anti-e antigen, seriousness? - Mothering Forums

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#1 of 12 Old 07-02-2006, 10:44 AM - Thread Starter
 
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Hi All,
I am working with a client (as a doula) who has the anti -e antigen. Her partner does have the "e" component in his blood. To my understanding, this is similar, but not as serious or common as Rh sensitivity. Is it correct to assume this would only be a problem if the fetal blood entered mom's blood (thus activating the antibodies). Is it aslo correct to reassure her of the unlikeliness of a problem, barring extreme physical trauma that might cause blood to mix. We are shooting for natural birth, to rule out any risks associated with induction, meds, etc. She is very very healthy, eats excellently, and is quite physically fit.

thank you for any input, smart women!:
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#2 of 12 Old 07-02-2006, 02:23 PM
 
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There are several minor blood antigens that can cause a positive antibody screen. The most concerning ones in terms of fetal effects are Kell and Rh-D. Anti-e is also associated with hemolytic disease of the newborn and fetal anemia, though, and her titers should be measured through pregnancy. Depending on the level of the blood titers, she may need an amniocentesis to identify the level of fetal effects (if any) and either pre- or post-natal treatment for fetal anemia.

It's not true that she must have a trauma in order for her titers to rise further. It's possible to have a silent feto-maternal bleed, which would increase her immune response, and it's also possible for titers to increase in the absence of any known fetal-maternal hemorrhage. If titers rise significantly, and the amniocentesis is positive for high levels of bilirubin, it's very likely she would be induced early. An alternate measure of fetal anemia if her titers do rise is a central cerebral artery Doppler US, but generally only university-affiliated hospitals are doing them.

These are all big "ifs". It's very possible to have a perfectly healthy initial sensitized pregnancy, but recognize that there is almost always some level of blood transfer at birth, and the next pregnancy is likely to be more affected. Again, anti-e tends not to be as problematic as anti-D or anti-K, but it's not benign, and she'll probably have a consult with an OB or a MFM at some point.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#3 of 12 Old 07-02-2006, 02:44 PM
 
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I have anti-kell antibodies and my three children have all had the kell antigen. It wasn't an issue with my first pregnancy (they didn't even dectect it until my second) It is likely that i got sensitized and started making the antibodies during my section with my daughter. My dh is heterozygous for the antigen, meaning that there is a fifty-fifty chance that our babies might have it. But if your clients dh is homozygous than the baby will have the antigen. And in that case, the antibodies can cross the placenta and attack the babies blood even if there is no trauma.

Baby is currently being monitored via doppler, checking the blood flow through the cerebral artery in the brain. My first son was born at forty weeks, very healthy even though he had the antigen and i had the antibodies. For whatever reason, my antibodies didn't effect him. And my current little one is still in the "no anemia" zone according to the MCA dopplers and i am 30.5 wks. So it is hard to tell how serious or not your client's case might be. I do know that it has the potential to be very serious, including severe anemia and stillbirth. Good luck with your client. If you need any further info, you can PM me. I know way too much about it

There is also a good section about it in Anne Frye's Diagnostic Tests in the Childbearing Year

Midwifery Student and Mama to 2 daughters and 3 sons.     
ribboncesarean.gif vbac.gifhomebirth.jpg I have given birth a variety of ways and I am thankful for what each one has taught me.

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#4 of 12 Old 07-02-2006, 02:46 PM
 
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OMFG, I was sure no one else in the universe was Kell antibody-positive. I'm in the middle of my first sensitized pregnancy, titers still low enough that no Doppler/amnio. DH is homozygous Kell (really, what are the ODDS?), so we know this baby is Kell-positive.

Sorry, didn't mean to threadjack.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#5 of 12 Old 07-03-2006, 12:16 PM - Thread Starter
 
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Thank you ladies. This is not just a "client" actually, it is my dear sister whom I love and adore, carrying my neice...

I own Anne Frye's book and it was reassuring to my sis (and mom) and to a degree, me, when we read it. Yes she will have bloodwork continuously throughout the rest of her pregnancy, and I know induction as early as safely possible is something that might be necessary. She is getting her care from an OB, as she prefers that. This is her second child, different marriage/father than her first. She likely got the antigen from a blood transfusion years ago. My nephew was never tested for anything during her preg with him, nor was she... no one picked up on it maybe? In any case, he was and is fine (8 years old). This is a second baby, more susceptible to complications perhaps? She is due in early November so we have a ways to go.

pray pray pray, that is what I am doing now.
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#6 of 12 Old 07-03-2006, 01:40 PM
 
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Quote:
Originally Posted by hippiemom
Thank you ladies. This is not just a "client" actually, it is my dear sister whom I love and adore, carrying my neice...

I own Anne Frye's book and it was reassuring to my sis (and mom) and to a degree, me, when we read it. Yes she will have bloodwork continuously throughout the rest of her pregnancy, and I know induction as early as safely possible is something that might be necessary. She is getting her care from an OB, as she prefers that. This is her second child, different marriage/father than her first. She likely got the antigen from a blood transfusion years ago. My nephew was never tested for anything during her preg with him, nor was she... no one picked up on it maybe? In any case, he was and is fine (8 years old). This is a second baby, more susceptible to complications perhaps? She is due in early November so we have a ways to go.

pray pray pray, that is what I am doing now.
First babies are generally not affected by blood incompatibilities. The minor factors aren't screened for routinely, either during transfusion or during blood typing, because for most people it's not a significant issue. Obviously, for women of childbearing age, that isn't the case. She probably had a routine antibody screen in the first pregnancy that was negative (as one would expect), and either from a transfusion or the blood transfer at birth was sensitized.

The first (few, even) babies born to sensitized moms aren't at terribly high risk unless her titers are quite high (the cutoff varies from lab to lab; at mine, 1:16 is a critical titer). I wouldn't worry too much, but recognize that she will probably be categorized as high-risk . It's okay; it's just a label.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#7 of 12 Old 07-03-2006, 05:49 PM - Thread Starter
 
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Thank you again, it helps so much to read this...
The transfuison was many years ago, occured when she was a kid, so maybe it was the first birth?

But anyway, what I have read is reassuring, and the anti-e seems less of an issue than some others. She chose OB care right from the start, that is her personality, so we'll see. I of course am starting my worry that she will need/be talked into induction, but we will just have to take that as it comes. If you could suggest further reading, particularly on what causes maternal-fetal bleeding that would be great. I will dig thru my books as well.

merci merci, and good luck to you!
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#8 of 12 Old 07-03-2006, 06:45 PM
 
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I did several searches on PubMed and came up with a lot of articles about Rh sensitization in general and a few on anti-e. Try www.pubmed.com ; it covers pretty much all the mainstream medical/academic journals.

The major risk factors for a fetal-maternal bleed are abdominal trauma and hypertension (because of the risk of placental abruption), as well as any invasive procedure like amniocentesis or external version. But it's possible to have a silent bleed with no symptoms and no risk factors, which is why they will follow titers throughout pregnancy.

Good luck!

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#9 of 12 Old 07-03-2006, 07:04 PM - Thread Starter
 
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Gotcha thanks. I was not aware it could just "happen" in a subtle way w/o outside trauma/invasion etc. Yes I read 2 articles on Pubmed as well.

So I will just try not to worry now!

thank you
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#10 of 12 Old 07-04-2006, 01:40 PM
 
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Looks like anti- e has less problems than c, kell or E. So..... maybe it will be no big deal. Glad to hear she has a wise woman looking out for her, hopefully her OB is as diligent as you, Hippiemom.

Good luck,

BE SURE TO LET US KNOW WHEN YOUR NIECE ARRIVES!!
Michelle
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#11 of 12 Old 07-04-2006, 05:33 PM - Thread Starter
 
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Thank you, soooo reassuring to read your kind words Yes if one is to have this issue apparently anti-e is the one that will cause the least amt of trouble..

Baby girl is due Nov 8, a Scorpio like her auntie Hippiemom! My 13 year old daughter could not be more like my sister, her build, her hair, the cusp of her sign, her brains...her temper! so it is my turn to have a kindred neice and I am so excited!

thanks again mamas, happy 4th!
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#12 of 12 Old 07-01-2008, 12:41 AM
 
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I'm having a hard time figuring out where exactly to post this so I hope you dont mind me adding it to this thread. This is my first post and I am about 21 weeks pregnant with baby number 2 (Due Nov 12). I developed the E anitgen with my last child during my emergency c section and I have a few questions. As anyone who is anti E will know it is SO difficult to find the answers to the oh so many questions that may be streaming through their head. I have stayed up til mind numbing hours of the night researching and trying to find the answers to MY questions without actually finding many to satisfy my worries enough to rest peacefully. As time has passed I have come to terms with what may or may not happen by convincing myself that the chances are very low that anything will actually come of this. So here I am about to be ending my 2nd trimester in no time and I find myself still wondering certain things. So hopefully SOMEONE out there will have any kind of answer for me. I assume that the problems that can occur with my being anti e present themselves in the late 2nd to anytime in the 3rd trimester, is this true? Should I be seeing a specialist? As it is right now I am a military wife and seeing a military doctor but they are hesitant to send me over to the high risk clinic. I am having my titers levels checked every 4 weeks but I still feel so lost because Im not seeing anyone prepared to deal with this condition if things start to take a turn for the worst. Well, I realize this post is getting a bit long so thanks to you who has read through the whole thing and I hope that there is someone out there who can help
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