Hi everyone 

We recently had a case where Mum's antibody screen was negative through out her pregnancy even the day she had her C-section.  We received 7 day postnatal sample, now she develop     anti-c. Just in case if baby need blood , do we need to provide little c neg blood eventhough baby's DAT is neg?

 

I would provide little-c negative blood for neonatal transfusion.  Don't understand why DAT status would be reason to deny or provide antigen-negative blood for transfusion.

Mum develop anti-c after delivery and baby's DAT was negative on day 0

 

what about the baby"s c antigen, is it pos or neg?

I will transfuse c neg blood to the baby, since there are anti-c antibodies in his or her circulation.

If mom had  a negative antibody screen at the time of delivery wouldn't there be little to no anti-c in the baby's blood? This seems to be supported by the fact that the DAT was negative.  I don't know why the baby would have any need to be transfused more than a week after delivery unless premature.  I guess you could test baby's sample through AHG against c pos cells and settle for good whether the baby's blood has anti-c in it.

Like Mabel, I would find it difficult to see why a normal healthy baby would suddenly require a transfusion a week after being born.

 

Of course, shiley is also correct in saying that the FIRST thing you should do is Rh type the baby, as a minimum for the C and c antigens, but, if the baby is NOT c positive, I can see no reason whatsoever why you would want to give c negative blood, when the baby's DAT was negative, and the mother's anti-c did not appear until after delivery, and the baby's own immune system is incapable of producing such an antibody itself at this stage of life.

I think you are worrying unduly.

Was mum transfused?  Just wondering where the anti-c came from (unless baby is c+ of course)

 

On ‎12‎/‎11‎/‎2015 at 0:42 PM, gagpinks said:

Just in case if baby need blood , do we need to provide little c neg blood eventhough baby's DAT is neg?

I think you-all missed the point of gagpinks' posting.  It was an hypothetical question, "Would you provide little-c negative rbcs or rbcs untested for little-c to this infant if transfusion was required on day 7?"

11 hours ago, Malcolm Needs said:

I can see no reason whatsoever why you would want to give c negative blood, when the baby's DAT was negative

Using DAT results as a criteria to determine/influence the selection of blood for neonatal transfusion is new to me.  Would you withhold antigen-negative blood for neonatal transfusion for any newborn with a negative DAT regardless of the results of the mother's antibody screen or antibody history?

So in direct reply to the question, I would test baby's phenotype, and then decide on the basis of a combination of those results + the reason for requiring blood.  Baby Cc + transfusion required because of anaemia - I would be tempted to give c- blood on the grounds that mum's anti-c was there all along, but not detected for whatever reason.  If possible, I would also do an eluate on baby, even if DAT neg.

Baby needs transfusion for surgical problem and is Cc - I would not look at c.

Baby is CC and needs blood for whatever reason - definitely c- blood for whatever reason if baby is a girl

11 hours ago, Dansket said:

Using DAT results as a criteria to determine/influence the selection of blood for neonatal transfusion is new to me.  Would you withhold antigen-negative blood for neonatal transfusion for any newborn with a negative DAT regardless of the results of the mother's antibody screen or antibody history?

The concentration of the maternal alloantibody is actually higher in the baby's circulation than in the mother's circulation, as the transfer of the antibody across the placenta is active, rather than passive (see Mollison), and so, if the DAT is positive, but there is no detectable antibody in the maternal circulation at birth, then it may be worthwhile identifying the specificity from an eluate from the baby's red cells - the positive DAT may just be ABO antibody, after all.  If there is no specificity, other than ABO, then I would quite happily give c+ blood to the baby, rather than hang about waiting for c- blood, when there is absolutely no reason so to do, other then a "vague worry".  Even if the baby was a female, and c-, I still wouldn't worry about giving c+ blood because, as I said above, the baby is unable to make anti-c at this stage.

On 12/12/2015 at 1:50 PM, Dansket said:

 

I think you-all missed the point of gagpinks' posting.  It was an hypothetical question, "Would you provide little-c negative rbcs or rbcs untested for little-c to this infant if transfusion was required on day 7?"

Short answer: No.

While I stick-by my answer above, as always there are exceptions and this topic is no different....

Long Answer: Maybe

The AABB Technical Manual and the "Standards" state: "The serum or plasma of either the neonate or the mother may be used to perform the test for unexpected antibodies..." (5.17.1).  It goes on to state: "If the initial antibody screen demonstrates clinically significant unexpected red cell antibodies, units shall be prepared for transfusion that either do not contain the corresponding antigen or are compatible by antiglobulin crossmatch until the antibody is no longer demonstrable in the neonate's serum or plasma." (5.17.1.3)

In this situation, if the transfusion service were to go the ultra conservative route and choose to use ONLY the mother's serum or plasma in their pretransfusion testing, then YES, they would be forced to select c- units as that would be the only unit that would be compatible with the mom's (or mum's) serum or plasma. 

If they choose to use the neonate's serum or plasma, then we are back to the "short answer" answer above, and NO, c- units would not be required.

 

1 hour ago, StevenB said:

The AABB Technical Manual and the "Standards" state: "The serum or plasma of either the neonate or the mother may be used to perform the test for unexpected antibodies..." (5.17.1).  It goes on to state: "If the initial antibody screen demonstrates clinically significant unexpected red cell antibodies, units shall be prepared for transfusion that either do not contain the corresponding antigen or are compatible by antiglobulin crossmatch until the antibody is no longer demonstrable in the neonate's serum or plasma." (5.17.1.3)

With all due respect to the AABB Technical Manual and the "Standards", a unit cannot "contain" the corresponding antigen!  A unit can "express" the corresponding antigen, but it cannot "contain" the corresponding antigen.  After all, red cell antigens are "expressed" on the surface of the red cell membrane (even those, such as Ch, Rg and Lewis, that are adsorbed on to the surface from the plasma are still "expressed" on the surface of the red cell membrane), and antibodies sensitise these surface antigens, rather than being absorbed into the cytosol of the red cell and sensitise red cell antigens "contained" in the red cells of the units.

 

One would have hoped that such a eminent organisation would have got that correct!!!!!!!!!!!!!!!!

 

Welcome to the US's world of regulations.....

 

It's been a VERY long time since I've done neonatal blood banking, Steve was correct as usual to cite the regulations. And kudos to Malcolm for the correction on their improper terminology...I didn't catch that!

That said...

In this hypothetical scenario, there is no mention whether the anti-c is Ig-M, Ig-M & Ig-G or Ig-G exclusively, and depending on the methodology used you may not know. I'll assume we're talking Ig-G only.

This would make me believe that mom had a low/undetectable titer of anti-c from a previous sensitization which was spiked by this pregnancy/birth (assuming mom wasn't transfused at delivery) and subsequently detected a week later.  So, that would lead me to believe that baby is in fact c+. Since mother's screen was negative at birth, any maternal antibodies in the baby's circulation would be at a very low titer if any were present at all, evident by the negative DAT. Baby would also have a negative antibody screen. This would exclude the necessity of transfusing c- negative units.

  If in this scenario they wanted to transfuse the baby at a week old, could not obtain a baby T&S, and mom's current blood was used for pre-transfusion workup/crossmatch, THEN you'd need to honor her antibody in order to have compatibility with mom, and hence transfuse baby c- RBCs.

(In my experience with neonates at 3 facilities, any baby requiring transfusion would have a Type & Screen performed on their own peripheral blood, we never used mother's.)

Edited December 30, 20159 yr by PammyDQ

I am guessing that the rate mom was producing an early anti c, in respose to a c pos stimulation from baby, was slow enough that it was hemolyzed before it was detectable. When the baby was out of the loop the Anti c was no longer taken up by the baby cells and the mom was increasing the speed of production. I would guess that the anti c that reached the baby was all hemolyzed and that is why the DAT was neg. Maybe the question would be, is the baby nursing, how long does the mom produce colostrum that might contain anti c. Is it hours or days etc. if this is not an issue the baby can no longer get anti c passively so it should be fine with c untested. Our protocol is to do a BTYSC (baby type and screen that includes baby screen, baby front type, baby DAT) the only way I can see needing to give c neg is if the crossmatching is done with mothers blood to avoid unnecessary draws on baby, we would do this if we have an unident aby on mom. Now I am confusing myself. PatO at 60!!!