Anti-D question

[junkfoodaddict]

When I was pregnant in 2011, I discovered I was rhesus negative. I had my anti-D at 28 weeks and was told that within 72 hours after birth, I would have the anti-D again if baby was rhesus positive.

I had a very traumatic labour and birth (rare, violent contractions due to a pessary reaction, low amniotic fluid during the last 4 weeks - it was only discovered then - a baby not growing, placenta abruption, uterine tear and a baby in distress). Four days after the birth, I asked a midwife what rhesus factor my baby was. i was told he was negative like me. i was reassured.

However, the next day, the midwife came in to remove my staples from my EMCS and said she had to give my anti-D. I was confused and told her what the midwife said the previous day. She looked at her notes and said baby was A-.

I was a little miffed at being given wrong information but I 'let it go'.

Anyhow, it has been bothering me since then and moreso now as we're planning to conceive number 2 in the new year.

Will I be safe to conceive number 2 even if my anti-D was given after 5 days instead of 3?

so, was your baby A- like you said? in which case you wouldn't have needed the anti d afterwards?!

I'm A- and have just had my anti-d injection, when I asked about it, even if the baby has a.negative blood group you have a 2nd after the birth to try prevent any problems with future pregnancies encase the.next one has a positive blood group. I don't think having the injection 2 days later would make a difference to be honest but worth double checking with your mw

Sorry! He was A+!!!

I'm A- and my husband is A+ when my first child was born my midwife made a mistake and wrote into my chart that he was A- when he was actually A+ and so I never received anti d,with my second pregnancy they checked me for antibodies(which is what you develop in your system if you don't receive anti d and your baby's blood is positive and you and your baby's blood have mixed) up until 28 weeks and I did not have any but when my daughter was born she was A+ also and she tested positive for the Combes test which is the test they do if your blood type is negative and you deliver a positive baby so see if your bloods had mixed,anyway she had to be put under phototherapy lights for 36 hours to break down the jaundice in her skin caused by the antibodies,the doctors tell me I must av had a silent bleed in the last few weeks of my pregnancy but I'm guessing its more likely from not being given the anti d shot when my son was born but obviously they aren't going to say that,my daughter was perfect besides and is now a healthy really advanced 16 month old,I'm also 20 weeks pregnant with my 3rd baby and because we know I already have the antibodies they did a test to find out my unborn babies blood type,because if it was negative the antibodies would have no affect and I would go on to have a normal pregnancy but if the baby is positive then the antibodies are likely to affect it,what the anti bodies do is cross over your placenta and attack your babies red blood cells causing your baby to eventually become anaemic,we just got the results back and unfortunately our unborn baby is also A+,so far I have just been having regular blood tests to keep an eye on the quantitation levels of the antibodies,and so far they are really low,but it's when the baby gets a little bigger we will be a bit more concerned,I'm having a scan on the 26 of sept and they will have a look at the baby's brain to see if he/she is showing signs of anaemia and if so my baby may need a blood transfusion through my belly button while in utero :-( and will continue to have these transfusions until its safe to be born,whether that's full term or before..will keep you posted :-)

I'm a bit worried now,I'm O- and 34 wks,had anti d at 30 wks cos they messed it up (no idea why) and no one has said about having another when baby is born,why would we need another one if baby is out?

MrsMusket, because during labour you and baby's bloods are likely to mix causing possible problems for future pregnancies.

I had anti D after my first baby and it didn't work! Apparently that happens to 1% of mums. Anyway, few days of light therapy in hospital and she was fine. She's now 10, fit and healthy and doing very well at school.

I wouldn't worry too much, easier said that done I know. And DO NOT GOOGLE!

The anti d you receive postnatal protects for future pregnancies. If you haven't had your anti d injection, get a blood test which will check whether you have produced your own anti d antibodies. If you have it means your are isoimmunised and therefore anti d injections will be pointless in the future. If not then you'll be fine to receive anti d in future pregnancies. If your are isoimmunised then you will need a management plan for future pregnancies. Don't get to worried about it, it's very rare to actually become isoimmunised.

Just read your OP more thoroughly. Usually it's recommended to have anti d within 72 hours, but it can still be effective if given within 9 to 10 days postnatal.

I didn't bother with the Anti-D with my first pregnancy as both DH and I are rhesus negative. Both O- so no chance of having a + baby. Despite the midwives trying to convince me on the basis that I might have had an affair and DH might not be the father.

Unsurprisingly DS turned out to be O- as well...

They have to do that Lady, to cover the possibility that a woman's DP / DH isn't the babies father. Part of the training, don't take offense at it!
And I heard recently from a pediatrician that there is a minute chance of two negative patents having a positive baby. Not sure how in the hell that works but he was adament it could potentially happen.

Oh ok Dropyoursword I can see that now!

DropYourSword - there IS the possibility, but it involves one of the parents not actually being RhD negative, but having a D variant which may not have been picked up; or because it's the sort of D variant that means if you're exposed to ordinary RhD antigen, you'll still make antibodies to it. This is possible if you have a bit of the RhD antigen missing yourself - you make antibodies to the bits you don't have. So people with D variant blood type are usually characterised as RhD negative for transfusion purposes.

Only other things I can think of are chimeric parents - where their own blood types as RhD negative, but parts of them are RhD positive, including their gametes.

OP - you should still be fine having the anti-D a couple of days late; although it is given if your baby is RhD positive as routine, you will have also had a blood test check called the Kleihauer test, to see if there are any foetal blood cells in your maternal blood. This test is usually negative, the post-natal anti-D shot is cautionary - however, if the Kleihauer is positive, this means that foetal blood has definitely entered the maternal blood stream and extra anti-D may be needed for additional "mopping up" of foetal blood cells.

All that aside, one of the things that will be tested at your booking bloods is your anti-D status. The foetus only develops RhD antigens at 12w gestation, booking bloods are usually done not long after, iirc, so if anything is picked up, it will be in time to do something about it.

You should be ok - but if you are worried about it now, you can ask your GP to get your blood tested for antibodies (you might have to pay for it though)

Thank you so much for explaining that to me! I've never been able to get a decent explanation before.

I have to say, in this day and age, it's unlikely now to get a mis-type of the RhD status - more common in previous times, where weak D variants were easier to miss - but as fathers are not routinely blood typed in relation to pregnancy, any with a weak D variant might have been told to consider themselves as Rh D Negative so think that's what they are.

So could a weak D variant have some sort of recessive positive gene (?) that would then determine childs blood type.

DropYourSword - this article explains most of it very clearly, if you're used to scientific literature. :)

What would happen if you had a Dvariant parent, is that it could be passed onto the baby; the baby could then type as D positive, while the D variant parent would have been called D negative, even though they were D variant positive. The RhD test for cord blood isn't very sophisticated, so it would be unlikely to pick up a D variant at that point unless it was known that the parent was D variant positive.

I knew I was Rh-be before I got pregnant because my mum is so was tested at birth and have been a blood donor and told them so at my booking appointment but don't think they believed me till my blood results came back. Know hubby is Rh+ve so have had my anti-D at 28 weeks and will make sure I get some postnatally if I need it.
They don't seem to test your husband and give you it regardless.

No they don't test your DH because it can cause unnecessary embarrassment and if you are lying to hide an affair, it could be potentially dangerous.

Thumbwitch - so really I should have had that explained to me rather than the midwife just saying "well if you are sure the father is O-..." and leaving it at that.

Am worried I'm putting current unborn DD at risk now. I thought I understood all the risks.

No, don't worry Lady, you are unlikely to have put your unborn DD at risk. D variants are very rare.

And your MW wouldn't have had the first clue about any of that, I used to work in a blood transfusion centre so transfusion science and blood typing is my area of "expertise" - you'd be lucky to find even a doctor (with the exception of a haematology consultant and even some of them aren't all that hot on the technicals) who knows about that.

I wouldn't have brought up the issue of D variants if DroptheSword hadn't been given some apparently strange information by a paediatrician (some of them take special interest in topics so do know more than others)

Ah, that's reassuring, thank you.

I'm confused.

Am I right in thinking that I will have a blood test as a matter of course after 12 weeks to check my anti-d status?
If it is positive, what is the likelihood of my baby not making it to full term?

My LO did have jaundice at birth and had to have phototherapy. Was this a coincidence or possible mild rhesus disease? (He is absolutely fine now!!!)

Sorry for being an absolute pain. I am going to make an appointment with my GP though to discuss it further.

As for D variants, am wondering if that was the trouble my brother had because before he signed up to the Navy, they were having trouble 'grouping' his blood.

I'm B- by the way!

A good group, junkfood - me too!

Whenever you have your booking bloods done, they will test your blood group as a matter of course, and check you for any antibodies, not just anti-D (it's not the only one that can cause problems but it is far and away the most common).

Even if you have made your own anti-D, it won't necessarily cause massive problems with the foetus, it depends on the strength, avidity and quantity you've made.

I have to go out just now but will write in more detail when I get back.

OK back now.
junkfood, your DS that needed the phototherapy, was he your first pregnancy?
If so, then it's extremely unlikely that he was affected by rhesus disease (although not impossible, but you should have had bloods taken at 28w as well, which could have picked it up and if there was any evidence of anti-D at that point, you would have needed further tests too, to keep an eye on your levels)

The way it usually works is this:
your first RhD+ pg/baby shouldn't be affected because first exposure to the D antigen will cause you to create an IgM antibody.
This is a large antibody, and is too big to cross the placenta. It also takes a few days to fully create this antibody from scratch, so it's a slow response.
When the body makes this antibody, it will keep a "memory cell" that remembers the template though - so next time your body sees that same antigen (works for all antigens, not just RhD!) it will be able to respond more quickly and produces an IgG antibody.
This is MUCH smaller (5x smaller) and can cross the placenta, which is why subsequent babies/pg are at risk of RhD.

However, it's not a given that any subsequent babies WILL get rhesus disease - you have to be provoked to produce the secondary response, and your levels of antibody have to be sufficient to cause problems. Any evidence of anti-D in your blood will mean that you are monitored closely throughout your pg to see if your levels rise and there are things they can do to avoid the worst outcomes. Intra-uterine transfusion is one - the most amazing thing! But hopefully not something you'd ever need to experience.

So - going back to your case - if DS was your first pg, then unlikely he was affected.
If there had been significant crossover of his blood into yours, then you would have needed more than one shot of anti-D; this WOULD have been picked up on the Kleihauer test - when you see your GP you can ask if you had a positive Kleihauer.
If you have produced your own anti-D, this will be picked up when your booking bloods are taken, and you will be monitored from then on, frequency will depend on the levels of anti-D in your blood.

Re. your brother - who knows, it could have been a weak D instead of a variant (much less rare) - if he is typed as RhDu, then it's a weak D. This type of person doesn't make anti-D because all the bits are there, they are just less obvious.
It was described to me as this: imagine the D antigen is made up of 6 teeth - with a Du, all the teeth are there, but they're only half out; but with a D variant, one or more of the teeth are missing and the person could make antibodies to the missing teeth.

The other possiblity is that he had an interesting collection of C, E, c and e antigens. When blood is typed, it's not just the D status that is given - CEce status is also required. This gives a Rh phenotype. "Rhesus negative" is usually cde/cde, also coded as rr. d = no D (there is no d antigen). This is the most common form of RhDneg blood. However, he could have C or E as well, in which case he would be typed as variously:
Cde/cde = r'r
Cde/Cde = r'r'
cdE/cde = r''r
cdE/cdE = r''r''
Cde/cdE = r'r''
CdE/CdE = ryry (VERY rare)

That might be more information than you actually wanted or needed but you can see it's all a lot more complex than it at first seems, which is why you couldn't really expect a MW to know it, or even a doctor who doesn't have a special interest in it.
If your brother has a card with his blood group on it, it should have some indication of his Rh status - if it's any of the above, you'll know now what it all means :)