FRCPath Haem Part 1 MCQs-Transfusion 482

A 29-year-old woman, G2P1, is found to have a positive antibody screen at 12 weeks' gestation. She is D-negative and has no history of transfusion. Antibody identification demonstrates apparent anti-C and anti-D. The anti-C titre is relatively high.

The obstetric team asks whether she should receive routine antenatal anti-D prophylaxis.

The case is referred to the red cell immunohaematology reference laboratory, where further investigation demonstrates that the apparent anti-D reactivity may be due to anti-G, with or without genuine anti-C. There is no convincing evidence of immune anti-D.

Which of the following is the most appropriate management?

A.

Withhold anti-D prophylaxis because anti-G provides protection against D alloimmunisation.

B.

Withhold anti-D prophylaxis because the presence of apparent anti-D indicates that she is already immunised.

C.

Give RAADP and appropriate post-delivery anti-D prophylaxis, while monitoring the pregnancy according to the clinically significant antibody identified.

D.

Give anti-D only after delivery because antenatal anti-D is contraindicated when anti-C is present.

E.

Give prophylactic anti-D only if the fetal genotype is confirmed to be D-positive.