Anyone rhesus negative ? What about anti D and CJD

[bunny2]

When I was pregnant, I was given my regular anti D jabs, now it emerges there may be a possibility of contracting CJD from the serum. Can anyone expand on this and is anyone else concerned?

[mears]

bunny2 - because anti-D is derives from blood there is a very minute risk that CJD could possibly be transmitted with it's use. I have to say that this is a concern expressed when using any blood product and all steps are taken to minimise the risk of any disease transmission.

I myself am rhesus negative and do have concerns regarding the prophylactic use of anti-D for rhesus negative women antenatally. This was proposed by the Royal College of Obstetricians and Gynaecologists but has been questioned by other professional groups. The RCOG advised that all rhesus negaive women should get anti-D at 28 weeks and 34 weeks(?) to try and avoid these women developing antibodies. There was criticism because, in fact, many women were not getting anti-D at the times it was already recommended such as post delivery - ensuring that a Kleihauer test was performed to see how many fetal cells were in the maternal circulation post delivery to ensure that enough anti-D was prescribed. The routine was to give 500iu as a once only injection but some women may need more than this. Also all Rh neg women with threatened miscarriage, miscarriage, amniocentesis performed etc. should have an injection incase there was an fetal blood passing into the maternal circulation.
As a midwife I do not support giving all Rh neg anti-D antenatally unless they have had incidents that increase the risk of developing antibodies such as vaginal bleeding etc. because that may mean unecessary exposre to an albeit rare risk.

I myself developed antibodies in my second pregnancy for some reason, resulting in my third and fourth babies requiring blood transfusions. I still do not believe that the right thing to do is expose everyone to prevent the few women like me having problems.

I hope you have been able to follow what I am saying - it is a bit late at night to be typing indepth responses Let me know if you would like me to clarify any points.

[jodee]

Mears, I've just seen your message and I'm concerned, also being Rhesus negative, because I had a miscarriage at 7 wks earlier this year and didn't get an anti-D injection. should I do anything about it now? We are still trying for a second baby - should I have an anti-D injection as soon as I'm aware I'm pregnant again?

Slightly off-topic, but I've been wanting to give blood (for the first time) for a while now and have received info from the National Blood Service. I don't want to spoil my chances of getting pregnant soon, we've been trying long enough, should I go ahead, or not, do you think?

[bunny2]

Thanks Mears, for such an in-depth response. You have certainly made me less anxious about CJD, a minute risk I can take! HOwever, alarm bells rang when you mentioned vaginal bleeding in pregnancy. I bled during my first pregnancy on several occasions and the hospital did check everything was in order by giving me extra scans, I seem to remember receiving extra anti D too. I then had a healthy baby boy. During my second pregnancy, I bled alomst from day 1 and bled every day. Unfortunately I lost the baby at 12 weeks. I dont, during this pregnancy, remember receiving extra anti D. There was no reason given for the msicarriage and we are now trying again for another baby. In your opinion should I be asking for anti D in the early stages of a preganacy given that I have bled in both previous? I live in Spain and it is diffivult to get good medical advice so any opinion from a professional would be welcome.

[KateLB]

Hi bunny2 - just wanted to reassure you a little. I recently had a baby in Spain and was similarly concerned when I found out I was Rh- (my Spanish is hopeless and I wasn't up to in depth questioning either). I had a gammaglobulin injection part way through the pregnancy, with no ill effects (at least none I'm aware of), and didn't need one after the birth because my daughter also turned out to be Rh-. In spite of all my worrying, the care we had (in Valencia), was excellent - it's less touchy feely perhaps than at home (no pain relief except epidural - my lovingly prepared bag of homeopathic remedies etc went out the window!) - but generally good

[mears]

Bunny2 and jodee - some more reassurance for you. It is unlikely that antibodies will develop in miscarriages up to 12 weeks. This is because there is very little fetal blood at this stage that can get into the maternal circulation.
Normally baby's and mother's blood never mixes. At delivery, a small amount of fetal blood can enter the mother's circulation (up tp 4ml) which is dealt with by the routine adminisration of 500iu anti-D to women who have Rh positive babies. This is the dose given after 20 weeks of pregnancy. It is when larger amounts pass through that problems occur, that is why the Kleihauer test is done which detects the fetal cells in the mothers circulation and then the dose of anti-D is increased. It must be given within 72 hours of delivery.
Before 20 weeks the dose is 250iu (international units).
Before 12 weeks there is so little fetal blood that the anti-D injection is not needed. The exception to that is if it is a surgical termination of pregnancy where there is extra trauma if you like. Spontaneous miscarriage is unlikely to cause a problem before 12 weeks.

If there are episodes of bleeding throughout pregnancy then anti-D should be given at 6 weekly intervals after 12 weeks of pregnancy.

Jodee - the blood transfusion will not allow you to give blood for a tear after childbirth or miscarriage to allow you to get back to full health so I would just forget that just now.

When you are pregnant next time bunny2and jodee you will not need anti-D as a routine unless you do start bleeding after the 12 week mark.

If your partners are Rh negative you will not need anti-D at all! Send them to give blood in the meantime then you will find out their blood groups if they don't know them already.

[mears]

Sorry - meant year after birth etc.

[jodee]

Mears, thank you so much for your reply, it's certainly put my mind at rest.

I knew giving blood was a no-no whilst pregnant/within a year of birth, but it hadn't occurred to me that the same reasons apply after a miscarriage, so thanks for that, I will wait.

I've also got no idea of my husband's blood group, so yes I think it's about time he went off to give blood!

[bunny2]

Thanks Mears, you should write a book! There is little info about this topic available to the lay person. thanks for your advice, I never even considered my husband's blood group was relevant -he will be off to the doc for a test soon. you mention that if bleeding occurs, anti D should be given a six week intervals, can you tell me if this is standard practice or something I need to request?
Thanks too KateLB, if I do have another baby here in Spain its nice to know my best friend the epidural is at hand! I am taking Spanish lessons but the teacher has yet to cover giving birth, probably thinks there is more important vocab to learn first such as "Hello" and "my name is ..."

[mears]

It is standard practice as long as the bleeding is recurrent. If you have a one-off bleed then you would have a one-off anti-D then, if the baby is Rh positive you would get anti-D repeated within 72 hours of delivery.

Did you know that, even if your partner is rhesus negative, the hospital would still want to give you anti-D incase you didn't want to own up to the fact your baby was the result of a liaison with a different Rh pos man? Women cannot be trusted you know!

[mears]

I should have clarified the point that a Rh neg woman and Rh neg man can only have Rh negative babies. Anti-D would then never be required.

Depending on the man's type of Rhesus factor, a Rh pos man and Rh neg woman might have Rh postive or negative babies.

In my own case my husband is homozygous positive therefore all babies we have will be Rh positive.

If he was heterozygous positive we would have an equal chance of having Rh positive or negative babies. Fascinating isn't it?

[SueW]

DH is A+ and I'm O-. Our DD is A-. I didn't know all this until last week!

I was given anti-D routinely during pregnancy and the midwife told me, as Mears points out, it was because they didn't assume the DH was the father! Not that I knew his blood group anyway.

I've been a blood donor for years and got a fright when I realised about anti-D being a blood product. I checked it out the next time I went to the donor centre but (after some discussion/referral) they said it was fine to donate.

That reminds me, it's about time for me to see if I can donate again. I stopped off at Dubai and Singapore airports on the way back from Australia a year ago and they weren't sure about the malaria possibilities so wanted me to wait a year. Ho hum. Sometimes you just can't give your blood away, even when it's O- and supposed to be the most precious stuff!

You can check out more about blood inc rhesus stuff and frequency of blood groups and how much blood is in stock on the National Blood Service website .

[SueDonim]

IKWYM about not being able to give blood away, SueW. My son now lives in the US and they won't accept his yummy O- blood, because of BSE.

My DH is also Rh- and is on an emergency list at the Brit Embassy here in Indonesia to donate blood, because Rh- is very rare among Indonesians. I just hope there is someone else Rh- living here, should my DH ever need blood!!!

[jodee]

SueW, it was because of you posting the link to the National Blood Service on another thread recently that I was spurred on to enquire about donating. I knew I was O rh neg, so when I read that that was the most wanted blood, I wanted to do something, but it looks like I will have to wait a bit now.

[mears]

Since my first posting in response to the question
posted by Bunny - our hospital is looking at implementing the NICE national guideline that says all rhesus negativewomen should be given the information to make an informed choice regarding routine administration of anti-D at 28 weeks and 34, unless they know it is their last baby or their partners are rhesus negative.
I have reservations about women being given all the facts as the guidance seems a bit slanted towards women having routine injections.
This is based on the fact that infection from blood products is a rare occurance and that anti-D administered in England and Wales is bought from America where there are no known cases of new variant CJD.
Any thoughts on the matter anyone?

[bunny2]

Hi Mears, I ma glad to hear that your hospital is considering the NICE guidelines, at least they are acknowledging there are concerns surrounding this issue. Having said that, will the information be of any use to the average laywoman? I consider myself intelligent and yet I am completely thrown by this whole blood thing and probably wouldnt be confident in my ability to make the right choice. I have made decisions in the past (ie MMR) and I can honestly say despite widely reading up on the subject I was still none the wiser and allowed myself to be coerced into the decision the doctor wanted anyway.

[karenanne]

a bit off topic but has anyone here ever been told their anti k .i had this with my daughter i had to have endless bloodtests all the way through my pregnancy and scans right up till the last minute.apparently it can cause severe anemia (sp)in the baby although it doesnt harm the mother.id never heard of it before and havent since so just wondered if anyone else had it or has any info

[SoupDragon]

I've found this fascinating! My mother is RH-ve, my dad RH+ve and I have older brothers, one +ve and one -ve. I was induced at 36 weeks and given exchange transfusions at birth, something I'd always known, but it's only since becoming pregnant for the first time that I finally understand what happened.