Antenatal Serology at Rotherham District General Hospital

1
Antenatal Serology at Rotherham District
General Hospital

• Gary Steel
• 1st April 2008

2
Long before testing can commence

• Estimate Costs (locate the budget !)
• - Serology and Microbiology
• - Consumables
• - Staffing
• Design a request form
• Agree on a SOP
• Establish lines of communication between
• - Blood Bank
• - Consultant Haematologist
• - Midwives ( Hospital and Community)
• - Obstetricians

3
Long before testing can commence

• Update I.T. System
• - Input gestation period
• - Input previous obstetric history
• - HIV testing
• - System capable of automatically calculating
  recalls
• - System capable of bringing together maternal
  paternal details

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Action chart for blood grouping and antibody
testing during pregnancy
All Pregnant Women
10 16 Weeks (Booking)
Test ABO RhD Blood Groups Antibody Screen
Anti-D Anti-c K related antibodies
No antibodies
Other Antibodies
All Pregnant Women
Test ABO RhD group Antibody Screen
Test at least monthly
28 Weeks
Anti-D Anti-c K-related antibodies
No antibodies
Other antibodies
Test two Weekly
Test cord cell D group If mother D negative
Perform cord red cell DAT MONITOR INFANT FOR HDN
DELIVERY
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Testing Procedure

• Receipt of request/ Samples
• - 7mls EDTA ( antenatal serology)
• - 7 mls SST (microbiology)
• - now with booking sample 4.5 mls EDTA and FOQ
  for
• antenatal haemoglobinopathy screening
• Number Up
• antenatal form and sample in bar-coded numbers.
• non bar-coded number on microbiology sample.

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Testing Procedure

• 3. Enter request into computer
• 4. Using details entered generate a microbiology
  request
• Form Sample

Microbiology
5. Sample grouped and antibody screened
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Testing Procedure
6. Positive antibody screen antibody
identified - c D - to NBS for quantification
recall every 4 weeks up to 28 weeks then
every 2 weeks (more frequently if
necessary) and delivery - Other clinically
significant antibodies require titre using a
heterozygous positive cell recall at 28 weeks
and delivery - Non clinically significant
antibodies recall at 28 weeks and
delivery. - request paternal samples for each
pregnancy for clinically significant
antibodies.
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Action required when
Anti D
4 iu/ml
Anti c
11 iu/ml
Anti Kell ( related antibodies)
identified Clinically significant antibody titre
32 or greater
- Inform ANC and Consultant Haematologist
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Clinical Advice

• Consultant Haematologist always available
• Consultant Haematologist runs a clinic in
  Obstetric dept each
• month to help manage pregnant ladies with
  haematological
• abnormalities including RBC antibodies
• Obstetricians also obtain advice from reference
  centre

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Antibodies currently detected
Anti Kell 4 E c 1
E 3 Le(a) 1
M 5 S 1
UI 1 IgG anti-A 1
Lu(a) 1 Auto 1 c
Fya 1
TOTAL 20