Rhesus negative sensitisation?

[MissJam]

Hi everyone just looking for some sort of explanation as I haven’t got one. Hopefully this is in the right place, I’m still finding my way on here!

I’ll try and be as brief and to the point as I can.

Had DS almost 5 months ago. I’m rhesus negative, he is positive.

12 week bloods showed no antibodies. I had 2x Anti D injections at 9 and 12 weeks due to unexplained bleeding.

I had my blood test at 20(? can’t remember exactly…) weeks to check again for antibodies before having the routine Anti D. My bloods were labelled incorrectly and so did not get tested. They were retake the following day (after Anti D) and the results say ‘abnormal antibodies found Anti D Passive.

When DS was born his cord blood and my blood test showed a mix had occurred but both of us had the highest positives you could get and so midwife didn’t think it happened during labour. My labour was quick at under 2 hours.

DS eventual blood results did not indicate jaundice or anaemia.

Midwife rang several days later and said that my blood had been referred to a different lab as it was ‘unusual’ to see both mother and baby with these results. According to the other lab, I had suffered a ‘sensitisation’ and Anti D would no longer work. She also said that I was to be sent a blood transfusion card because I had antibodies that I didn’t have before and it could be a problem if I required a blood transfusion in the future.

I have never received a card, nor has anyone explained what exactly any of this means.

Does anyone have any ideas or advice? Thank you for reading.

Hi OP. I’m also rhesus negative, but I can’t offer a lot to help, this didn’t happen to me. Been watching your post interested in answers myself but maybe it’s not so common.

Have you read the NHS page on it? All I can suggest is reading what you can and making a list of questions to ask the health visitor/GP.

www.nhs.uk/conditions/rhesus-disease/prevention/

A blood test to screen antibodies taken
shortly after a dose of anti-d is given can show the anti-d.

There are lots of things that can happen that are classed as sensitising events (bleeds, abdominal trauma, procedures like amniocentesis) which is basically an opportunity for the baby’s blood cells to mix with yours. And if you don’t have anti-d after these events, then that’s when sensitisation can occur. The dose at 28 weeks is prophylaxis. The biggest sensitising event of all is giving birth itself, so it would be expected to find some of your baby’s blood within yours in the blood test after birth - the blood test is to see how much and then the anti-d dose tailored to this and given within 72h to prevent sensitisation.

All of this is only an issue of you are Rh- and your baby is Rh+

No one can tell you exactly what happened when you were pregnant/gave birth as we can’t see your record and you seem unsure on a few details. You should request a debrief session with your maternity trust and they will be able to review your notes and answer your questions. Or go via PALS if you have complaints about your care.

You need to chase this up

Definitely request a debrief and an explanation of any follow up care. It sounds like there may be additional risks and treatment needed if you decide to have another baby.

Just wanted to say thank you for all the replies.

I think I’m just frustrated - I (stupidly) forgot to ask the GP at our 6-8 week check it just came to me in the dead of the night when I was awake!

I will try PALS to begin with and see how I get on.

I read about anti D potentially causing false positives in baby (when he was born he was referred to as the DCT positive baby which I didn’t appreciate either) but was dismissed.

Had the blood test I initially had at 28 (thanks to the pp I couldn’t remember what week it was given!) weeks been tested it would have given a result before the anti D was administered. I would have been interested to see what it was.

Ultimately, I know I can’t change what’s happened and it was no one’s fault, I just wish I had been given all the information of what it means now. I just got told by my excellent midwife about a blood card that I needed to carry with me in case I got into accidents (that I’ve never received) and also if I wanted another baby and our blood mixed I could require a blood transfusion in the womb! It’s quite a lot to take in without anyone going through it properly with me.

Thanks again!

also if I wanted another baby and our blood mixed I could require a blood transfusion in the womb!

I'm a RH +ve baby from a sensitised RH-ve mother from a time before anti D. Yes, I had to be induced and received an exchange transfusion at birth with some time in SCBU but it's not all doom and gloom and medicine has moved on since in was born! I have two older siblings who were not affected at all (so presumably one is rh-ve and the other +ve)

@MissJam it sounds from your initial description like the sensitisation occurred before this pregnancy, if you had levels the midwife said were too high to have just occurred. So you’ll maybe never know how it happened. (And it only matters if you fall pregnant with another positive baby. I only had one positive baby (in 4) so it was never an issue for me.) And you had a new baby, not surprising you had other things on your mind! So yeah, ask for a debrief appointment. I’ve found PALS hugely helpful, they should be able to set you up and then you’ll have the information you need 💕

Thank you for that, I wasn’t suggesting it was all doom and gloom at all but it’s good to know that you’re ok!

I’m lucky I had a very ‘easy’ birth with my son, my partner would like another - but I don’t think I’m prepared for potential induction and/or in utero transfusion. Of course if we have a rh -ve baby it wouldn’t be required but no one can be predict it… it’s a difficult one. And I’m no spring chicken anymore!

My booking blood showed no antibodies - would this have been the case if it had happened before the pregnancy? I’m clueless 😂

It’s so interesting to hear of people having positive and negative babies! My nan was rhesus positive and her non identical twin rhesus negative!

Thank you for the advice everyone 🙂 I’ll try and string an email together to PALS, though if my posts on here are anything to go by I’ve got no chance!

@SoupDragon

I hope my post didn’t seem rude I didn’t mean it to but reading it back it comes across snappy!

I’m a terrible worrier!

Thanks again for the input, it makes a lot more sense now, hopefully someone who dealt with me can give me a full explanation 🙂

@MissJam right, sorry, I have misread. I was thinking of your midwife saying it hadn’t happened in labour. So what you don’t know is, did the 20 week bloods show a positive because of a sensitisation or because you’d had anti D the day before. Either way, you now have the antibodies so it could maybe risk a future positive baby.

I wonder if you need anti D in future if you’ve already had a sensitisation? Could it help? Or would it do nothing?

It’s an interesting topic like you say. And it means I know all of my children’s blood groups, and I know my husband carries the recessive negative gene - if he was DD to my dd, all our children would be Dd (positive) but he must be Dd so we can have dd children.

Hope you get your answers - Id be interested to know what they say if you had time and didn’t mind sharing. xx

@LulaK

The midwife at the 28 week bloods was adamant (to the point of shouting me down!) that I MUST have the blood test before the anti D. Which she then labelled incorrectly 🙄

According to my midwife, anti D wouldn’t do anything now, so I wasn’t given any after birth.

I’ll definitely update the thread if/when I get any answers 🙂

I know you weren't all doom and gloom (and not were you snippy) but it is very easy to only see the difficulties and risks so sometimes it's nice to hear positives 🙂

It's natural to worry and very often you do only hear the potential risks. I bet a lot of these interventions are fairly common now and nothing to be too worried about compared to some of the truly miraculous things they do for babies - forewarned is forearmed though!

It would be good to find someone to talk you through what happened and what the implications are. The time when you have just had a baby is not the right time to take in information I don't think.

I agree with @SoupDragon and also I should point out my kids are late teens so any info/understanding I offer (not that it was much) may well be out of date, these things change all the time.

@SoupDragon @LulaK

again, thank you so much for the kind words, it has helped just talking about it as no one I know has any idea about it so good to know some people who have a little knowledge 😊 xx

I'm O rhesus negative and on my last baby I had antibody E, antibody G and another one and have a card to carry with me with my name, nhs number, and date of birth and saying I'm rhesus negative I would mention it to your doctor

I would email or phone the antenatal screening midwives at the hospital you delivered at. Alternatively the lead transfusion practitioner/nurse. They will be able to explain better than anyone else.

It seems strange that you weren’t given anti D after birth if DC is positive. Our trust policy is to test antibody levels every two weeks after a positive screen at 28 weeks (even if it is due to an avoidable repeat test after anti d was given, as we can’t guarantee that this is the reason). Did you not have any follow up after the 28 week bloods?

I didn’t have a ‘proper’ positive test at 28 weeks because they didn’t get my pre anti D blood results due to them not being labelled correctly. They took a repeat blood sample the day after, after which I’d had anti D. I’m assuming that because whatever is in the anti D showed up they weren’t concerned because they thought it was from the anti D? I’m sorry, I don’t really know what I’m talking about 😂 this is just an assumption.

That’s why I included anti D ‘passive’ as I don’t really know what it means- but that’s what is on my maternity notes at 28 weeks.

My next bloods were after birth and then when they got the results of that, my blood got referred to another lab due to transfusion thinking it was strange both me and baby had these high results. Apparently usually one or the other but not both present these. Supposedly they were trying to work out a dose for me because of the results but when the referral lab said I’d had a sensitising event it was deemed anti D would be of no benefit anymore.

Did any of that make sense?!

There is an excellent book by Dr Sara Wickman called Anti-d explained, which covers all about the anti-bodies and rhesus negative blood group etc.

Once you have been sensitized it is irreversible, therefore yes you would be at increased risk of having a baby in future with Rhesus disease. Not sure about carrying the blood card?

@Christinagreens Hi! Thanks for the recommendation.

I eventually got to the bottom of this (well sort of)
I should have been offered a blood test 6 months post natal to see if the antibodies were still present, which I never was.

After submitting a SAR from the hospital I finally received the card - which I should have got in February 2022!

I will take a look at the book, thanks again