Sigh, Any mothers with stories about anti little c antibodies

[Babieseverywhere]

In particular I would like to know :-

: What tilter level did you get to ?
: Did the level alter much ?
: Did you do all suggested blood tests and scans ?
: Did you get pressured into being induced or were you left alone to labour properly ?

Thanks in advance

Hello all - hope I can shed some light on this thread but it's been a while since I was in the business so I am not fully up to date!

First off, a minor niggle but it does matter - anti-D (always a capital please) prophylaxis will only work for the D antigen (there is no such thing as a d antigen, it is used only to denote the absence of D).

Afaik there is no prophylaxis available for anti-c, anti-C, anti-e or anti-E. c, C, e and E are all common Rh antigens - anti-c is probably the most common problem after anti-D in Rh-incompatible pg.

The next thing is that titres aren't the be all and end all of how "bad" the antibody levels are - you can be high titre, low avidity which means that you have a lot of antibody but it is a bit feeble and doesn't do much; similarly you can be low titre, high avidity - less antibody but it's much more potent. Generally speaking though, if the titre is very low it's not causing much of a problem. The biggest problem is if there is a sudden rise, suggesting that there has been another crossover of foetal blood, provoking the antibody reaction again.

They don't like to leave babies inside for too long as the longer they are inside, the more chances there are for a foetal blood crossover, iirc.

babieseverywhere
"If they had bothered to blood matched the blood transfusion for me properly, following the operation they mucked up on, I wouldn't be in this situation. Do you know it would only of cost a sodding £3 to cross match properly (i.e. for all major antibodies), but they did it the wrong way and I am suffering for their poor judgement but I am meant to suffer the next three months"
It is not standard practice to crossmatch anything other than RhD positive blood with an Rh D positive patient unless they already have antibodies. Your judgement of this situation is biased, of course, but there is no suggestion of impropriety in the crossmatch, the crossmatch was carried out according to standard practice for a patient with no known antibodies. You were unlucky, that's all.

To clear your own confusion up - if you have managed to make anti-c and anti-E then your own Rh genotype is CDe/C(D)e (R1R1).
Your DH has both C and c so is most likely a CDe/cde ((R1r) although there are other options (this is the most common scenario given the info you have supplied).
You yourself do not have c.
Your child has a 50:50 chance of being c-negative.
The C is irrelevant as you have not got antibodies against C.

I am assuming that you are Rh positive, babieseverywhere - if you aren't then your genotype would be slightly different but the C and e would be the same.

emmakc1977,

I am planning a home birth and no one has mentioned I can't because of this blood factor. They wanted me in hospital because this will be a VBAC but as there is no flexibility or support for me in hospital I continue to plan my home birth.

Fetal blood test is when they take maternal blood sample and they can figure out the baby blood test. My hospital has refused to do this for me, as my tilter levels are currently low so it is not clinically necessary. Which is bollocks as TW says tilter levels really vary woman to woman and their effect on their baby varies too. I would be much happier if they would do this test.

No one has mentioned inducing at 38 weeks to me either, not possible with a home birth so maybe why they haven't mentioned it to me.

Thumbwitch,
Thanks for posting, you really know your stuff.

I understand that it is not standard practice, but as it would of only cost them £3 to fully cross match the blood shouldn't it be standard, at least for RH positive women of child bearing age ? So women like me unlucky enough to draw the short straw, could avoid additional pregnancy and baby problems.

I suppose I am sad as I didn't want the blood transfusion two years ago and made a big fuss about refusing, as I was planning more babies and the doctors treated me like a child and told me I was being over anxious and there was nothing in a blood transfusion which would affect future pregnancies...He was wrong.

My biggest concern ATM is that I fell down the stairs on Monday and ended up in hospital. I was so terrified about the antibodies increasing and asked them to take a blood sample. The midwifes kept telling me not to worry as I was RH+ I had to explain that RH+ with anti little c was very similar to RH- anti D. They took blood at the end, but I have to wait 10 days for the results.

Will this fall affect my tilter levels ?

No one has mentioned inducement at 38 weeks or anything like that, should they have ?

It would not cost them only £3 to "fully crossmatch" your blood, babieseverywhere - if you have no antibodies to start with, then you would have to have a full antigen typing screen and believe me that costs a whole lot more in time and money than £3 and would be completely impractical in real terms in a busy transfusion lab, even for women of childbearing age (you'd also have to include young girls).

The doctor couldn't have known that you would react to the transfusion by producing antibodies but he most certainly should not have patronised you in that fashion. There is always a minor risk with any kind of blood product infusion (usually very minor).

MWs (and pretty much every doc apart from haematologists) are pretty unknowing re. antibodies - you did the right thing to insist on the blood sample and hopefully they will have sent it to be tested for anti-c titre. To affect your levels, the fall would have to have induced leakage of foetal blood cells into your own bloodstream (always a slight risk with physical trauma) and then the antibody-production cells would have had to react to the c+ blood cells (assuming that your baby is c+) and started to produce more anti-c. However, this isn't very likely to have happened within 24 hours - it takes a while for the antibody-producing cells to react.

Are you not under a consultant haematologist? I would have thought you should be, tbh, as anti-c is a known risk factor for HDN. The consultant haematologist would be the best person to ask re. induction; the "business end" of it is a bit outside my sphere of expertise, I'm afraid.

Thanks Thumbwitch.

I can see I have an oversimplified view of things and it sounds a lot more complicated than I thought it was.

Yes, I am still waiting for an appointment from the blood specialist. Midwife was to chase this appointment up for me a couple of weeks ago. I'll chase this up tomorrow.

Do you have any idea when the tilter level will start to raise after a fall. Should I ask for another blood test soonish ?

well, if it's going to rise, it would probably start a couple of days after the fall so it could be worth getting another test done tomorrow - and definitely push for that haematology appt asap. You need to have them on side for things like this, IMO. They are usually more on the ball. See, if you were already under them then you could have gone directly through them and they would have told you the best time to have the blood test. Time to kick some arse, I feel!

(can I just politely point out that there is no 'l' in titer - and I always spelled it the English way - titre - although I'm aware that americanisms are taking over medicospeak so titer is probably just as likely. I'd pronounce it teeter as well, although some would say tie-ter)

HTH - I might have to go to bed soon (in Oz so it's 2:30 am here) but am happy to answer any further questions - you might just have to wait a bit for the answer

Thanks, Got it "titer"

I'll chase up stuff and maybe bend your ear after I get the appointment and some more information.

no probs - good luck with it and I expect you'll be fine but better safe than sorry.

Babieseverywhere - I'm obviously no expert but I saw my consultant last week and she told me that my hospital induces at 38 weeks as the longer you are pregnant the higher the risk of the levels rising and as the baby is "cooked" at 38 weeks there's no reason to take the chance.

With me, she thinks its where I had a fall towards the end of the pregnancy which caused my maternal bleed as I had no little c at the beginning of my second pregnancy and it was only picked up at the end. She said it can take a few weeks for body to develop the antibodies.

They are taking my blood every 4 weeks to start and will then take them every 2 weeks later on in the pregnancy and I will have scans every four weeks to check the baby's blood flow for anemia. She said that if my levels go about 7.5 they will refer me to another hospital that specialises in this kind of thing but at the moment mine are only at 1 - she said it is usually worse the more pregnancies you have with this condition from the beginning of hte pregncnay and some women start with levels much higher than me so its unliekly that I would need the baby to have a blood transfusion whilst in the womb (which is apparnetly one of hte things that can happen).

Good luck with your appointment with the consultant - hope it all goes well.

It would take the body longer ( a week or so) to make the antibody the FIRST time but it's much quicker any subsequent time of exposure because the body already has the template for the antibody.

Apparently there is no need to retest after a fall as I am RH+ not RH- We have been referred to a Hematologist and should have an appointment in the next few weeks...no rush I am only 31 weeks pregnant !

In one way I am very relieved that they are not bothered about more tests etc. Ironically, considering the start of this thread, I am now worried that I am not having another blood test because of the fall I had and no one else thinks it matters.

Oh well, they are the experts so I will try to be positive and look forward to the new baby.

hello..... baby 4 is now 13 weeks having had HDN from anti-c sensitisation. My titre levels rocketed at 12 weeks and then stabilised, although still high nearing the end of my pregnancy and I had fortnightly scans/blood tests until elective c section at 38 weeks, with blood banked in case of any trouble. Baby 4 is ok now, but I would say without any hesitation to have as many tests as you can bear - however much of a drag it is to go to hosp and have scans/bloods all the time. If just for peace of mind it helps, but actually if things start looking a little odd then to be aware of it helps massively if HDN does develop as you are prepared for it and kind of know what to expect.

big big good lucks to you...x

Glad to hear your baby is doing well, duckduck

My blood results are still very low barely 1.1 so hopefully they will remain low for the rest of my pregnancy

I finally have notification of my essential, important haematologist appointment and it is still a few weeks off when I am 38 weeks pregnant ! (and clashing with the only flipping event I had planned for months )

Well, I will have to attend and make sure there is nothing I need to know about this blood stuff before my baby arrives or post labour(assuming he/she has not made an appearance by then) Bit about having to wait months for an appointment when it is meant to be urgent, won't like to wait for a routine appointment. Sigh.

Forgot to update, last blood results had gone up to 3.5 (not surprising after I fell downstairs !)

But the hospital haematologist was happy that risk of HDN is low at 3.5 and he was horrified that I had virtually no blood tests with DC2 and was only picked up at 26 weeks pregnant this time around. Apparently I should of been blood tested every 4 weeks from 12 weeks pregnant !

No extra tests needed during labour or for the baby after birth, just standard cord blood tests. Thank goodness. So the best possible scenario lets see what happens when the baby decided to arrive.

Babieseverywhere - hope everything went well for you.

I just wanted to clear up something - if you were given the original blood in an emergency situation then there may not have been time to crossmatch it fully (as it takes over 40 minutes). Also you almost certainly didn't produce the anti-c until >3 days after exposure to the cells you were given, so the units would have been compatible anyway.

Hoping somebody still reads this thread wondering if anyone has any experience with my situation?

second pregnancy , bad blood transfusion ending in high anti d and c then mixing with second babies blood made anti g! so i have anti C D and G hospital haven't a clue (said theres no such thing and had to repeat bloods only for the same to come back!) any advice would be great! 29 weeks now !

www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg65/

Here is a link to the RCOG guideline
You should be referred to Fetal Medicine for more blood tests and scans

Hi!
I realise this thread is very old but I’m hoping maybe this might notify you ladies that are in the know, since all I ever hear is about D and nothing about little c!

I had a baby 5 years ago naturally , difficult birth but no transfusions or anything. Two years later I became pregnant again. All fine until 28 weeks bloods show up these little c antibodies ...kept being asked if I had had a transfusion , which I hadn’t, so it was all very strange.

Luckily I was under the care of a big hospital with a Fetal medicine unit and titre levels were monitored for the last 10 weeks - they didn’t rise significantly and all was with baby at birth. They did say it was a very rare antibody though and when I asked about future Pregnancies they said they didn’t know and to come back at the time.

Now we have moved country and we are considering a third baby, but this is something I wanted to find out more about before we actually try. When I googled it increased likelihood of miscarriage came up : also now I have the antibodies before (possibly) getting pregnant does that make it more of a an issue?

I can’t find any doctors that list this as a special interest where I am since I’m not pregnant I’m not on the midwife system here.

Any info or knowledge welcome !

Thanks