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Antibody Titer Case Studies

CLS 422 Clinical Immunohematology I. Antibody Titer Case Studies. Please work through these 2 case studies. Ask your site instructor for additional help if necessary. Case One. A twenty-eight year old woman, Gravida 2 para 1, is seen by her nurse midwife for a routine prenatal visit.

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Antibody Titer Case Studies

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  1. CLS 422 Clinical Immunohematology I Antibody Titer Case Studies Please work through these 2 case studies. Ask your site instructor for additional help if necessary.

  2. Case One • A twenty-eight year old woman, Gravida 2 para 1, is seen by her nurse midwife for a routine prenatal visit. • The clinician orders a Type and Screen. • The Transfusion Service performs the screen. The screen is positive with anti-E being identified. • The Transfusion Service performs an anti-E titer, with the following results:

  3. Case One – Initial Titer

  4. Case One – Initial Titer • What is the titer of this sample? • 16 • What is the score? • 43

  5. Case One – Initial Titer • Is this infant at risk of HDFN? • Yes, anti-E can cause HDFN. • What test might the clinician order next? • E antigen typing on the father of the baby. • How would that information be useful? • If the father types E negative, the fetus could not have inherited the gene for E, and would also be E negative. Therefore, the maternal anti-E would not destroy the fetal RBCs.

  6. Case One • The father of the baby was typed for E with positive results. • The mother had a repeat titer drawn at her next prenatal visit, one month later. • The Transfusion Service performed a titer on the current sample with the following results:

  7. Case One – Titer Two

  8. Case One – Titer Two • What is the titer of this specimen? • 32 • What is the score? • 50

  9. Case One – Titer Two • What additional testing must be done to determine the significance of this titer? • Repeat the titer on the initial specimen, and compare results. • The initial sample was titered in parallel, with the following results:

  10. Case One – Parallel Titer

  11. Case One – Parallel Titer • What it the titer of this specimen? • 16 • What is the score? • 43 • Has there been a significant change in the titer? • NO. There is not a difference of 2 tubes, or a change in score of 10 or more.

  12. Case One • The mother returned for a prenatal visit in 1 month, and had a titer drawn at that time. • The Transfusion Service performed titers on the current specimen, and ran the initial specimen in parallel, with the following results:

  13. Case One – Titer Three Initial Titer run in parallel

  14. Case One – Titer Three • What is the titer and score of the third titer? • >E titer is 64, with a score of 69. • Has there been a significant change from the original specimen? • Yes, the parallel titer is still 16, with a score of 43. The new titer has increased by 2 tubes, and the score has changed by more than 10. • How might the clinician follow the pregnancy from now on (other than additional titers)?

  15. Case One • Ultrasound • Peak systolic velocity of the middle cerebral artery (MCA PSV) • Amniocentesis • Bilirubin levels • Fetal lung maturity • PUBS (cordiocentesis)

  16. Case Two • A 42 year old woman was seen by her obstetrician at 26 weeks of gestation during a high risk pregnancy. • An antenatal Rh Immune Globulin evaluation was drawn at that time. • The laboratory performing the RhIG evaluation got a positive antibody screen, with anti-D being identified.

  17. Case Two • The physician requested an anti-D titer be performed. • The results were as follows:

  18. Case Two – Titer One • What is the titer and score? • Anti-D titer is 2, score 10. • What question might the technologist ask at this point? • Has the patient already received Rh Immune Globulin during this pregnancy? • Anti-D from RhIG rarely titers greater than 4.

  19. Case Two – Titer One • A review of the woman’s chart revealed she had received RhIG following amniocentesis at 18 weeks gestation. • The anti-D detected at 26 weeks was attributed to passive anti-D from RhIG. • The patient received an additional dose of RhIG, and the pregnancy proceeded without complications.

  20. The End How did you do? If you had problems, review the titer presentation.

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