This is a cost cutting question. I would like to approach my pathologist about allowing us to report out Presumptive Passive Anti D on L&D patients that have the cells on our 3 cell panel reacting on the D+ cells. We have hundreds of panels a year on patients who deliver w/o needing blood & have a documented HX of prenatal RHIG. Has anyone out there tried this scenario and if yes, what were the stipulations?

:cries:We don't usually identify it. If we can establish that the patient has received prenatal RHIG, we just run the 3-4 Rh Negative cells on the panel that are designated with an @ and result these cells as negative and report the antibody screen as negative. We also enter a patient comment about it in the computer. No one is really interested in passive anti-D and it takes too many man hours to identify it.

This discussion has come up a couple of times in the past. You may want to look through the archives and see if you can find them.

Prior to my coming to my current Institution, that is exactly what they did; they made the assumption. Sorry, I am old school; I will not assume anything. And if you run the abbreviated Passive D Panel (designated on antigrams), it certainly does not take that long. I believe in my 4 years here, we did have 1 person who had something other than just Passive D.

Also, when you are talking about an antibody that can hit 2 of the 3 screening cells (I say can because I have certainly seen many instances where the Antibody Screen is Negative, and/or only 1 of the cells, ususually the R2R2 is Positive), that does not leave much room for noticing anything else (only leaves 1 cell). My biggest reason for promoting doing it is this; if you don't and you miss the early formation of a new alloantibody in this pregnant woman such that it affects future pregnancies, seems to me there may be some liability issues there (not saying there are; just a thought I have). But even if no liability, I would not feel I was doing my best "service" for this patient to not follow-up on any potential antibody that could affect future pregnancies.

At the first place I worked, there was a woman who had an abortion her first pregnancy. She made Anti-K at that time. At the time I left, she had had about 7 miscarriages due to the antibody (her husband was K homozygous). So who is to say that when you obtain 2+ reactions on Screening Cells I and II on an Rh Negative woman who received Rhogam, that there is not something new underneath? So it becomes a game of statistics then; what are the "chances" they made something new. I personally would not want to take any chance with a woman's potential to have future pregnancies. But that is just where I am coming from....

Brenda Hutson, CLS(ASCP)SBB

This is a cost cutting question. I would like to approach my pathologist about allowing us to report out Presumptive Passive Anti D on L&D patients that have the cells on our 3 cell panel reacting on the D+ cells. We have hundreds of panels a year on patients who deliver w/o needing blood & have a documented HX of prenatal RHIG. Has anyone out there tried this scenario and if yes, what were the stipulations?

I am with Brenda on this one. Don't assume anything.

Don't do antibody screens unless there is a good reason to, then do at least the mini-panel others have mentioned rather than assume something.

We do just like Mary with the stipulation that we have "documented evidence" of RhoGam administration. We call L&D and get the date and enter that on our manual abid workup.

We result it as "passive Anti-D due to RhoGam administration". We have a ProVue and we just run the whole panel on the pt but refer to the cells with the @ on therm.

Probably doesn't save us much $$ since we do the whole panel but once we know it's RhoGam we don't worry about an indepth antibody ID.

Ah, so perhaps this brings up the need for clarification then on what one means by "identification." We also do as you (run the cells designated by @). But in a "less than perfect" way, I am considering that a form (albeit modified) of antibody identification (or at least, elimination of other explanations). Those cells do not rule out all major alloantibodies in with the same criteria we rule them out for non-Rhogam patients. Rather it is kind of a "quick and dirty" way to make some attempt to feel more comfortable in stating (concluding) the antibody is just Passive D. But of course, if one of those cells comes up positive (which has happened to us), we would then proceed with a full panel.

Brenda Hutson

:cries:We don't usually identify it. If we can establish that the patient has received prenatal RHIG, we just run the 3-4 Rh Negative cells on the panel that are designated with an @ and result these cells as negative and report the antibody screen as negative. We also enter a patient comment about it in the computer. No one is really interested in passive anti-D and it takes too many man hours to identify it.

The cells marked with @ on the Ortho panel do not always have double-dose expression of the antigens like the screen cells do. I find this a drawback because if I am going to use them as an antibody screen, I want the same sensitivity as my regular screen.

We do the same as Mary and Brenda.

Correct; that is what I meant in saying it is not ruling things out using the same criteria one would normally use. So I see this as a "happy medium" between doing nothing (just assuming it is Passive D), and "some sort of screen" for other alloantibodies. I guess it is a game of statistics and it depends on how comfortable each Institution is with various assumptions.

Brenda Hutson

The cells marked with @ on the Ortho panel do not always have double-dose expression of the antigens like the screen cells do. I find this a drawback because if I am going to use them as an antibody screen, I want the same sensitivity as my regular screen.