How Much Testing?

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The page below is a sample from the LabCE course Rh-Negative Mother with Anti-D at Delivery: A Case Study. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

Learn more about Rh-Negative Mother with Anti-D at Delivery: A Case Study (online CE course)
How Much Testing?

As noted, policies for further testing to confirm anti-D, exclude other antibodies, and assess whether the anti-D is passive or immune vary among TS laboratories.
Even though patient A.D. had a negative antibody screen at 28 weeks and a positive antibody screen before the C-section with their current pregnancy, it appears to be anti-D from RhIG administration at 28 weeks, but some TS laboratories may set up a full antibody identification panel to confirm the presence of anti-D. Others would proceed straight to a mini-panel of red cells, specifically selected to exclude other clinically significant antibodies in the presence of anti-D, providing these criteria are met:
  1. Mother is Rh-negative and has been tested on two separate occasions.
  2. The laboratory has confirmed the administration of RhIG prophylaxis.
  3. The result of the current antibody screen is positive and typical of anti-D due to RhIG.
  4. There is no record or history of an unexpected antibody.
In this case, all criteria were met and a selected mini-panel was set up to confirm the presence of anti-D and exclude possible co-existing maternal antibodies, which may have implications for possible HDFN and for transfusion to both the mother and newborn.
A mini-panel of six selected red cells (rr, r'r, and r''r cells), along with a positive Ror control and an autocontrol were set up.