Re: OB: Abnormal Antibody Screens (long)
From: Jeff Korotkin (jkorot@mindspring.com)
Tue Dec 9 13:54:32 1997
At 02:52 PM 12/6/97 -0600, you wrote:
Gary, besides getting a new lab, I strongly suggest that the patients
insurance carrier be advised of the difficulty you are having and that they
are being forced to pay more due to the inefficiencies of the lab and lack
of proper controls. Also, get the patient involved.
Clinically, the patients will most likely be unaffected by the results in
the first case, at least as of now. In the second case, Anti-M has been
associated with hemolytic disease and this will need to be followed with
titres and if the titre goes above 1:16 amniocentesis for delta od 450
should be considered.
>It seems that our local Smith Kline Lab, who is the major player in
>Atlanta since they have most of the contracts, has a newer, more
>sensitive technique for prenatal antibody screens, which, of course, has
>led to more problems. 2 examples, and any comments/suggestions are
>welcome. Both of these tests were done with routine blood in the first
>trimester. Both are Rh positive.
>
>patient 1
>
>38 YO with a long history of infertility, Para 0020 (one Tab years ago,
>and one missed Ab in 1993 that I did a D and C for with a *negative
>hospital antibody screen preop* ) now is pregnant through ART with a
>singleton, and has a report that states that she has a postive antibody
>with "no apparent specificity." How silly of me, I submit a repeat and
>get the same results. Next, I talked to the head of the labs' blood
>bank department, who tells me this probably isn't important. I then
>asked her to put something like that in the report, and she balked, so I
>asked her to have the Pathologist call me. She then told me that she
>probably knows more about this stuff than does he (and I believe her);
>nevertheless, I did receive a call from the Pathologist after I called
>our client services rep, and he agreed that further testing with the
>refernce lab and discussing the situation with the manufacturer would be
>helpful, and, yes, that it is reasonable to ask the lab/Pathologist for
>guidance here. Whew!
>
>patient 2
>
>37 YO Para 1011, first pregnancy missed AB/D and C by me, second
>pregnancy uneventful term, with a negative prenatal Antibody screen with
>Smith Kline 2 years ago. At some point, I think in her term pregnancy
>with her Prenatal panel, she had a false positive RPR of 1:2 or so, and
>when I told her, she told me she's always had that (I guess from her
>premarital blood, which in Georgia is an RPR/Rubella). Anyway, I did a
>Lupus Anticoagulant, and Anticardiolipin anitbody, and both were
>negative, and she went to term uneventfully.
>
>Now, in her third pregancy, I get the "no apparent specificity" report,
>and submit more blood, and the next report says that the antibody cross
>reacts with all of her cells, and autoimmune disease is suspected. If
>this is her first pregnancy, it is unlikely to be a problem.
>
>Well, it's *not* her first pregnancy, so when I talked to the blood bank
>director, I asked again for guidance, and eventually she agreed to
>submit more blood to the reference lab. I talked with the Pathologist
>about this one, too.
>
>BTW, in the midst of all of this, I had a patient (P 1001) with a 1:8
>anti-M. That one is a whole lot easier!
>
>Any thoughts, besides get a new lab?
>
>Garry
>
>--
>Garry E. Siegel, M.D., FACOG
>Private Practice
>Roswell, Ga.
>
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