![]() Giving Rh immune globulin to these women is not harmful.Īll women, regardless of their D type, should be tested during each pregancy for clinically significant antibodies, ideally at their first obstetrician visit. The clinical implication of this change is that a few women who actually have weak expression of the D antigen will be classified as Rh negative and will be candidates for Rh immune globulin. All women are now typed as either Rh negative or positive. The main reason is that today’s blood typing reagents are much more potent and most of the patients who were previously typed as weak D are now typed as Rh positive. The AABB has determined that weak D testing is no longer necessary for obstetric patients. Historically, if a patient typed as Rh negative, additional testing was then performed to determine if they had weak D expression. Serologic confirmation of the D type is also recommended at the beginning of each subsequent pregnancy. This recommendation is especially important as a safeguard to prevent an Rh negative woman from being falsely typed as Rh positive and denied RhIG. A record of the maternal ABO type is also helpful should the newborn infant develop signs and symptoms consistent with ABO HDN.ĭ typing should be done on at least two separate occasions and the results should be identical. ![]() Any discrepant results must be fully investigated. The results should not conflict with historical records. ABO typing is done primarily for patient identification. Repeat at 2-4 week intervals if below critical titerĪll women should be tested for ABO and D as early as possible in pregnancy, preferably during their first trimester visit. Rh or other clinically signficant antibody Eliminating this laboratory test from clinical practice will not adversely affect pregnancy outcomes and will decrease the costs of prenatal care.3 rd trimester if history of antibodies or transfusion Although 6 of these 53 patients (0.06% of the study population) had clinically relevant antibodies for hemolytic disease of the new-born, no significant neonatal sequelae occurred among these 6 patients.īased on the patient and hospital records studied, a repeat third-trimester antibody screen for Rh+ patients is clinically and economically unjustified. Among the Rh+ patients, 178 (1.9%) had 1 or more atypical antibodies at the first-trimester screen, and 53 (0.6%) had a positive third-trimester antibody screen despite a negative first-trimester screen. Of these, 1233 patients were Rh- and 9348 were Rh+. Using a computerized laboratory database from 2 teaching hospitals, we identified 10,581 obstetric patients who underwent routine first- and third-trimester antibody screening between 19. ![]() We also reviewed the neonatal medical records for evidence of direct Coombs-positive cord blood, anemia, need for transfusion or phototherapy, other medical complications, and death. We reviewed the maternal medical records for antibody identification and final pregnancy outcome. ![]() Because entry into a group was decided by the investigators, it could not be randomized. Patients were grouped into those with a positive third-trimester antibody screen (cases) and those with a negative third-trimester screen (controls). We identified Rh+ pregnant women who had received prenatal care and retrospectively analyzed their laboratory data. To determine the need for routine third-trimester antibody screening in Rh+ women.
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