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P41
Anti‐Cr a , Pegnancy and Transfusion Support
Author(s) -
Win N.,
Needs M.
Publication year - 2006
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/j.1365-3148.2006.00694_41.x
Subject(s) - medicine , pregnancy , fetus , antibody , blood transfusion , gestation , obstetrics , placenta , pediatrics , surgery , immunology , genetics , biology
The managemet of a patient with anti‐Cr a presents a challenge as it is impossible to locate Cr(a‐) blood from the UK donors. The data regarding haemolytic transfusion reactions (HTR) in association with anti‐Cr a is very flimsy. Patients with anti‐Cr a have been transfused with Cr(a+) blood uneventfully, some have provided Cr(a‐) units when red cell survival studies demonstrated shorten survival. UK guidelines (Daniels et al ) recommended that weak Cr antibodies are not considered clinically significant, and Cr(a‐) blood is not indicated. There is no firm evidence that anti‐Cr a causes HTR, but has been suggested to provide Cr(a‐) units for those with strong antibodies. Anti‐Cr a is unique as the antibody may diminish or even disappear during the course of the pregnancy. Weber et al have demonstrated that the decrease in anti‐Cr a during pregnancy is due to sequestration by the placenta. This protects the fetus from developing HDN. There were only four reported cases of anti‐Cr a during pregnancy. We report our experience in planning transfusion support for a pregnant patient with anti‐Cr a . Anti‐Cr a (IAT titre 32) was identified in the booking sample of a 31‐year‐old Somalian woman. Her blood typed as O,R1R1 At 28 weeks gestation antibody titre dropped to four. Plan for transfusion support was discussed with the obstetricians. Previous pregnancies were uneventful and the patient did not require any transfusion. In view of the significant drop in antibody level, instead of searching for rare Cr(a‐) blood, we advised transfusing group O, R 1 R 1 , K‐ rbcs if the patient required a transfusion. It was planned to deliver by vaginal route. The patient was seen again at 35 weeks gestation. By that time, the IAT titre had further dropped to 1. The healthy baby was delivered by vaginal route during the weekend. There was no clinical evidence of HDN. Delivery was uneventful and the mother did not require blood transfusion. Both the mother and baby were discharged the next day. Attempts to obtain cord and post delivery infant's sample was unsuccessful. Anti‐Cr a has not been reported causing HDN, therefore the patient with anti‐Cr a does not require close monitoring.The purpose of the serial antibody titration study in our case is to demonstrate the drop or disappearance of antibody. This assisted in making a final decision for selection of suitable blood for the patient.