How do people report patients with prophylactic anti-D?  We report them as antibody screen negative but a comment stating the remains of prophylaxis detected.      I'm not convinced we should be saying it's neg if Anti-D ig is present.  I'd be interested to see what others do and if I'm getting my knickers in a twist over nothing! 

We report the positive antibody screen and add a chartable comment that the patient demonstrates anti-D and it may be due to Rh Immune Globulin given (date) at (facility).  Our LIS will allow us to do an electronic crossmatch in the future when her antibody screen returns to neg.

19 hours ago, A little lab lost said:

How do people report patients with prophylactic anti-D?  We report them as antibody screen negative but a comment stating the remains of prophylaxis detected.      I'm not convinced we should be saying it's neg if Anti-D ig is present.  I'd be interested to see what others do and if I'm getting my knickers in a twist over nothing! 

If antibody screen is positive  and if we have upto date record  of  prophylaxis anti-D than we report as AntiD detected due to prophylaxis or sensitizing event. Please check history and  confirm with clinician. BUT If patient has sensitizing event prior to 28  weeks we treat as immune antiD and send sample for quantification  and continue antenatal and postnatal prophylaxis. 

4 hours ago, cam1987 said:

We report the positive antibody screen and add a chartable comment that the patient demonstrates anti-D and it may be due to Rh Immune Globulin given (date) at (facility).  Our LIS will allow us to do an electronic crossmatch in the future when her antibody screen returns to neg.

We too report them as Anti-D, probably due to rhogam administration, plus the date of administration. followed by the nurse initials and the tech initials.

We report as positive for Anti-D with a notation in history of the last date Rhig given. We do full workup and report as Anti-D if we cannot determine this information.

Jenny

We have always resulted the antibody ID as anti-D with a comment added that it is probably due to RhIG given on a certain date.  The RhIG in our facility is now issued by the Pharmacy, so we have been adding comments to patients' histories to indicate that the RhIG was given.  Now that we are doing Electronic Crossmatches, I'm not sure how to designate the anti-D from RhIG so that the LIS will allow us to do Electronic Crossmatches on those patients.  Any ideas?

Perhaps check with your LIS analyst to see if they can create a separate antibody in the dictionary that would represent RhIg and set the clinical significance of the antibody to 'no.'

We have an antibody "Passive Anti-D" that we report if we have identified a recent Rhogam injection. 

We built the 5, 6, 7, 8 Ortho panel cells in Meditech.  It has a comment not screened for Anti D and we record the date given.  We have that test built for Labor Room as part of an Rh negative panel. If the baby has a positive DAT, an elution is reflexed and  we will also do an panel & titer on Mom if indicated.

21 hours ago, goodchild said:

Perhaps check with your LIS analyst to see if they can create a separate antibody in the dictionary that would represent RhIg and set the clinical significance of the antibody to 'no.'

This is what we did.  I built a separate antibody called RHIG and made it not clinically significant.  It translates to PRESUMED RH IMMUNE GLOBULIN and we report the date given.

Report as a Passive D due to Rh IG and date given

We have a canned result "Probable Passive D due to RhIG"  with a comment added noting the RhIG date administered and name of whom we received the information.

This is slightly off topic, but I wondered if anyone does a gel crossmatch for a patient with anti-D or just selects an Rh negative unit.  We also have a separate antibody for Rhogam (DRHIG) and do IS XM when the screen is negative.  I am not sure if I want to make an exception for my techs and have them not do a gel crossmatch.  Sometimes the less they have to think about exceptions the better!

15 hours ago, mollyredone said:

This is slightly off topic, but I wondered if anyone does a gel crossmatch for a patient with anti-D or just selects an Rh negative unit.  We also have a separate antibody for Rhogam (DRHIG) and do IS XM when the screen is negative.  I am not sure if I want to make an exception for my techs and have them not do a gel crossmatch.  Sometimes the less they have to think about exceptions the better!

Also curious about this topic.

We do not do an IAT XM if the antibody is only a passive anti-D.  We still do IS XM here - but if/when we move to EXM I hope that it would allow it for passive anti-D.  (Great idea above re: creating a new antibody! thanks!!)

It can be a little confusing for some people, especially new staff, since we have generalists rotate through the core.  But, worse case scenario is that they do extra work if they do an IAT XM.

s

I am in the process of editing in Meditech to automatically order an IAT (gel or tube) XM for all patients with antibodies, but I wasn't sure if that was required for a patient with a REAL anti-D (mostly older women) or if we could do an IS XM with an Rh-negative unit.  

 

How are deciding if it is a real antibody or if it is from the RhIg shot?

to mollyredone: If patient has Anti-K and we crossmatch K neg units, we still do the IgG crossmatch. So, we do the IgG crossmatch on the patients with Anti-D. Like someone else said; sometimes to have a rule and no exceptions is easier for the generalists.

Texas Lynn,

We call the patient's doctor or check hospital records to see if they have gotten a Rhogam shot.  If we can't document it, we call it anti-D.  

After reading the AABB technical manual, I agree we need to continue to do gel XM.  

I also thought it would be easier on my techs not to have an exception.

Thanks for the confirm! And welcome to the forum!

Another question.  If a patient has a history of a warm autoantibody with no underlying alloantibodies, but the current screen is negative, do you still need to perform an IGG crossmatch?

13 hours ago, mollyredone said:

Another question.  If a patient has a history of a warm autoantibody with no underlying alloantibodies, but the current screen is negative, do you still need to perform an IGG crossmatch?

I see no reason why you should.

Thank you Malcolm!