Antibodies found in blood before 28wks

[grumperina]

I'm currently 28 weeks pregnant with my first pregnancy. I was sent off for antibody blood tests at 26.5 weeks because my blood group is ORh- (and DH's is ORh+), as a routine preliminary to having the anti-D injection next week. I've just received a letter saying that they've detected anti-D antibodies in my blood, and enclosing a card to show medical staff in case I need a transfusion. There was very little other information in the letter, and nothing aimed specifically at pregnant women - so I've been trying to find out the implications. (I realise this is a pretty rare situation for a first pregnancy.)

I'm hoping someone can answer my questions about this, as there's no chance of contacting a midwife until Monday morning!

1. I've never had a blood transfusion or a previous pregnancy. I haven't been aware of any potential sensitisation event, either (or else I would have gone to get an anti-D injection). Does that mean that I've had a silent bleed of some sort since the last lot of bloods at 12 weeks - and that I've reacted to the (presumably Rh+) fetal blood by producing antibodies?

1. Is it pointless my having the prophylactic anti-D injection next week, given that I've already produced anti-D antibodies? Or is it still worth having it in case I have any more sensitisation events between now and delivery?

1. All of the information I've seen so far suggests that HDN is only a risk for second and subsequent pregnancies because most women don't become sensitised until the actual delivery (and they get the routine prophylaxis to prevent that in most cases). Obviously, this isn't the case for me, since I've already got the antibodies in my blood. Does this mean that my baby is already at more risk of HDN?

1. What are the likely implications of this for the rest of my pregnancy and the delivery (e.g. more scans/blood tests, induced early delivery, etc.)? I think there's a NICE protocol that says I should have weekly blood tests and bi-weekly scans for the rest of the pregnancy?

1. What are the implications for any future pregnancies, given that it is quite likely that I'll have another Rh+ baby?

Sorry for the long post! I rang the midwife first thing this morning, but she didn't seem to be able to answer any of my questions (I guess I'm in quite an unusual situation) and said we'd just have to ring the lab to ask them to explain when I go in for my 28-wk appointment on Thursday. So I'm still a bit in limbo, especially as I don't even know what my antibody levels are. I'm hoping someone who knows about these things will come along soon and set my mind at rest...

I didn't want to leave your post unanswered, though I don't have any information for you. Hopefully you will be able to discuss all this with your mw on Thursday. I'd be interested to hear what she said. It's really annoying that she doesn't know more about it. I'm rh- negative too, but haven't had an issue with anti-bodies. Good luck!

I can't answer your questions but in your shoes I'd call the haematology department at your local teaching hospital and ask the questions there, as they'll undoubtedly be able to help, and run through the protocol for pregnant women in your position. Hope that helps x

Hi can't answer all your specific queries but I have anti M antibodies identified (just given birth to my first). I had previously miscarried so they might be from that but they said sometimes you just have antibodies and they don't know why.

I can only speak from my own experience but they have caused no problem. As a precaution they referred me to a consultant who said the type I had was highly unlikely to cause any problem. I had a normal pregnancy and gave birth in a midwife led unit.

When I first found out, I went on google and read all sorts of alarming things - rather than that, I 'd suggest you book an appointment with either your midwife or doctor to reassure yourself (my midwife knew nothing about them so I booked a GP appointment).

I was given the same letter and transfusion card with my blood results - in my case it mentioned that the antibodies were unlikely to cause HDN.

I still had all the standard anti D jabs and they tested cord blood at the baby's birth to check whether he was positive or negative (he was positive which meant I needed a final anti D jab as standard).

Sorry for the ramble - have a week old newborn in the background - but hope it helps.

Thanks for your replies, and for sharing your experiences. Unfortunately, anti-D are among the antibodies that can cause a problem, so my hospital is taking this quite seriously. I went in for follow-up blood tests last week, and have just been told that the levels have risen quite "significantly" in the intervening two weeks - taking me from "low risk" to "moderate risk". I'm going to see a consultant early next week and hope to find out more then. But I'd still be grateful to hear from anyone else who has gone through this!

PS They also told me that I can't have the anti-D injections because I already have the antibodies in my blood (making the jabs useless). So there's nothing much I can do to prevent further sensitisation :(

just posting briefly I'm afraid but I have anti-E antibodies which have been linked to HDN before. These were detected during my first pregnancy, and were most likely from blood transfusions.
I was monitored closely as my levels were rising, they have a threshold whereby they consider HDN a risk so will not worry too much until you reach that threshold. Scans were performed to monitor fetal health- however I developed severe pre-eclampsia (HELLP syndrome) at 30 weeks around the same time as the antibodies were getting towards the threshold, resulting in emergency delivery of DS (due to the PE), so I can never know if the pregnancy had continued whether HDN would have resulted. DS was very jaundiced (moreso than most premmies) and the consultant said this was due to my antibodies so it was having some impact on his health. He needed a blood transfusion and phototherary but was fine (except for other premmie issues) and now aged 5 has no probs at all!
I went on to have 2 more pregnancies and thankfully with both of those my antibodies stayed fairly low and the girls have my blood antigen rather than my husbands.

I know it is scary but with close monitoring and management under a consultant I'm sure you and the baby will be ok. x

Hi JumpingJellyfish - thank you so much for sharing your story, which is actually quite reassuring. I realise that early induction is a possibility, depending on how monitoring goes over the next few weeks - I'm currently 29+4, so just trying to hang in there as long as possible, because every week that goes by means a better likely outcome for my baby! Anyway, congratulations on the healthy births of your three children!

Like you said every day even is a bonus in pregnancy- just make sure you are happy with the level of monitoring you receive from your medical team so that you can feel reassured that they will detect anything as early as possible. And try your best to relax and enjoy your pregnancy- I hope you make it to 37+ weeks and all is well! :)