saralm88 Posted August 31, 2017 Share Posted August 31, 2017 Hi everyone! I hope everyone had a nice summer! I have a confusing scenario going on. I have a mom who received 2 doses of Rhogam (one for spotting and the other at 28 weeks) and upon delivery, I am picking up a strong Anti-D on the baby's cells and I did a titer on mom and it is 1:512. Anyone ever experience something like this before? I deal with a lot of Rhogam and this is a first for me . Thanks! Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted August 31, 2017 Share Posted August 31, 2017 I think that, without doubt, this is an immune anti-D that has been produced by the mother. Anti-D immunoglobulin (Rhogam), even several doses, would never reach a titre of 512. I would keep a very close eye on that baby! Carrie Easley, exlimey and galvania 3 Link to comment Share on other sites More sharing options...
saralm88 Posted August 31, 2017 Author Share Posted August 31, 2017 Thank you Malcolm! We have done an exchange on the baby but now I am completely confused - one of my seasoned techs just did a quick few D+ cells on mom and she is getting barely weak reactivity. Needless to say - a redraw is happening. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted August 31, 2017 Share Posted August 31, 2017 I wouldn't expect to see many D Positive red cells in the mother's circulation. Any such red cells can only have come from the baby, and these would have been sensitized by the maternal anti-D and immediately removed from the maternal circulation by her own reticuo-endothelium system. It is very likely that the mother was sensitized to produce an immune anti-D by a foeto-maternal haemmorhage quite early in her pregnancy for this baby to be so badly affected, possibly with a chronic FMH further into the pregnancy. Link to comment Share on other sites More sharing options...
richj Posted August 31, 2017 Share Posted August 31, 2017 I think saralm88 is saying that the Mom's plasma vs D+ cells is barely reactive. Where is the high titer Anti-D? Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted September 1, 2017 Share Posted September 1, 2017 12 hours ago, richj said: I think saralm88 is saying that the Mom's plasma vs D+ cells is barely reactive. Where is the high titer Anti-D? Oh, sorry, I misunderstood. An anti-D with a titre of 512 is pretty high (not the highest I have ever seen, by any means, but pretty high. An anti-D with a titre of 512 is quite capable of forming blocking, by swamping the D antigen sites on the red cells, even with the use of AHG. This could be the answer (it may not be, but it could be). Link to comment Share on other sites More sharing options...
galvania Posted September 1, 2017 Share Posted September 1, 2017 There is clearly a problem here. If you did a titre on a D+ cell and it was 512 then the antibody should be coming up quite strongly positive against ALL D+ cells unless...... 1. this is not an anti-D but another antibody and you were just lucky that you hit the spot when you did the titre (or maybe a weak anti-D + an anti-LFA) 2. Technical error during the titre 3. technical error during the 'quick few D+ cells on mum 4. Mum has been plasmapheresed inbetween you doing the titre and the 'quick few D+ cells 5. The titre is actually now higher than 512 and you are seeing a prozone effect I suggest you re-test the cell you used for the titre, plus do a panel - and look for anti-LFA exlimey, Yanxia and Malcolm Needs 3 Link to comment Share on other sites More sharing options...
Candybar Posted August 12, 2019 Share Posted August 12, 2019 On 8/31/2017 at 8:03 AM, saralm88 said: Thank you Malcolm! We have done an exchange on the baby but now I am completely confused - one of my seasoned techs just did a quick few D+ cells on mom and she is getting barely weak reactivity. Needless to say - a redraw is happening. Could it also be that because the baby has been delivered that the Anti-D crossed the placenta and has coated the baby's RBCs? This might cause a decrease in reactions if there is not the same amount of antibody to detect?!? Link to comment Share on other sites More sharing options...
R1R2 Posted August 12, 2019 Share Posted August 12, 2019 (edited) I posted a stupid question and then deleted it. I answered my own question...... Edited August 12, 2019 by R1R2 Link to comment Share on other sites More sharing options...
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