I just found out the other day that we are now doing antibody titers on Anti-D due to Rhogam. Is there anyone else doing this? 

We don't, if we know they received Rhogam.  

 Why would you? It is not a true antibody. We don't.

We do not if we can figure out RhIg injection history, unless specifically requested by MD.

Last week we had one where mom did not get the 28 week shot yet, apparently fell at some point, and didn't tell anyone, and her pre-natal anti-D titer was 1024!

We do not, not a true antibody.

I think it is a ridiculous practice also. I just wondered if anyone else has encountered this. I think our doctors make some very strange requests.  This is something that has just started in the last week or so. It just makes more work for a very busy blood bank that is short staffed

They have probably read something about the idea that a low titer - 4 or less - that doesn't rise is RhoGAM, not a 'real' antibody. We had requests for titers  for 3 or 4 months from a newbie OB/GYN doc who wanted to follow any of his patients who had anti-D reported post-delivery or post-miscarriage.   (We always report 'patient received RhoGAM on DD/MM/YYYY' on these patients to give docs a hint as to why the patient might have an anti-D identified, but his comfort zone apparently didn't go there.) He stopped doing it abruptly - maybe he was realizing that a lot of his patients had detectable RhoGAM, far more than could actually be sensitized to the D antigen or maybe one of his experienced partners educated him. 

It might be worthwhile to have a pathologist feel them out about why they are doing it and to casually mention how much a patient is charged for a titer, suggesting a follow up antibody screen at 3-4 months if they really feel that they need to do something. If the patient is not pregnant, titers are not going to affect patient treatment/care.

 

Just now, AMcCord said:

They have probably read something about the idea that a low titer - 4 or less - that doesn't rise is RhoGAM, not a 'real' antibody. We had requests a couple of years ago for titers  for 3 or 4 months from a newbie OB/GYN doc who wanted to follow any of his patients who had anti-D reported post-delivery or post-miscarriage.   (We always report 'patient received RhoGAM on DD/MM/YYYY' on these patients to give docs a hint as to why the patient might have an anti-D identified, but his comfort zone apparently didn't go there.) He stopped doing it abruptly - maybe he was realizing that a lot of his patients had detectable RhoGAM, far more than could actually be sensitized to the D antigen or maybe one of his experienced partners educated him. 

It might be worthwhile to have a pathologist feel them out about why they are doing it and to casually mention how much a patient is charged for a titer, suggesting a follow up antibody screen at 3-4 months if they really feel that they need to do something. A little education might go a long way. If the patient is not pregnant, titers are not going to affect patient treatment/care and this would be considered unnecessary testing.

 

 

Not doing this.  Wow you must have a ton of time on your hands, just kidding!!

And do you get paid for this "meaningless" work.  If you can document pt had Rhogam administration you need to get your pathologist to stop this, it's crazy I tell you.

What value does this add to the patient??

Unfortunately, we get antibody ID and titer referral specimens from a reference laboratory, so we don't know for sure if these anti-D's are from RhIG or not.  I think the docs may just be covering certain parts of their bodies!  We have asked the reference lab to provide that information to us, but they don't contact the physicians' offices.

As a reference lab, if we identify anti-D in a prenatal sample and don't have patient history of RhIg administration, we try to get it from the hospital/Doc's office.  We also test a 1:4 dilution (no enhancement) at AGT.  If it's negative (which most of them are), our report includes a statement, "Due to the recent administration of RhIG, the antibody may have been passively acquired.  To establish this as the sole cause of the antibody's presence, repeat testing six months post-delivery should demonstrate a negative antibody screen."

We do not.  I have played in the past with it when a doc asked.  Used tube method. Titer was <1.