Readers Questions About Du Blood Types and Cholestasis of Pregnancy
Wednesday, September 12, 2007
Kenneth F. Trofatter, Jr., MD, PhD
Tue Sep 11, 07:24:00 AM 2007 beegley101 said...
I have been typed by the Red Cross as a volunteer blood donor as O+. I am now 21 weeks pregnant and have been typed twice by my OB's office and the results are calling me O-. My OB says I'm probably 'weak D.' I'm worried about taking Rhogam. What happens if an Rh-positive patient gets Rhogam?
Kenneth F. Trofatter, Jr., MD, PhD said...
To beegley101 Sept 11: If the Red Cross has typed you as O-positive, and your doctor's office laboratory has not, I would go with the Red Cross. They are about as good as one can get in the blood-typing arena! Your doctor is probably correct - you likely have the Du-variant of Rh, sometimes referred to as the 'weak' Rh D-antigen, and technically this makes you Rh-positive. Du-positive women cannot become sensitized to the D-antigen. Therefore, Du-positive women do NOT need Rh-immune globulin (Rhogam) during their pregnancies. If you got it inadvertantly, it would probably not cause any harm to the baby, but you just don't need it. But, your doctor needs to get this sorted out once and for all, even if he/she has to send you to a hematologist to do so, althoough usually it is simply a matter of notifying the laboratory that there has been a discrpeancy in blood-typing and they need to screen for the Du-variant. This was a great question that I have not addressed in any of my posts on this subject. Du is very common in Black women, so I am sure a lot of readers will be interested in my response to your question. Thanks for reading! Dr T
Tue Sep 11, 05:25:00 AM 2007 Anonymous said...
I have 3 sons all of which I was induced at 37 weeks due to cholestasis. During all 3 pregnancies I also had gallstones, after my third baby I had my gallbladder removed. I am now 28 weeks pregnant with a girl and have no gallbladder, am I likely to get cholestasis in this pregnancy the same as the others? or should I be ok as i have no gallbladder/stones this time?
Kenneth F. Trofatter, Jr., MD, PhD said...
To Anonymous Sept 11: True cholestasis of pregnancy is linked to genetic polymorphisms involved in bile acid metabolism in the LIVER, not the gall bladder. Think of the gallbladder as simply a storage sac for certain digestive enzymes produced in the liver and released when fatty foods are present in the digestive tract. So, true pregnancy cholestasis will probably NOT be improved by removal of the gallbladder. However, if your cholestasis was related to obstruction of the bile duct by gallstones (causing bile acids to back up into the liver), not by an enzymatic defect in the liver, then you just might do better this pregnancy. But, having your gallbladder removed is a heckuva way to confirm the diagnosis of true pregnancy cholestasis! Hope you don't itch this pregnancy. Thanks for reading and for a great question! Dr T
Wed Sep 12, 05:05:00 PM 2007
Labels: Du-positive blood type, intrahepatic cholestasis of pregnancy, Rh-negative blood type
8 Comments:
At Sat Feb 09, 12:38:00 PM 2008,
Anonymous said…
Hi there!
I have a question about blood typing. I am seven weeks pregnant and at my first prenatal visit, my blood type was shown to be A+, which I knew already, but my antibody screen came back positive. I have never gotten a blood transfusion, and this is my first pregnancy. I have never had any STDs, and all of my other tests came back negative. (HIV, HepB, RPR, Rubella.) When I tried to reserach this, all I've found are articles about Rhogam, which I don't think I need as I'm Rh+. My OB wants me to repeat the test. I'm worried about hydrops fetalis or anything else that might be harmful to the baby. Can you help me shed some light on this? (By the way, ironically, I am an L&D nurse. I've never heard of this clinical finding in any of my patients.)
At Sat Feb 09, 05:02:00 PM 2008,
Anonymous said…
I also had this cholestasis of liver in pregnancy & had my gallbladder removed after. How did you get on with your pregnancy? what would my chances be if I were to get pregnant again as I am 41 & would love another child...
At Thu Feb 14, 08:41:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Feb 9: I will answer your question after you find out what antigen you have become sensitized to. We are seeing more and more women who become sensitized to non-Rh antigens and Rh-antigens which they do not carry, even if they are Rh-D antigen positive. But, if this is your firts pregnancy and you are only weeks pregnant, you may be 'sensitized' to something such as the Lewis antigen that will not have a deleterious effect on the pregnancy. Let me know... Dr T
At Thu Feb 14, 08:44:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous Feb 9: If you had TRUE obsteric cholestasis, it is related to an enzyme defect in your liver and you have a 90% chance of getting it again. However, if your symptoms related to 'cholestasis' were the result of gallbladder disease, now that your gallbladder is out, you will probably not have a problem. Dr T
At Mon May 05, 07:31:00 AM 2008,
Anonymous said…
I am Anti-E for my blood. I was told that given the blood type of my husband, it must have been as result of getting a blood transfusion back when I was only 16. They did blood tests often with my first pregnancy, but everything turned out well. My doctor said there was really nothing to worry about for future pregnancies as long as they were with my husband because his blood type didn't have the E factor for my blood's anti-bodies to the E factor to fight.
I am now pregnant again, but have a different doctor. After doing the first set of blood tests, they told me I was "high risk". I immediately mentioned the Anti-E and told them what my past doctor said about that. She said that yes, that was one concern, but that I also have a foctor (or an antibody to it...I don't remember which) to a factor that she called the "Kill Factor"? (She said it's easy to remember because it is spelled "kill, like to kill someone" and it is the most dangerous one to be concerned about). She asked if I would like her to get info for me, but I told her I would just "Google" it...but can only find articles about how blood types can kill someone, not about the Kill Factor.
Could anyone give me some info on it, or point me in the right direction please? Thanks :D
At Mon May 05, 10:03:00 AM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous May 5: You have antibody to the KELL antigen. This is something else you might have become sensitized to as the result of that previous blood transfusion. What is your antibody "titer?" Just like before, your husband's red blood cells should be checked to see if they are Kell-positive. If they are not, then your baby is at no risk; if they are, have your doctor refer you to a maternal-fetal medicine specialist. At this point, it is nothing to panic over and it also unlikely to 'kill' your baby as long as you have an experienced person helping to follow your pregnancy. Good luck and thanks for writing. Dr T
At Thu Jun 11, 08:36:00 AM 2009,
Malena said…
When I was pregnant with my first in 1986 I tested O- and received both the prenatal and post natal rhogams in 1987.
I also received rhogam with #2 in 1989, I'm not sure if they tested or just went on past history.
When pregnant with #3 I tested O neg Du positive and told to have Rhogam to be safe.
In my 4th pregnancy in 1991 I again tested O neg Du positve, but this time did not receive rhogam.
In 1999 I miscarried at 18 weeks tested O- and got rhogam.
Then in 2006 pregnant with #5 I tested O positive twice and did not receive rhogam.
Can you explain how this happens?
FYI I am a 40 year old white female with Scandanavian, English and possibly Irish and native American roots.
At Mon Jun 15, 06:39:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Malena June 11: It appears you are O-negative Du-positive which, as is pointed out in the post, makes you the equivalent of being Rh-positive. You did not need Rh-immune globulin but it is unlikely to have caused any harm that you got it.
Dr T
Post a Comment
<< Home