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RH sensitization - Dr Braun opinion please!!!!!!!From: mary (anonymous@obgyn.net)Thu, 26 Oct 2000 20:58:17 -0500 (CDT)
At Wed, 25 Oct 2000, mary wrote: > >At Wed, 25 Oct 2000, mary wrote: >> >>At Tue, 24 Oct 2000, anonymous@obgyn.net wrote: >>> >>>I would concur with Dr. Wang. >>> >>>At Tue, 24 Oct 2000, mary wrote: >>>> >>>>At Mon, 23 Oct 2000, j wang, M.D. wrote: >>>>> >>>>>Even a small placental bleed can allow enough blood to develop a >>>>>sensitization, this could easily be missed by pathology, because they >>>>>are not able to look at every bit of palcenta microscopically. If you >>>>>had a neg screen at the beginning of #3, the conversion would have to >>>>>have been during that pregnancy. Based on the scenario, it would have >>>>>had to have been relatively early. The poly may have been developing >>>>>for weeks before it was diagnosed on US. >>>>>Hope this helps. >>>>> >>>>>At Mon, 23 Oct 2000, mary wrote: >>>>>> >>>>>>I would like some opinions I became RH sensitized to anti D and I am >>>>>>trying to figure out when. Thanks to allk of your help with my >>>>>>questions and alot of research I have it boiled down to two scenarios - >>>>>>what do you all think. >>>>>> >>>>>>Facts: >>>>>>preg one - normal pregnancy, screen at beg, middle and end neg, Rhogam >>>>>>28 weeks and end. baby bpos everything fine, coombs neg >>>>>> >>>>>>preg two - screen at beginning neg, miscarriage at 14.4 weeks, lost >>>>>>1800cc's blood during D and C, partial mole pregnancy, single shot of >>>>>>Rhogam after - no Coombs test after >>>>>> >>>>>>preg 3 - normal preganacy except for polyhydraminos ranging from >>>>>>27-31from week 32-36 , screen at beginning neg, no shot of Rhogam or >>>>>>screen at 28 weeks, Baby born at 36 weeks of RH, symptoms severe, Delta >>>>>>OD .118, dbl exchange transfusion, anemic, jaundice..... My titers at >>>>>>delivery were 8, 6 months later were 256. >>>>>> >>>>>>I figure either I am one of the 2% who became sensitized and had an >>>>>>affected child in the same pregnancy, with no physicalsigns or perhaps >>>>>>the bleed during the D and C was such that the Rhogam shot didnt cover >>>>>>it, I became sensitized and during a small bleed this preg became the >>>>>>affected one. Any guesses? My dr thought that it may have been caused >>>>>>in this preg by a placental bleed. But my >>>>>>placenta was normal, and I spoke to the pathologist and he doesnt see >>>>>>any evidence in the placenta to think so. Unfortunately not having the >>>>>>screen at 28 weeks is sort of the missing link. Any ideas? I need >>>>>>closure on this and I am stuck. >>>>>> >>>>>>Can any of you forsee any other scenarios? >>>>> >>>>>-- >>>>>James Wang, M.D >>>>>Assitant Clinical Prof. >>>>>Tufts University School of Medicine >>>>> >>>>>**Note: Opinions expressed here are for educational purposes only >>>>>and, as such, do not constitute a physician-patient relationship. >>>>>This information is not intended to supplant the need for you to >>>>>consult with your physician prior to choosing therapeutic options >>>>>and/or interventions. >>>>> >>>-- >>>William D. McIntosh, MD, FACOG >>>Clarksville, TN >>> >>>This is for educational purposes only, and is not intended to be replacement >>>or substitute for consultation and examination by an appropriate medical >>>professional. Due to time constraints, private e-mails cannot be answered. >>>
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