I feel as though the answer should be very cut and dry on this, but I am having a really hard time finding a source for this question.  Can you run an autoadsorption on a pregnant person?  I can find all of the documentation in the world about not doing this procedure on someone that is recently transfused, but the crowd goes quiet when it comes to the pregnant folks.  Does anyone have a reference for this?

 

Thank You!

I would think that  it is fine to do a pregnant woman unless there is reason to believe that there was a massive fetal bleed. No reference that I know of.

Edited May 23, 201510 yr by R1R2

I'm sorry, but I would disagree with R1R2.

 

The reason is similar to why one should not use autoadsorption if the patient has been transfused 3 months prior to when adsorption needs to take place.  By 3 months, it would be exceedingly difficult to detect any "foreign" transfused red cells in the circulation, but, at this stage, we would still perform alloadsorptions.

 

Many foeto-maternal haemorrhages are "silent", in that we do not know about them (which is why, in the UK, we now give universal routine antenatal anti-D prophylaxis - and this has brought down the cases of anti-D sensitisation even further than it was).  Therefore, if there is a small FMH, you would not know about it, but there would be a sufficient number of foetal red cells present to adsorb out a weak, forming alloantibody in the woman's circulation.

 

Sadly, I am on holiday at the moment, and may find it difficult to locate a reference, but I'll look as soon as I can.

Okay, so a reference that does not actually include pregnant women, but makes the same point as do I above.

 

Petz LD, Garratty G.  Immune Hemolytic Anemias.  2^nd edition, 2004, Churchill Livingstone, Chapter 10, pages 382-383.

 

If I remember correctly, and I should as a coauthor, but I can't(!!!!!!!) the soon to be published BCSH Guidelines on testing for antibodies during pregnancy, will say this.

I'm sorry, but I would disagree with R1R2.

 

The reason is similar to why one should not use autoadsorption if the patient has been transfused 3 months prior to when adsorption needs to take place.  By 3 months, it would be exceedingly difficult to detect any "foreign" transfused red cells in the circulation, but, at this stage, we would still perform alloadsorptions.

 

Many foeto-maternal haemorrhages are "silent", in that we do not know about them (which is why, in the UK, we now give universal routine antenatal anti-D prophylaxis - and this has brought down the cases of anti-D sensitisation even further than it was).  Therefore, if there is a small FMH, you would not know about it, but there would be a sufficient number of foetal red cells present to adsorb out a weak, forming alloantibody in the woman's circulation.

 

Sadly, I am on holiday at the moment, and may find it difficult to locate a reference, but I'll look as soon as I can.

Malcolm, I hope you're not too sad that you're on holiday.........

It's really tough Phil, but I am doing my very best to put up with the situation!!!!!!!!!!!!!!!!