Red cell antibodies

Question 1

Risk of red cell antibodies

Answer 1

• Fetal anaemia
• IUD
• IU/neonatal transfusion
• Jaundice

Question 2

Testing

Answer 2

• G+S at booking and 28 weeks for all women
• If mum has antibodies- test the father or fetus

Question 3

ffDNA testing

Answer 3

• after 16 weeks with maternal blood

Question 4

Referral to fetal med

Answer 4

• Anti D >4iu/ml
• Anti c>7.5iu/ml
• Any level of anti K/E

Or if concerns of fetal anaemia/hydrops

Refer if prev severely affected preg

Question 5

Checking levels for mum

Answer 5

• Every 4 weeks till 28w
• then every 2 weeks till delivery
• X-match- every week

Question 6

Fetal monitoring

Answer 6

• MCA PSV for anaemia every week (reliable till 36w)
• if >1.5x normal- refer to fetal med

Question 7

If IU transfusion is needed

Answer 7

• Group O/ ABO compat w fetus
• Maternal antibody negetive
• K neg
• CMV neg and irradiated
• Hct 0.70-0.85

Question 8

Neonatal tx

Answer 8

• ABO compat w fetus and mum
• Rh D w fetus
• K neg/maternal natibody neg
• CMV neg and irridiated
• <5 days old

Question 9

Maternal tx

Answer 9

• ABO and Rh compatable
• K neg
• CMV neg
• If multiple antibodies- blood might need to come from Liverpool national blood bank

Question 10

Anti D

Answer 10

• Give at 28 and 34 weeks, PN and any sensitising event
• If immune anti D is detected- no need for prophylaxsis

Question 11

Delivery

Answer 11

• If stable- 37-38 weeks
• If IUT or concerns- plan case by case

Question 12

Cord bloods

Answer 12

• DAT
• Hb
• Billirubin

Question 13

Baby

Answer 13

• Monitoring for anaemia and jaundice
• No early discharge
• Regular feeding