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The page below is a sample from the LabCE course Rh-Negative Female 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.

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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 her positive antibody screen prior to the C-section with her current pregnancy appears to be anti-D from RhIG administration at 28 weeks, 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. Laboratory has confirmed administration of RhIG prophylaxis;
  3. Result of 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 was set up.