Re: Anti D Injection
From: Efrain Ramirez (eramirezt@coqui.net)
Wed Feb 11 18:06:39 2004
I think the CREST figures are lower than that - ( used to use your
figures until recently in my consent forms) but you are right the risk
is small - BUT - IMHO - she can change her mind - I think that a hundred
dollars or so ain't worth it the risk - mis dos chavitos..
>At Wed, 11 Feb 2004, Jafar6 wrote:
>
>--Boundary_(ID_wtmrTv833jGY12IyC0oVpw)
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>on 2/11/04 12:28 AM, jayant shantilal at bhadesiajs@yahoo.com wrote:
>
>I have patient who delivered 3rd kid by C/section
>Mother is A negative blood grouped
>She had previous 2 kids, one was positive grouped and she had taken Anti D
>injection.second time kid was negative grouped and not given anti D
>injection.Now third time kid deliverd by C/sec is A positive blood grouped
>and she had undergone strilization operation too.Will she need this time
>Anti D injection?
>
>Dr. Shantilal
>
>1. A mathematic calculation suggests the patient is very unlikely to benefit
>from Rh immune globulin.
>
>15% chance of sensitization without protection of Rh immune globulin (ant-D
>injection). Chance of failure of tubal sterilization about 1/200 - 1/500.
>Therefore, a conservative estimate of 1/1300 that patient will conceive
>again and become sensitized.
>
>Usually a first Rh sensitized pregnancy is not dangerous to a baby, but may
>require ultrasound and maybe amniocentesis for surveillance. So odds of an
>affected baby in the future is small.
>
>Also, with a positive anti-D, I doubt the patient would be more difficult to
>transfuse in the future, since A negative blood or O negative blood is
>usually readily available.
>
>The risk of Rh immune globluin administration is minimal. I would guess the
>cost is about $200 US, but I am not sure, since our hospital buys it and
>administers it for us.
>
>2. I give it anyway for such a situation, partially for the small chance
>that the patient may conceive, and partially for medicolegal reasons. If she
>is the 1/1300 that becomes sensitized, that leaves me open to the potential
>of a multimillion dollar lawsuit.
>
>I hope that helps with your decision.
>
>Gary Kleinman, MD
>Bridgeport, CT
>
>For those in the USA, I would suggest we can improve this by voting
>Republican unitil tort reform is passed, then voting the Republicans out of
>office as soon as possible after that.
>
>--Boundary_(ID_wtmrTv833jGY12IyC0oVpw)
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>Re: Anti D Injection
>
>on 2/11/04 12:28 AM, jayant shantilal at bhadesiajs@yahoo.com wrote:
>
>I have patient who delivered 3rd kid by C/section
>Mother is A negative blood grouped
>She had previous 2 kids, one was positive grouped and she had taken Anti D injection.second time kid was negative grouped and not given anti D injection.Now third time kid deliverd by C/sec is A positive blood grouped and she had undergone strilization operation too.Will she need this time Anti D injection?
>
>Dr. Shantilal
>
>1. A mathematic calculation suggests the patient is very unlikely to benefit from Rh immune globulin.
>
>15% chance of sensitization without protection of Rh immune globulin (ant-D injection). Chance of failure of tubal sterilization about 1/200 - 1/500. Therefore, a conservative estimate of 1/1300 that patient will conceive again and become sensitized.
>
>Usually a first Rh sensitized pregnancy is not dangerous to a baby, but may require ultrasound and maybe amniocentesis for surveillance. So odds of an affected baby in the future is small.
>
>Also, with a positive anti-D, I doubt the patient would be more difficult to transfuse in the future, since A negative blood or O negative blood is usually readily available.
>
>The risk of Rh immune globluin administration is minimal. I would guess the cost is about $200 US, but I am not sure, since our hospital buys it and administers it for us.
>
>2. I give it anyway for such a situation, partially for the small chance that the patient may conceive, and partially for medicolegal reasons. If she is the 1/1300 that becomes sensitized, that leaves me open to the potential of a multimillion dollar lawsuit.
>
>I hope that helps with your decision.
>
>Gary Kleinman, MD
>Bridgeport, CT
>
>For those in the USA, I would suggest we can improve this by voting Republican unitil tort reform is passed, then voting the Republicans out of office as soon as possible after that.
>
>--Boundary_(ID_wtmrTv833jGY12IyC0oVpw)--
--
"The opposite of a correct statement is a false statement.
But the opposite of a profound truth may well be another profound truth."
Niels Bohr (1885 - 1962)
