Alloantibodies and pregnancy Lab Matters 26th June 2019

Alloantibodies and pregnancy Lab Matters 26th June 2019

Alloantibodies and pregnancy Lab Matters 26th June 2019 Tim Wreford-Bush Transfusion Laboratory Manager North Bristol NHS Trust Alloantibodies and pregnancy Alloantibodies and pregnancy BCSH guidelines 2016

ABO and D typing Red cell antibody screening/identification Screening cells C,c,D,E,e,K,k,Fya,Fyb,Jka,Jkb,M,N,S,s,Lea Homozygous expression of Rh, Fy, Jk, S antigens Follow up tests Alloantibodies and pregnancy

MAIN RECOMMENDATIONS Sample labelling ABO and D grouping Antibody screens Timing of tests (early in pregnancy and again at 28/40)

Labs to keep records of anti-D administration Alloantibodies and pregnancy MAIN RECOMMENDATIONS FMU referrals Antibody Card Post delivery testing of babies

Regular audit of practice Alloantibodies and pregnancy

Clinically significant antibodies (IgG) Anti-D Anti-c Anti-K Anti-C Anti-E Anti-Fya Anti-Jka Other antibodies Alloantibodies and pregnancy

Anti-D+C specificity Possible anti-G Demonstrated by disproportionately high titres of anti-C ALWAYS refer to a reference lab as patients with anti-G are still eligible for RAADP and post delivery anti-D Ig Alloantibodies and pregnancy Techniques CAT Capture Tube

Paternal testing Fetal genotyping Referral to reference laboratory Alloantibodies and pregnancy Anti-D quantification (NIBSC 2003)

Differentiation between immune and prophylactic anti-D Test every 4 weeks to 28/40 then Test every 2 weeks to delivery <4iu/ml HDN Unlikely 4-15iu/ml Moderate risk of HDN >15iu/ml High risk of hydrops fetalis Alloantibodies and pregnancy Anti-c quantification (NIBSC 2003) Test every 4 weeks to 28/40 then Test every 2 weeks to delivery <7.5iu/ml Continue to monitor

7.5-20iu/ml Risk of moderate HDN >20iu/ml Risk of severe HDN Alloantibodies and pregnancy Anti-K titration

Anti-K often present as a result of previous transfusion Severity not correlated with antibody titre Affected pregnancies usually titre of 32+ Paternal sample K negative Alloantibodies and pregnancy

Other antibodies Many other specificities Repeat testing at 28/40 No further testing recommended Medical decision regarding women with hx of HDN Alloantibodies and pregnancy Routine ante-natal anti-D prophylaxis (RAADP) 1500iu at 28/40 gestation OR 500iu at 28/40 and again at 34/40

Alloantibodies and pregnancy BCSH guidelines 2013 Administration of anti-D immunoglobulin for the prevention of HDFN NICE guideline 2008 Routine antenatal anti-D prophylaxis for women who are rhesus D negative RCOG guidelines 2011 (Archived) The use of Anti-D for Rhesus (D) prophylaxis Alloantibodies and pregnancy

ffDNA testing 16/40 Results dictate issue of RAADP Alloantibodies and pregnancy Potentially sensitising events Amniocentesis, chorionic villus biopsy and cordocentesis Ante-partum haemorrhage/vaginal bleeding in pregnancy External cephalic version Fall or abdominal trauma Ectopic pregnancy Evacuation of molar pregnancy

Intrauterine death and stillbirth In utero therapeutic interventions (transfusion, surgery, insertion of shunts, laser) Miscarriage, threatened miscarriage Therapeutic termination of pregnancy Delivery normal, instrumental or Caesarean section Intraoperative cell salvage Alloantibodies and pregnancy Miscarriage or painless PV bleeding at <12 weeks, no anti-D required unless surgical intervention T.O.P./Ectopic pregnancy/Molar pregnancy need PAD

Any sensitising event after 12/40 gestation regardless of whether RAADP has been given or is due to be given Guidelines say at least 250iu Between 12 20 weeks give 500iu >20 weeks perform Kleihauer (or flow) and give at least 500iu Alloantibodies and pregnancy A CAUTIONARY TALE

Result at booking PAD issued for use at 28/40 Result at 28/40 rr test Delivery

Recently Viewed Presentations

  • Outline  This Presentation contains slides appropriate for all

    Outline This Presentation contains slides appropriate for all

    This Presentation contains slides appropriate for all the sections of the activity. ... The EM spectrum is (arbitrarily) split up: ... Clouds of gas & dust in constellation of Taurus. First shows visible light, then click to add in far-infrared...
  • Visual Schedule Finder - courses.cs.washington.edu

    Visual Schedule Finder - courses.cs.washington.edu

    Visual Schedule Finder SDS Presentation Members Peter Beckfield Xia (My) Cam Rylan Hawkins Jordan Hoyt Sandra Li Devy Pranowo System Architecture Page & Class Processes Database Accounts User Admin Catalogue myUW Degree Req Development Plan Team Structure Project Manager /...
  • The Engineer and the Genie - National University of Singapore

    The Engineer and the Genie - National University of Singapore

    So a million bucks appeared in front of the engineer and the genie said, "Remember, every lawyer in the world now has 2 million bucks." The Engineer and the Genie The engineer was non-committal and then said, "I always wished...
  • ENVIRONMENTAL REGULATIONS FOR EQUINE AND SMALL FARM OPERATIONS

    ENVIRONMENTAL REGULATIONS FOR EQUINE AND SMALL FARM OPERATIONS

    Water and nutrient holding capacity. Micro nutrients (Calcium, Magnesium, Sulfur, Zinc, and more) ... Pastures that continue to lack plant cover will suffer from the effects of soil erosion. The picture on the right is a pasture that is being...
  • The Yellow Card Scheme: Reporting Adverse Drug Reactions

    The Yellow Card Scheme: Reporting Adverse Drug Reactions

    * The Yellow Card Scheme is run by the MHRA and Commission on Human Medicines and collects, collates and investigates reports of Suspected ADRs The thalidomide tragedy of the late 50's and early 60's highlighted the urgent need for routine...
  • Optical interferometry - Basics and Application Examples ...

    Optical interferometry - Basics and Application Examples ...

    Optical Interferometry and Industrial Interferometers - a Tutorial - Friedemann Mohr Pforzheim University of Applied Sciences Outline 1 Physical Basics and components 2 Interferometry for path measurement 3 Laser vibrometry for vibration measurement The photoelectric conversion process Detecting a light...
  • Business User Group - Nebraska

    Business User Group - Nebraska

    Business User Group. Pre-audit. Submit claims within 60 days of when expense was incurred. Include Start and Stop times for travel events on Expense Reimbursement Request. Must have detailed, not summary credit card, receipts ... IBT - e.g. TSB Rental...
  • Meraka Institute - Monash University

    Meraka Institute - Monash University

    Ver. 1.00. 17 May 2011 Marlien Herselman Agenda What is LL & elements LLiSA - where we started Purpose of LLiSA Challenges Value proposition It is not the strongest of the species that survives, nor the most intelligent that survives.