Inconsistent Rh typing results

A physician in Texas reports that his transfusion service laboratory has encountered an interesting patient/ dilemma. The patient had her first pregnancy in 2003 and a commercial laboratory typed the patient as Rh positive, but qualified the result with a comment that the patient was 'Weak D' or Du. This finding was discussed with the physicians caring for the woman and RHIG was NOT administered to the patient. The women became pregnant a second time, and a different commercial laboratory typed her as Rh positive (with no comment about being Weak D or Du). She did not receive RHIG during her second pregnancy. She patient is now pregnant for the third time and the commercial lab that did her initial Rh typing now reports that she is Rh negative!!! The inquiring colleague has verified the records to be correctly reflect that the patient has had 3 pregnancies and 3 different (discordant) Rh typing results. The woman is in the first trimester and spotting. The inquiring physician wonders if any colleagues would recommend administering RHIG at this point in time. Furthermore, the lab director at one of the commercial labs was contacted and acknowledged that they are following 'new' guidelines, so that they do not 'look' for weak D patients any more.

NOTE: The Editors think that colleagues will find the following discussions to be germane to the above case:

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Ira A. Shulman, MD
CBBS e-Network Forum Senior Editor & Moderator

W. Tait Stevens, MD
CBBS e-Network Forum Editor & Moderator

Elizabeth M. St. Lezin, MD
CBBS e-Network Forum Associate Editor & Moderator

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