I was curious how other places are titering prenatal patients with multiple Rh antibodies (antiE,c or anti-e,C). I "thought" I had read somewhere that multiple Rh antibodies should be titered together for these prenatal patients to get a better indicator of how the baby might be affected. However, when I am trying to find the reference now, I can't find it.

Does anyone titer the Rh combo antibodies together or do you perform each Rh antibody titer separately?

I was curious how other places are titering prenatal patients with multiple Rh antibodies (antiE,c or anti-e,C). I "thought" I had read somewhere that multiple Rh antibodies should be titered together for these prenatal patients to get a better indicator of how the baby might be affected. However, when I am trying to find the reference now, I can't find it.

Does anyone titer the Rh combo antibodies together or do you perform each Rh antibody titer separately?

Just to be awkward (as ever, some would say!) the NHSBT is doing a study on this kind of thing at the moment (although only for anti-c, anti-E and anti-cE). We are titrating the anti-E (using an R1Rz cell) and the anti-cE (using an r"r cell).

In the UK, we do not titre anti-c, but rather perform quantitation by continuous flow, using rr red cells.

So, we are, for want of a better way of putting it, "titrating" the anti-c, the anti-E and the anti-cE.

There was/is a theory that anti-cE is "virulent" incausing HDN, than a mixture of monospecific anti-c and anti-E. I think I am right in saying that, although the study is not yet complete, there is no proof of the theory being correct.

I don't really suppose this answer helps you much, but that is what we are doing.

:)

We titer separately, assuming we can find appropriate cells to perform the titer against.

we titre each separatly

Might be worth doing both. I saw a case recently (woman is still pregnant and i don't know how the pregnancy's going) of an R2R2 lady with, it would seem, anti-C, anti-e and anti-Ce. Anti-C and anti-e titres 'alone' (against r'r' and rr) were 1:2 in Coombs; against an R1r cell it was 1:32. Don't know yet if it will be significant.

Might be worth doing both. I saw a case recently (woman is still pregnant and i don't know how the pregnancy's going) of an R2R2 lady with, it would seem, anti-C, anti-e and anti-Ce. Anti-C and anti-e titres 'alone' (against r'r' and rr) were 1:2 in Coombs; against an R1r cell it was 1:32. Don't know yet if it will be significant.

I'm prepared to bet somebody else's money that it will not be. Clinically-significant HDNF due to anti-Ce is exceptionally rare.

I would just ask though, if you are using r'r' and rr red cells, why the difference between r'r' and rr red cells and R1r red cells.

r'r' is "double dose" for both Ce and C. rr is "double dose" for e. R1r is "single dose" for Ce and C, but "double dose" for e.

To my mind (such as it is) something doesn't add up.

I've got man flu again, so I may not be thinking straight and have missed something.

:D

Edited December 2, 200915 yr by Malcolm Needs