Strategies for antigen typing an alleged "father" of a fetus whose mother has developed alloantibodies capable of causing hemolytic disease of the newborn

A transfusion medicine physician who works at a large university medical center in Texas would like to know the practice at other hospital blood banks with regard to performing antigen typing of alleged 'fathers' as part of a prenatal work-up for pregnant females who have developed red cell alloantibodies capable of causing hemolytic disease of the newborn. Such studies are performed at his hospital by drawing a sample from the alleged father, labeling the specimen with the mother’s medical record number, and “Father of Baby”.

The inquiring physician is concerned about this approach for several reasons.

First, the blood bank in question is not licensed to perform "paternity testing", which he thinks this kind of testing really is. For the sake of accrediting agency and licensing inspections the blood bank states that paternity testing is not being performed.

Secondly, he is concerned about specimen integrity, because specimens are being labeled with a medical record number that does not truly belong to the person who is being tested.

Third, because the medical record number and the name on the specimen do not 'match', the test cannot be billed, which puts the blood bank in the awkward position of offering a free test, which raises additional concerns.

Finally, there is no way to guarantee that the alleged father is the biologic father (and from time to time he is not!).

Numerous attempts by the blood bank staff to change this procedure have met with stiff resistance from the OB/GYN department, which apparently wields immense power at the institution. The OB/GYN physicians maintain that such testing is essential in order to care for the developing fetus, in the event that a maternal antibody should develop.

The inquiring physician thinks that it would be better to clinically monitor the mother and fetus and intervene when appropriate, regardless of the antigen status of the alleged partner. For example, if a fetus appears to be worsening clinically, it would be irrelevant if the alleged father happens to be negative for the antigen for which the mother has an antibody (remember, he might not be the real father!).

One possible solution proposed by the blood bank would be to enter the alleged father into the hospital system, thereby giving him his own unique medical record number. Although this would eliminate the issue of specimen integrity and allow for test billing, it does not deal with the underlying issue of the manner in which the results are being applied in the clinical setting. Unfortunately, this too has met with stiff resistance from the OB/GYN department who do not want to burden the 'father' with the cost of the test. How do others address these issues?

The following comments have been received.

1. The Editor believes the following discussions are germane to the current issue.
   • The role of the husband's Rh (D) status in policies for administering RhIg to pregnant Rh-negative women
   • A case of suspected Kell HDN with apparent discrepancy between red cell antigen typing of fetal red cells by standard serologic techniques and amniocyte antigen typing by PCR

ADDENDA Feb. 14, 2005

2. A colleague at a Chicago hospital reports that when they do prenatal work-ups that require testing of an alleged father, the testing is done only if a physician orders it under the name and number of the man. By taking that approach, the testing is billable and linked to the correct person. In addition they do not consider the testing to be paternity testing, since they are not providing any interpretation regarding paternity.

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