Hi Everyone,

I am giving a presentation on Haemolytic disease of the newborn - i will be presenting a case study in which i was involved, which looks at when the management of pregnant ladies with antibodies goes wrong. ie my patient case involved a woman with an anti-D being induced during the out of hours service on a sunday afternoon when no blood provision had been put in place for the baby -who had a hb of around 60 at birth, trying to illustrate how communication is vital in the management of pregnant woman with antibodies. I was wondering if any of you guys out there have any interesting experiences of patient cases where something has went wrong due to lack of communication etc surrounding patients with maternal antibodies which i could incorporate into my presentation.

Many Thanks

Patricia Bradley:)

Rarely a woman will come in to deliver who either has had no prenatal work done or is not local so no prenatal studies are available . . . and she will be sensitized. Depending on how fast she delivers we may or may not have completed the ab screen or id. Most of the time the sensitized infant does not need immediate transfusion support - but sometimes they do. I can't give you any particulars. An interesting case was one where one of our per diem BB techs (who was a BB supv at another hospital) was the father of a child with a positive DAT - mother's ab screen was negative. Turned out to be an antibody directed against a private ag from the father. This was written up in TRANSFUSION in the mid-1980's as a letter. You might be able to find the article but it was too long ago for me to have an accurate date.

Good luck - good topic - - - I think you meant the baby's hct was 60, not the hgb.

Win N, Amess P, NeedsM, Hewitt PE. Use of red cellspreserved in extended storage media for exchange transfusion in anti-khaemolytic disease of the newborn. Transfusion Medicine 2005; 15: 157-160.

This one ended happily, but it was touch and go for a while.

Thanks guys for that info - will have a look at those articles, any other scenarios will also be gratefully received.

Thanks

Tricia:)

Sorry folks, I had a HDN story that I posted but after seeing it here I decided that it might not be suitable for a public forum and removed it.

Edited January 24, 201312 yr by Dr. Pepper
second thoughts

Good luck - good topic - - - I think you meant the baby's hct was 60, not the hgb.

I just assumed she was talking about hgb in g/L ?

Oh dear - I think there's a problem with the last post. I can't read it

I have stories of babies born to moms with antibodies that no one seemed like they were going to order a DAT until a blood banker called and checked on it (even though there was a policy at the time to do one on all babies of O or Rh neg moms). Ever since those days, I try to keep these ladies on my radar and help everyone be ready. When you are out in the boonies and these things don't come up all that often it is a good drill even if baby turns out to be fine.

We had a case last year where the mom had a crazy collection of anti-D,C,G and was Rh pos. I got a call at home one evening from a neonatologist saying he had this garbled message about an antibody from this lady's OB Dr. that the baby was likely to have HDFN but the OB couldn't articulate what the antibody was clearly. I had her on my list to keep tabs on but lost track of what month it was so hadn't realized she was already ready to deliver. Since the neonatologist called the blood bank, he got some information that he felt better with--although with that patient we really had no idea how things would go. Since then, I put tasks in Outlook for moms with high enough titers that they could be a problem early and email the neonatologists when the time gets close (no, you can't do that in a 2000 bed children's hospital). The last two I emailed about together; they had heard about one that was in the hospital for bed rest but didn't know the other was out there getting US every week. We had a blood exchange "drill" last week for as much of our staff as we could gather since no one has done the procedure in 15 years. I don't like coming from behind on these things even though they mostly turn out fine.

I did have a patient once with anti-c that in testing the parents I realized the baby could be Rh neg (fairly long shot--Mom was R1r') and she was! I had plans in place for finding blood for that baby but she got better with just bili lights so we didn't have to do it. Nobody is happy if you mess up on a baby.