This is my first post after reading this site forever!

If the baby needs blood, what would I give?

If you can get it, r'r'. Good luck

My post was not suitable

Edited September 22, 201113 yr by John Eggington
Out right incorrect post by me!

I'll try again! What's the Rh pehenotype of baby and mother (and father, if you have it)?

Does the baby have a positive DAT?

I think there is a fair chance that the baby is dCe/dce John.

Mum must be c-. Dad must be c+.

I agree with Anna that you need r'r' blood (probably K- too).

It should be fairly easy to get from a frozen blood bank (although not, necessarily, from your usual supplier) or, if your blood supplier is on the ball, from known donors so that the blood is fresh.

Thanks to everyone for your responses. Malcolm is right with the babys phenotype. Here's the whole story. An O neg baby was born to a mother who had a 4+ anti-c (little). Amazingly, the baby's antibody screen was negative with a negative DAT so my scenerio thankfully is hypothetical.

If we had to give this baby blood in an emergency, I dont think I would have the time to have one thawed. Best case of course would be a fresh r'r' unit from my supplier, which they do not have. What would be the product of choice in an emergency? I thought an O Pos, little c negative crossmatch compatible with the mother unit would be a better choice than an incompatible O negative, little c positive unit.

I have not read the package insert on Rhogam in some time, but I'm pretty sure it's not recommended for a newborn. Has anyone ever given rhogam to a newborn? Would you even need one because the babies immune system isn't yet developed and most likely wouldn't develop the anti-D?

We have a case like this once. The child (a girl) needed a exchange transfusion. After intnce discusion the option of a large exchange with ccdee blood was chosen. During that exchange most of the antibodies (from the plasma, not the tissue) was removed. No big dip in Hb was seen after that.

The option of CCdee was not chosen because of the time needed for defrosting and washing (to remove the freezing fluid). The option of CCDee was not chosen because of the fear of anti D formation in this girl.

ackkap "I have not read the package insert on Rhogam in some time, but I'm pretty sure it's not recommended for a newborn. Has anyone ever given rhogam to a newborn? Would you even need one because the babies immune system isn't yet developed and most likely wouldn't develop the anti-D?"

I hope you are not thinking of giving D positive blood and give anti D to prevent anti D formation. In that case you have to give quite some Rhogam and the effect of it is that the D+ cells will be removed. Time for another transfusion.

Peter

So, we've got the hypothetical, familial, Rh phenotypes but what were/are the actual phenotypes?

In our case they were;

Mother CCDdee

Father ccddee

Child Ccddee

given that the baby was actually OK and its DAT was negative (I think I understood that to be the case) is it possible that the mother's ant-c had only just been formed and was still IgM. Otherwise I don't understand why the baby was OK

given that the baby was actually OK and its DAT was negative (I think I understood that to be the case) is it possible that the mother's ant-c had only just been formed and was still IgM. Otherwise I don't understand why the baby was OK

I see from where you are coming Anna, but it could just be that the maternal anti-c was so weak (well below 7.5 IU/mL), and that was why it was not affected - BUT, this does nto explain the negative DAT. IgM could well be the answer (as you say).

Let's remember that this is a "hypothetical" case. i can't imagine a 4+ anti-c in the Mother with the baby's DAT being negative (c+ baby). I also think these "hypothetical" cases should be documented UP FRONT. While they are nice brain teasers, we all spend time trying to figure out the "whys" of these events - literature searches, calls to mentors, etc). Be fair to us when it's not "real world".

Thanks for letting me vent on this.

[ATTACH]553[/ATTACH]

This is a real Case Study that I recently gave at the 2011 IBMS Congress.

See if you get the answer before the last slide (and mark yourself, if you like).

Be honest with yourselves, as there are no goodies to be given out if you do get it, and no nasties to be given out if you don't!

It is just for a bit of fun.

:handshake:handshake:handshake:handshake:handshake

Alas, I was close, but no cigar!

Donna

Well, to be honest Donna, I didn't think it was going to be what it was until after I got the results of the newborn (but before I sent it to the IBGRL for confirmation), so you are not alone!

David, I think the 'hypothetical' part that ackkap was referring to was the potential need for transfusion, not the entire case. Seems that ackkap and the baby had good luck on their side!

Malcolm, very interesting case - and I certainly did not think that would be the answer. Thanks for sharing. It's cases like these that keep us on our toes and make our field so interesting!

[ATTACH]553[/ATTACH]

This is a real Case Study that I recently gave at the 2011 IBMS Congress.

See if you get the answer before the last slide (and mark yourself, if you like).

Be honest with yourselves, as there are no goodies to be given out if you do get it, and no nasties to be given out if you don't!

It is just for a bit of fun.

:handshake:handshake:handshake:handshake:handshake

Great case Malcolm,

I always use this one when I am teaching. I use an R1R1 mother and an R2R2 father with an R2R2 child. But I have to admid that I am a little envious because I have never seen one in real live. And as you can see in my nicname, this is a case I would have loved to find.

Peter

Sorry Peter. I didn't mean to boast, but it was perfect for the Congress, and more than a bit of a surprise to me. I could have sworn that it was going to be something wierd on the "D front", as it were, and never dreamed that it would be an amorphic null phenotype.

It was simply a case of me being in the right place at the right time.