RH- to RH+?

[Maggi315]

HI,
I had a client, primip, transported for failure to progress this weekend, ended up with c-section due to baby stress. Anyway, I tested her early in her pregnancy with eldon card, she was A-, I retested with another card (different lot and exp) to verify, again A-. At hospital, after c-section, tested blood,she came back A+, retested at her request, again A+.

Another midwife forward me info from Anne Frye's book and an ob/gyn book by Gabbe that says in rare cases, if there is fetal cells in moms bloodstream (even low amounts, 20ml), this can cause mom to falsely test positive, even though she is negative. Anyone have experience with this?

After doing some research, I called and talked with doc and asked if he had run a Kleihaurer Bettke test (not sure on spelling?). He did not think necessary or warranted and if fact, they were considering giving her some blood because her platelets were low (which let to a diagnosis of HELLP?), so after some discussion (OK, started out as a discussion, turned into a bit of a heated disagreement), he agreed to run test. Haven't heard today if it was done or not.

So maybe I'm wrong and test is inappropriate, but still, I feel before giving blood and deciding not to give RHogam, we need to be positive, right?

any references or experiences would be helpful, I admit to not knowing much about this, haven't heard of it before.

thanks,
Barb
I did cross post this on sagefemmes, so you might see it twice

[Ackray]

One of the tests must have been wrong. It's not possible to change blood types. I've never heard of fetal blood cells being in the mother's blood.

[pamamidwife]

Eldon cards are NOTORIOUSLY inaccurate. It's why I never use them. I would only trust blood sent to a lab.

[Maggi315]

yeah, I'm thinking it's the cards, however, my friend at the local lab tells me they use the cards just like I do to do the blood typing?

On another list, someone mentioned the sensitivity of the labs to pick up the weak D too, which is another possibility, again, the eldon cards wouldn't pick that up.

I will have a hard time with some of my population talking them into getting blood drawn, but that's what I'm thinking needs to be done to be the most accurate.

[pamamidwife]

Yeah, well I worked at a birth supply house and we were getting bad reviews on the Eldoncards all the time. Labs may use something similar, but IMO there is too much subjectivity to non-labs utilizing this method. You know? The interpretation can be a bit off. I used to use them, but now I just send it to the lab.

Can you draw the labs yourself and then take it in? Sometimes if you save them a trip that helps.

[lorijds]

When they type and cross for blood, they are going to run a multitude of tests to confirm blood type and antigen/antibody presence. Just FYI.

I, too, would trust blood from the lab over blood on the cards. The labs in our hospital do not use cards.

[Maggi315]

Yeah, I'm going to have to just have the labs run the whole type, cross and match I think.

and I'm not going to waste any more money doing the baby's type at birth on the card, I'll send in the cord blood, I guess.

Thanks! Does anybody happen to have any comparisons or studies with the eldon cards? I just told my senior and my 7th grader about it, I think it would be a very cool science fair comparing the accuracy! they love my science fair project ideas, we've done: comparing the absorbency of brand vs. generic diapers, breast milk bacteria growth and others!