , does she need to have Inb negative blood ? 

 

Edited by gagpinks

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21 minutes ago, gagpinks said:

A pregnant lady in her first prenancy  develop Anti-Inb at that time her titre was 8.  As far as I know anti-Inb doesn't cause HDFN but  it can cause HTR. In her first prenancy  we kept ready 2 unit of  ABO ,D Rh and K matched compatible blood. No blood required in first prenancy. But now in her second pregnancy her titre gone upto 64 at 28 weeks .   If  blood required  , does she need to have Inb negative blood ? 

 

She almost certainly does.  If, however, it is the same woman as I dealt with in her previous pregnancy, good luck!  The lady I am thinking of was something of a "wanderer", who was booked with about five different hospitals covered by NHSBT-Tooting Centre, and finally gave birth in another hospital completely, in the NHSBT-Colindale Centre catchment area!  It made for a fun life for us, as there were only two units of In(b-) blood in the national frozen blood bank at the time, and I would be simply amazed if there are any more than two now!

I would let the NHSBT know pretty quickly about this woman, if you have not already so done!!!!!!!!!!!!!

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When you say let NHSBT know you mean reference lab or frozen blood bank? Reference lab are already aware of this case.

I was checking history and found the email communications where it suggested in her last pregnancy  that if patient show 2+ or>2 reaction then  need Inb negative blood. Do you think this is why we didn't provide Inb neg blood in her first pregnancy? 

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1 hour ago, gagpinks said:

When you say let NHSBT know you mean reference lab or frozen blood bank? Reference lab are already aware of this case.

I was checking history and found the email communications where it suggested in her last pregnancy  that if patient show 2+ or>2 reaction then  need Inb negative blood. Do you think this is why we didn't provide Inb neg blood in her first pregnancy? 

Hi Gagpinks,

As long as the Reference Laboratory know that the lady is pregnant, have had a sample to ensure that she hasn't produced any other "surprise presents" (in the form of an additional antibody specificity or specificities (always fun when the patient already has an antibody for which it is nigh on impossible to find compatible blood) and know her EDD, that should be enough.  It is now up to the likes of the NHSBT RCI Consultant, with special reference to Dr Rekha Anand, who does such a fantastic job, to find either frozen units or, in the case of Rekha, "tame" donors to cover the labour.  Otherwise, it is down to the equally fantastic Dr Therese Callaghan to import said units from elsewhere in the world.  All of this will go on in the background, and I would suggest that the hospital, let alone the patient, will not know it is happening.

If it was the lady of whom I was thinking, the reason blood was not supplied was because 1) she didn't need blood and 2) because she went to a hospital who had no idea about her antibody specificity (thank goodness).  The two units at the NFBB were never defrosted.

How many weeks is she pregnant now?  Don't be surprised if the titre of the antibody falls during the pregnancy, as the baby's Inb antigen will be expressed on the apical surface of the placenta, and so will adsorb out some of the maternal antibody anyway.

Keep us informed, if you don't mind.  This should be an interesting case for virtually everyone on this site - it is VERY rare (worth putting in an HSD portfolio, for example!).

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7 minutes ago, gagpinks said:

She is 28 weeks now and titre is 64. 

I'm sorry gagpinks, you already told us that didn't you!  Time for me to go to the opticians again!

Well, that gives ample time for NHSBT to organise a couple of units for her (as long as she STAYS at one hospital!), and I wouldn't worry about her antibody titre (from the point-of-view of the baby).  The interesting thing is the original comment about the strength of the reaction (whether or not it was 2 plus or stronger) because 1) it depends on who is reading the result (too many variables between individuals) and 2) so what anyway ( Dombrock antibodies tend to be weak, but that doesn't mean that they are not clinically significant - far from it)!

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Lady is at low risk bleeding at delivery so plan is to transfuse ABO and D and Rh compatible in case of emergency with methylprednisolone or if she is stable but need blood than frozen unit can be obtained. 

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10 hours ago, gagpinks said:

Lady is at low risk bleeding at delivery so plan is to transfuse ABO and D and Rh compatible in case of emergency with methylprednisolone or if she is stable but need blood than frozen unit can be obtained. 

That sounds reasonable.

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18 minutes ago, gagpinks said:

After all these preparation patient delivered at home. Baby and Mum didn't need any blood.

Tee, he, he!  I am glad neither required blood, but I am prepared to bet that it is the same lady as we dealt with a couple of years back.  We followed her around about five or so hospitals in the Tooting area, until she gave birth in a sixth (or whatever) in the Colindale area.  Have a look on Hematos (NHSBT computer programme, for those that don't know), and see if it is the same one (but, obviously, do not post her name here).

Thank you for the update!

:haha::haha::haha::haha::haha:

Edited by Malcolm Needs
I missed out a bit!

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1 hour ago, Malcolm Needs said:

Tee, he, he!  I am glad neither required blood, but I am prepared to bet that it is the same lady as we dealt with a couple of years back.  We followed her around about five or so hospitals in the Tooting area, until she gave birth in a sixth (or whatever) in the Colindale area.  Have a look on Hematos (NHSBT computer programme, for those that don't know), and see if it is the same one (but, obviously, do not post her name here).

Thank you for the update!

:haha::haha::haha::haha::haha:

Yes it is same lady. Now this time she delivered at home☺

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Don't you just LOVE patients like this!  You do your very best for them.  You get the situation explained to them (in their native language in this case, as well as English).  Still, they put themselves (and their baby) in danger, and, possibly, in other circumstances, waste some incredibly rare units of blood, so that they are no longer available for others.

RANT OVER!

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11 minutes ago, gagpinks said:

And guess what now she also developed anti-c . It will be so difficult if she get pregnant again. 

OMG!  Well, at least we know the anti-Inb will not affect future pregnancies, but an anti-c could do so.  The good news is that, as far as I can remember, the UK units of In(b-) blood are R1R1; the bad news is that there are only a couple.

I suggest we start planning now!!!!!!!!!!!!!!!!!!!!!!!!

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RCI will have to prepare as well for quantification.  Can't imagine every two weeks after 28 weeks.  How would they perform quantification?  Will they absorb anti Inb and then perform quantification? 

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17 minutes ago, gagpinks said:

RCI will have to prepare as well for quantification.  Can't imagine every two weeks after 28 weeks.  How would they perform quantification?  Will they absorb anti Inb and then perform quantification? 

No problem at all gagpinks.  Anti-Inb is sensitive to proteolytic enzymes, and quantification uses enzyme-treated red cells, so the anti-Inb will not interfere with the anti-c levels.  Now take a deep breath and RELAX!!!!!!!!!!!!

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