Hi, I have a question that has been covered in the forums about antibodies in pregnancy but I just wanted a little clarification. I have tested positive to anti e and anti cw at the 8 week blood test. This is my third pregnancy with the same father but it is the first time I have tested positive to these antibodies. My husband has tested negative in his screen and blood group test. Does this mean that there is now no risk to my baby? The Dr mentioned that I would still be high risk so am a little confused and would need monitoring but he did mention this wasn't his area. Any information/ knowledge will be greatly appreciated.

Kelly

Dear Kelly

It sounds as though what has happened is that when you gave birth the second time (presuming you have not had any blood transfusions) some of the baby's red cells got into your circulation, and it was these that stimualted the antibodies that you mentioned.  What is relevant in your husband's test is not his antibody screen (there is no reason why that should be positive), nor his blood group.  What is important to know is what is his Rh phenotype.  That will look something like this:  CCD.ee.  If he has 2 'little e' then the baby has to be e+, so could be affected by your antibody.  If he has 1 little e and 1 big E (Ee), then the baby has a 50% chance of being little e + - so also a 50% chance of NOT being little e +.  BUT - even if the baby IS e+, and your antibody does affect him, it should not do very much harm.  But, to be on the safe side, you will be monitored much more closely for any signs of anaemia or distress in the foetus, and your levels of antibody will be monitored too.  This means more visits and more blood samples, but this is important as this information will allow the clinicians to react very quickly at the slightest sign that anything is wrong.  As for the anti-Cw, this is almost always unimportant - but it will be monitored too.

I hope this helps a bit and that you can enjoy your pregnancy.  Please do let us know of any further developments.

Best wishes

anna

Hi Kelly.  First question:  Have you ever been transfused?  Second:  Please confirm that the father of this pregnancy tested negative for the antigens  for e and Cw.  This can be quite confusing especially when the one trying to explain it mentioned "this wasn't his area".  If the father of the current pregnancy truly is negative for these antigens, then, in my experience you have little to be concerned about during this pregnancy as far as the antibodies causing problems for the baby.  My curiosity, at this time, is towards the source of you antibodies.  The general rule is that to produce these antibodies you need to be exposed to blood containing the antigens.  The two most common ways for this to occur is either transfusion or pregnancy.  Of course there are exceptions to every general rule and at this point trying to cover those exceptions would probably only increase your confusion.

 

Good luck with this pregnancy.  Hope all goes well.

As a note, there's also a difference between "E" and "e" when it comes to antibodies.

Hi Kelly,

 

Anna, John and goodchild are all quite correct, but, in a way, goodchild is the most correct of the three!

 

The problem is that we, in the world of blood transfusion, may well be experts in what we do, but are amongst the worst in the world for naming the antigens and antibodies with which we work.  It actually does make a huge difference as to whether we are talking about a "lower case e" or an "upper case E), and the only cw antigen is actually an "upper case C" and a "lower case w".  What I can say is that all of these antigens were named many years ago, so the mix up is not the fault of anyone who writes on this website!!!!!!!!!!!!!!

 

If you could clarify whether you have an anti-E or an anti-e, that would be great, but, that having been said, neither antibody is renowned for causing any big problems in pregnancy, and neither is anti-Cw.

 

Sorry to be so pedantic, but the correct name of the antibody really is important.

Thank you for the quick responses and information. Anti capital E and husband tested negative to the antigens (I think they are called but dr called them antibodies). I am A+ and husband is o+. No blood transitions. Thanks again, much appreciated

In that case Kelly, there is even less to worry about.

 

If your husband does not carry the RHE gene, he cannot pass it on to your baby, and so the baby will not express the E antigen.  If there is no E antigen present on the baby's red cells, your own anti-E cannot "attack" the baby's red cells.

 

Both anti-E and anti-Cw can be, what is termed "naturally occurring".  By this, we mean that they can be stimulated by something other than exposure to red cells by either transfusion or pregnancy.  Of course, in reality, they cannot be "naturally occurring", and must have been stimulated by something, but the stimulus is most probably something like a bacterium, many or which carry proteins and sugars on their surface that mimic humanblood group antigens closely enough to stimulate the immune system to produce antibodies against these proteins and sugars, but these antibodies are almost always clinically insignificant, and nothing whatsoever to worry about.

 

Have a great pregnancy and enjoy your new baby when he/she arrives into the big wide world!

Update: thanks again because of everyone's help we enquired further and the wrong test was done so ier are in the. process of getting the right test. What an amazing site and dedicated members that provide a wonderful backup for people to double check their situation. Thanks again!

Dear Kelly

Well, when you have the results of the right test, please do feel free to come back to us.

We'll do what we can.

Best wishes

anna

Hi again, my husband tested positive to the anti Cw and anti E antigens and I have been getting monthly blood tests. The results have been very positive and the titres are as low as can be detected and less than 1. They haven't risen throughout the pregnancy. I just received the latest results and it said "antibody non reactive by iat". Just wondering what this could mean for me. Can antibodies be low one day and higher the next? I am yet to find a dr who can fully explain these results or antibodies and this site has been invaluable. Any information would be greatly appreciated!

Thank you

Kelly

Hi Kelly,

 

I am delighted to say that there is nothing to worry about.

 

IAT stands for indirect antiglobulin test, which is one of the tests we use to detect antibodies.  It is a very sensitive test.

 

If your antibody (or antibodies) can no longer be detected by this technique, it means that they are very weak indeed, and will have no effect whatsoever on your unborn baby.

Thanks so much! I wanted to be excited/relieved by the new result but I just wasn't sure if it was likely to change from month to month. Would further testing/ monitoring be necessary after a result like this?

In the UK, we wouldn't test such antibodies after 28 weeks gestation.

 

I do not know what the situation is in the USA.

Thanks so much! I wanted to be excited/relieved by the new result but I just wasn't sure if it was likely to change from month to month. Would further testing/ monitoring be necessary after a result like this?

Probably not.  When your baby is born they will take some of the blood in the cord and test the baby for a Direct Coombs test just to make sure there are no issues.  But as Malcolm said...your worries are over!    Congrats to you!

Thanks again. I am in australia so it will be interesting to see what the dr says.

I have a couple of people working in my own laboratory who are Australian.  I will ask them if their routine is different from that in the UK and get back to you.

According to the Guidelines for Blood Grouping and Antibody Screening in the Antenatal and Perinatal Setting of the Australian and New Zealand Society of Blood Transfusion Limited and The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (3rd edition, March 2007), once an anti-E is detected in a pregnant woman's circulation, the recommendation is that the antibody is checked and titrated every 4 weeks until delivery.

 

This is quite different to the UK Guidelines.