Hi everyone!!

Has anyone ever had experience with ob patients and warm autoantibodies? Especially ones with specificity to the Rh family? If so, do you mind sharing what you did or your case?

Any experiences are welcome!!

Thanks!

Sara

The accepted rule of thumb is that if it is not causing hemolysis in the mom it probably won't in the baby. Was that your concern?

Hi Sara,

We have seen many, many cases and, Mabel is absolutely correct (as usual) when she says that, unless there is haemolysis in the mother, there will not be HDFN. Even then, the cases of HDFN in the literature are very few and far between.

Don't worry about the apparent Rh specificity. The vast majority of auto-antibodies have a specificity that appears to be against a C, c, D, E or e antigen (usually E or e, occasionally D, rarely C or c), but, if you perform more sensitive testing, the actual specificity is usually something like anti-Rh17, anti-Rh18 or anti-LW, and we all (well, nearly all - not Rhnull individuals, of course) express these antigens, and yet clinically significant AIHA, with frank haemolysis is rare.

Thank you to both of you for your insight!! THe patient has a Hgb of 10 and is holding steady so we are monitoring her and the baby and keeping an eye on the strength of the reactions .

Thanks again for all the help

Hi Sara,

We have seen many, many cases and, Mabel is absolutely correct (as usual) when she says that, unless there is haemolysis in the mother, there will not be HDFN. Even then, the cases of HDFN in the literature are very few and far between.

Don't worry about the apparent Rh specificity. The vast majority of auto-antibodies have a specificity that appears to be against a C, c, D, E or e antigen (usually E or e, occasionally D, rarely C or c), but, if you perform more sensitive testing, the actual specificity is usually something like anti-Rh17, anti-Rh18 or anti-LW, and we all (well, nearly all - not Rhnull individuals, of course) express these antigens, and yet clinically significant AIHA, with frank haemolysis is rare.

Strangely, or coincidentally, we've had two of these type of pregnant patients in to the laboratory in the last two days!

They come in bunches!

A retic count could help determine if she is frantically making RBCs to be able to maintain a hgb of 10. A high LDH or bilirubin or a low haptoglobin could also suggest hemolysis.