We have a patient who is 29 weeks pregnant with placental previa and anti-E.  She is expected to remain as an inpatient until delivery.  We have been doing T&S every three days, which requires an antibody ID with it.  Is there any info to support extending the T&S timing?  My thought is no, given her pregnancy status, but I'm hoping there's something out there that I don't know about that will eliminate some of this extra testing!  

I would be very worried about any extension, for exactly the reason you have given (i.e. that she is pregnant) and has already shown herself to be a responder.

If you know she has anti-E, you can probably put together a custom screen of E negative cells.  That screen would only be positive if she developed another antibody.  Be careful that you cover all the antigens that the FDA requires.  That list used to be in the Technical Manual.  I think it is D, C, E, c, e, M, N, S, s, P1, Lea, Leb, K, k, Fya, Fyb, Jka, Jkb.  

 

We do as Baby Banker does, create a selected cell panel to rule out everything else.  The game we play is how few cells can we run and have a valid rule out panel   We have had several patients that we do every 3 days until delivery.  One of our patients had Anti-c and Anti-E.

19 hours ago, Baby Banker said:

If you know she has anti-E, you can probably put together a custom screen of E negative cells.  That screen would only be positive if she developed another antibody.  Be careful that you cover all the antigens that the FDA requires.  That list used to be in the Technical Manual.  I think it is D, C, E, c, e, M, N, S, s, P1, Lea, Leb, K, k, Fya, Fyb, Jka, Jkb.  

 

 

15 hours ago, pbaker said:

We do as Baby Banker does, create a selected cell panel to rule out everything else.  The game we play is how few cells can we run and have a valid rule out panel   We have had several patients that we do every 3 days until delivery.  One of our patients had Anti-c and Anti-E.

I like the approach taken/suggested by Baby Banker and pbaker, but it does need  a moderately high skill set to make up the selected panel. Perhaps that's not possible in the "average" blood bank?

A follow-up question: Are you performing titrations (potency) of the antibodies that are identified? If so, how often ?

1 hour ago, exlimey said:

 

I like the approach taken/suggested by Baby Banker and pbaker, but it does need  a moderately high skill set to make up the selected panel. Perhaps that's not possible in the "average" blood bank?

A follow-up question: Are you performing titrations (potency) of the antibodies that are identified? If so, how often ?

We don't titre because we don't have anything to do with the mother's care, but I know the hospital down the street tracks the titre.

As for the panel/screen, I take the antigen profile and circle all the required antigens.  Then I select a cell that is homozygous for each one.  I sometimes have to use cells from other panels or screens.  I know the rule is that you can substitute two heterozygous cells for one homozygous cell, but I never do that if I can help it.  

1 hour ago, Baby Banker said:

As for the panel/screen, I take the antigen profile and circle all the required antigens.  Then I select a cell that is homozygous for each one.  I sometimes have to use cells from other panels or screens.  I know the rule is that you can substitute two heterozygous cells for one homozygous cell, but I never do that if I can help it.  

A sound approach.

 

I wouldn't bother with an ab screen, you already know it is positive.  I'd just run selected panel cells to rule out any new abs.

6 hours ago, David Saikin said:

 

I wouldn't bother with an ab screen, you already know it is positive.  I'd just run selected panel cells to rule out any new abs.

But that is, in effect, what is being suggested David.

Unfortunately, our LIS is set up to require a 3-cell screen.  We do a select cell panel to rule everything else out.  We perform titers if requested by the physician, but they are not automatically reflexed.