Rh Antibody Titre

Immunity

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Critical in pregnancy to assess the risk of hemolytic disease of the fetus and newborn (HDFN) caused by Rh incompatibility

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Rh Antibody Titre - Comprehensive Medical Test Guide

Why is it done?
- Measures the concentration of anti-D (anti-Rh) antibodies in the bloodstream, which are immunoglobulin molecules directed against the RhD antigen found on red blood cells
- Identifies Rh sensitization (alloimmunization) in pregnant women, particularly Rh-negative mothers who may have been exposed to Rh-positive fetal blood
- Assesses risk of hemolytic disease of the newborn (HDN), a serious condition where maternal antibodies attack fetal red blood cells
- Determines the need for anti-D immunoglobulin (RhoGAM) administration in Rh-negative pregnant women
- Evaluates patients with previous Rh sensitization from transfusion of incompatible blood products or previous pregnancy
- Monitors antibody levels throughout pregnancy to predict severity of hemolytic disease and guide clinical management
- Performed at first prenatal visit, 28 weeks of gestation, and with any sensitizing event (trauma, abruption, antepartum hemorrhage)
Normal Range
- Negative or <0.5 IU/mL (International Units per milliliter): Indicates no detectable anti-D antibodies; absence of Rh sensitization
- Titre reported as ratios (e.g., 1:4, 1:8, 1:16, 1:32): Sequential dilutions showing the maximum dilution at which antibodies are still detectable
- Units of measurement: International Units per milliliter (IU/mL) or titre expression as ratio of dilution
- Normal interpretation: Absence of anti-D antibodies means no prior sensitization to Rh-positive blood or fetal antigens; pregnancy can proceed with standard precautions
- Positive results: Any detectable anti-D antibodies indicate Rh sensitization has occurred; titre level quantifies antibody concentration
- Critical titre threshold: Approximately 1:4 (≥0.5-1 IU/mL) is often considered the critical level above which fetal anemia risk increases significantly
Interpretation
- Negative Result (<0.5 IU/mL or 1:0): No anti-D antibodies detected; no previous sensitization; Rh-negative patient is not immunized and can safely receive anti-D prophylaxis if needed; low risk for hemolytic disease
- Low Titre (1:2 to 1:4): Mild sensitization present; early stage of immunization; close monitoring recommended; may still be below critical threshold; assess for sources of sensitization
- Moderate Titre (1:8 to 1:16): Significant sensitization; may be approaching or at critical level; moderate risk for fetal anemia; recommended to perform middle cerebral artery (MCA) Doppler ultrasound; consider amniocentesis for amniotic fluid bilirubin assessment
- High Titre (≥1:32): Substantial antibody levels; above critical threshold; high risk for moderate to severe hemolytic disease; definite need for non-invasive fetal monitoring via MCA Doppler; may require intrauterine transfusions; close obstetric follow-up essential
- Rising Titre on Serial Testing: Indicates active immune response and ongoing sensitization; suggests worsening hemolytic disease risk; may result from recent fetomaternal hemorrhage; requires urgent intervention and close monitoring
- Stable Titre on Serial Testing: Indicates chronic sensitization without active immune response; risk remains dependent on absolute titre level; continued monitoring recommended but less frequent than with rising titre
- Factors Affecting Results: - Recent anti-D immunoglobulin administration (may cause passive antibodies) - Time interval since sensitizing event - Volume of fetal-maternal hemorrhage - Individual immune response variation - Presence of complement-binding vs non-complement-binding antibodies - Laboratory testing methodology (indirect antiglobulin test, enzyme techniques, gel technology)
Associated Organs
- Primary Systems Involved: - Hematologic system: Red blood cells carrying RhD antigen - Immune system: B and T lymphocytes producing anti-D antibodies - Placental system: Site of fetal-maternal hemorrhage - Fetal system: Fetal red blood cells at risk of hemolysis
- Associated Medical Conditions: - Hemolytic disease of the newborn (erythroblastosis fetalis) - Hydrops fetalis (severe fetal edema, ascites, pericardial effusion) - Intrauterine fetal anemia - Kernicterus (bilirubin-induced neurological damage) - Fetal growth restriction - Intrauterine fetal death - Neonatal anemia requiring transfusion
- Conditions Associated with Abnormal Results: - Rh negative maternal status with Rh positive fetal blood exposure - Prior transfusion of incompatible blood products - Placental abruption or preeclampsia with fetal-maternal hemorrhage - Amniocentesis, chorionic villus sampling, or cordocentesis - Intrauterine fetal death with retained fetal tissue - Multiple pregnancy with complications - Ectopic pregnancy rupture - Miscarriage or therapeutic abortion
- Potential Complications from Abnormal Results: - Severe fetal anemia requiring intrauterine transfusion - Hydrops fetalis causing fetal death - Severe neonatal jaundice requiring phototherapy or exchange transfusion - Permanent neurological damage from kernicterus - Fetal or neonatal death - Requirement for intensive neonatal care - Long-term neurodevelopmental complications if severe disease occurs
Follow-up Tests
- For Negative Results: - Repeat Rh antibody titre at 28 weeks gestation - Kleihauer-Betke test or flow cytometry if any sensitizing event occurs - Administer anti-D immunoglobulin (RhoGAM) at 28 weeks as prophylaxis - Standard prenatal care without special fetal monitoring
- For Low to Moderate Positive Results (1:2 to 1:16): - Serial Rh antibody titre every 2-4 weeks - Middle cerebral artery (MCA) peak systolic velocity Doppler ultrasound - Consider amniocentesis for amniotic fluid bilirubin analysis if titre at or above critical level - Obstetric consultation with maternal-fetal medicine specialist - Specialist fetal assessment
- For High Positive Results (≥1:32): - Serial Rh antibody titre at least every 2 weeks - Weekly or bi-weekly MCA Doppler ultrasound - Amniocentesis with amniotic fluid bilirubin measurement - Cordocentesis (fetal blood sampling) if Doppler suggests fetal anemia - Intrauterine transfusion if significant fetal anemia confirmed - Nonstress testing to assess fetal well-being - Early delivery consideration based on gestational age and fetal condition
- Monitoring Frequency: - First visit: Baseline assessment - 28 weeks: Routine repeat screening - If negative: Standard antenatal care only - If low titre: Every 2-4 weeks or as clinically indicated - If moderate titre: Every 2 weeks with MCA Doppler - If high titre: Every 1-2 weeks with intensive fetal monitoring - After sensitizing event: Within 72 hours
- Related Complementary Tests: - Blood typing (ABO and RhD) for maternal and fetal/neonatal confirmation - Direct antiglobulin test (DAT/Coombs test) on neonatal blood - Kleihauer-Betke test or flow cytometry to quantify fetal-maternal hemorrhage - Indirect antiglobulin test (indirect Coombs) for other alloantibodies - Complete blood count (CBC) for hemoglobin/hematocrit assessment - Reticulocyte count indicating bone marrow response - Serum bilirubin levels in neonatal period - Ultrasound assessment of fetal anatomy and hemodynamics - Doppler studies of fetal cardiovascular function
Fasting Required?
- Fasting Required: No - fasting is not required for this test
- Food and Fluid Intake: Patient may eat and drink normally before the test; no dietary restrictions apply
- Medications: No medications need to be avoided; continue routine medications as prescribed; inform laboratory of recent anti-D immunoglobulin administration as this may affect interpretation
- Sample Collection: Single venipuncture from arm vein; typically 5-10 mL of blood collected in appropriate tube (usually EDTA or serum separator tube depending on facility protocol)
- Patient Preparation: - Wear comfortable, loose-fitting clothing to facilitate vein access - Inform phlebotomist of any history of difficult venipuncture - Remain seated or reclined during blood draw to prevent dizziness - Drink adequate fluids before collection to improve vein visibility - Inform laboratory of recent blood transfusions or anti-D administration - Provide accurate last menstrual period and delivery date information when applicable - No special timing restrictions; can be drawn at any time of day
- Special Instructions: - Report any recent blood transfusions or suspected transfusion reactions - Disclose all sensitizing events (trauma, abruption, vaginal bleeding, invasive procedures) - Document exact timing of any previous anti-D immunoglobulin dose - Ensure samples are properly labeled with correct patient identifiers - No restriction on physical activity after blood draw - Results typically available within 24-48 hours; some labs offer stat/urgent processing

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