Rhesus Disease

[Kristian Cauchi Inglott]

Good morning / day / evening,

I realise this is a very specific question, and thus I'm not surprised to have not read about it in my Ob & Gyn book.

If a woman were to receive a blood transfusion which contained Rh +ve blood, but she is Rh -ve, would she require earlier shots of Anti-D if she becomes pregnant in the future?

Thank you!

---

Members don't see this ad.

 

[dingdong28]

Only in emergency situations should a blood bank issue Rh positive blood to an Rh negative woman within child bearing age, and I mean really emergency situations with an Rh negative blood shortage. In order to combat the patient from developing anti-D, Rhogam should be given within 72 hours after the transfusion (similar to a Rh negative mom giving birth to an Rh positive baby without complications). I would expect that the patient may develop a transfusion reaction and may develop an anti-D in response to receiving the Rh positive blood if Rhogam wasn't administered. The same logic can be applied to any Rh negative patient, male or female, old and young, receiving Rh positive blood.

To answer your question: I don't think they'll have to receive earlier shots of Rhogam, but should receive a shot after the transfusion and could receive more depending on how many units were transfused.

This is from 2014: Rhesus Negative Woman Transfused With Rhesus Positive Blood: Subsequent Normal Pregnancy Without Anti D production

 

[Kristian Cauchi Inglott]

Perfect thank you. I was thinking along the lines of the transfusion being done accidentally and then discovered after a transfusion associated reaction for example.

 

[dingdong28]

Perfect thank you. I was thinking along the lines of the transfusion being done accidentally and then discovered after a transfusion associated reaction for example.

I should let you know that I'm not a physician and am a medical lab tech that rotates in the blood bank.

I can't speak for outside the US, but whenever blood is ordered to be transfused, a patient will have a type and screen performed (if one hasn't been performed within the last 3 days). A confirmatory ABORh may be needed to (obviously) confirm the patient's blood type if the blood bank has no history of a blood type on file for that patient. After both tests are completed, compatible blood can be crossmatched and transfused at that point. As long as the incorrect patient was drawn both times, transfusing incompatible blood is an extremely rare incident. There are plenty of fail safes in place to prevent incidences like this from occurring. Most hospital blood banks are going to have O Negs on the shelf ready for traumas, MTPs, urgent surgical needs, etc. so you shouldn't run into that issue either.

Once a transfusion reaction occurs, the blood bank performs their own transfusion reaction investigation with pre and post transfusion specimens, DAT, UA, and whatever other test that may be part of that lab's transfusion reaction investigation. Once the ABO incompatibility is the known reason for the reaction, I would assume the attending physician should consult with a transfusion medicine pathologist in order to proceed with issuing Rhogam.

Let me know if you have any more questions

 

[theshellyb]

Would not affect timing of Rhogam in future pregnancies. If the Rh+ transfusion was not noticed and she became sensitized, you don't give Rhogam (the ship has sailed). If they did notice and she got Rhogam after the accidental transfusion and she avoided sensitization, you would give the Rhogam at the normal times when she did get pregnant.