question 1

A woman with sickle cell anaemia is found to have an Anti-U alloantibody during her pregnancy booking bloods. She does not currently require blood. Later in the pregnancy she is found to have placenta praevia.

How will you manage this patient’s pregnancy?

Antenatal

  • Monitor titre (serial dilution IAT)

  • USS for MCA dopplers, amniotic fluid volume

  • Refer fetomaternal unit, MDT approach

Delivery

  • Planned C-section

  • Pre-op anaemia Mx

  • Cell salvage

What options do you have to source blood for this patient, and what would be your preferred choice?

  • 1st choice – Is there any fresh U neg in stock?

  • 2nd choice - Blood from a directed donor – fresh, longer shelf-life, better quality.

  • 3rd choice – Frozen blood bank

 

Could you use a relative as a directed donor?

Risk is the increased pressure to lie on the donor safety check forms.

Would need irradiating up to 2nd degree relatives. 

 

What are the risks to the baby and how will you manage these?

At risk of HDFN. (Anti-U can target U antigen even buried beneath S or s.)

  • Cord blood at birth – DAT (—> elution if positive), Group, FBC, Bilirubin

  • Monitor for jaundice

  • Will need U neg blood at birth if transfused due to maternal antibody