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Coombs Positive?

Last post 10-25-2013 2:18 PM by beckypokemon. 6 replies.
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  • 01-28-2011 2:14 PM

    Coombs Positive?

    Does anyone know what being Coombs positive means?

    About 8 yrs. ago an aunt had her 3rd daughter (hospital). they told her she was Coombs Positive. The Dr. said that if they got pregnant again she needed to mention her positive Coombs test to the OB.

    Years later she got pregnant, (never mentioned to the OB about the Coombs test), and at about 6mos. they told her the baby had heart/lung problems and she should probably abort. She chose not to, and long story short, her baby lived. He had several heart surgerys in those first days. Then he ended up having a heart transplant at about 1 yr. He was doing fine, until about his 2nd birthday when he passed away from Heart failure. (That is not the full testimony of his wonderful life-will include that some other time)

    Less than a year after his death, she got pregnant again. Things were going well, her family was back on their feet and recovering, when she called one day saying she was headed to the hospital because her water broke.(about 22 weeks). They said she started having cntx. and so they induced her. The baby passed away as he was being delivered. It was heartbreaking.

    A couple of months after that she had her tubes tied, saying the OB told her she had a "rare blood problem" that anytime she got pregnant would either cause her to miscarry or the child to have heart defects. She had made the comment to me that she wonders if that Coombs test was in any relation to all that happened?

    I have no clue. Does it link in with this? What "blood problem" could cause such things? Frye talks about Coombs in Diagnostics, but frankly I didnt understand it. Just thought I'd throw this out there for someone to ponder.

  • 02-28-2011 4:17 PM In reply to

    Re: Coombs Positive?

    Hi there,

    I'll explain it as I understand it. (And hope it's correct, if somewhat simplified...)

    There are two kinds of Coombs test:

    The direct Coombs test and the indirect Coombs test.

    The indirect Coombs test is done on pregnant women's blood. It is what is called the antibodies test. If it is positive, it means that the woman's blood has developed antibodies against the Rhesus factor or some other factor that crossed into her blood from her unborn baby's blood. She might also have got these antibodies from a previous pregnancy or birth or from some other cause altogether. 

    Let's pause quickly to explain what the Rhesus factor is:

    The Rhesus factor is something that exists on the surface of red blood cells. Being Rhesus factor positive means one does have the Rhesus factor. Being Rhesus factor negative means that one does not have the Rhesus factor.

    During pregnancy and more so at birth, a problem can occur if the mother is Rhesus factor negative and the child Rhesus factor positive. If in such a constellation the bloods of mother and baby mix, which can very rarely happen during pregnancy or somewhat less rarely at birth (although it is not supposed to happen normally), then the mother will make antibodies against the child's Rhesus factor, which is alien to her blood.

    It takes some time for these antibodies to form, so they would not harm this particular child. However, if her body continues to produce these antibodies, they can then harm a future child. Because in a future pregnancy, these antibodies against the Rhesus factor can cross the placental barrier and get into the unborn child's blood. If the unborn child is Rhesus factor negative, no harm will happen. But if the child is Rhesus factor positive, then these antibodies attack the Rhesus factor. As the Rhesus factor is on the red blood cells, what this basically means is that the red blood cells are attacked. The red blood cells are in charge of transporting oxygen through the body. If they don't work properly, then the unborn child has anemia. As a result, the heart will try to compensate by pumping the blood quicker. This over-exertion of the heart causes fluid to accumulate in the body (e.g. the heart and lungs) and in the worst case, it can lead to heart failure and thereby stillbirth. In a mild case, the unborn baby might be completely fine. After the birth, such babies might possibly still be completely fine or just show more pronounced jaundice.

    Jaundice occurs as a result of the breakdown of red blood cells. One by-product of the breakdown is bilirubin, which causes the yellow colour.

    In a bad case, a Rhesus positive baby whose red blood cells are being broken down by maternal antibodies, would have very severe jaundice and even require an exchange transfusion, whereby the old red blood cells are removed and replaced by new ones (from donor blood). 

    The name for the disease that occurs when a Rhesus positive child's red blood cells are broken down by maternal antibodies is hemolytic disease of the newborn or Rh (Rhesus factor) disease.

    Remember I previously mentioned there are two types of Coombs test, the direct and the indirect one? Here the direct one comes in. It is done with cord blood after the birth, if mother is Rhesus negative. If the direct Coombs test is positive, it means baby has hemolytic disease of the newborn.

    This disease was more common before. (Although it by no means happened to a majority of Rhesus negative women, as is sometimes suggested. Even back then, it was among the rarer things to happen.) Nowadays it is extremely rare, because Rhesus negative mothers who give birth to Rhesus positive babies receive a shot of anti-D within 72 hours after the birth. Often Rhesus negative mothers even already get one or two shots in pregnancy, either routinely or after an accident or bleeding. This might be helpful, but is not as relevant as the shot after the birth, which is much more important, as it is at birth that the bloods of mother and child are most likely to get in contact, if at all.

    The anti-D shot contains antibodies against the Rhesus factor. As they are provided from an external source (the shot), the mother's body does not need to produce them herself and therefore has no memory for producing them, meaning it won't produce them. Therefore no risk for future babies. (In very very rare cases, the shot might not work and a mother might produce her own antibodies anyway.) 

    So to sum the whole story up and relate it to your Aunt, from your story it seems like your Aunt, who is supposedly Rhesus negative, developed antibodies against the Rhesus factor, which caused hemolytic disease to her fourth and fifth baby, who both must have been Rhesus positive.

    Sad story. I hope she and her family are doing fine nowadays?

    My heart-felt regards to her and to you for trying to understand what happened. I hope you understood my explanations. And to you others out there who understand these things better than me, if I said anything incorrect, please correct me.

    Sisterly love,

    Nina

     

    Nina Rinkes, homebirth midwife

    "Life shrinks and expands in relation to one's courage." Anais Nin
  • 03-27-2011 5:17 PM In reply to

    Re: Coombs Positive?

     thanks for the answer.

    the family is doing okay. I am sure they are still hurting though. So I assume that means her child bearing days are over? Poor thing. Barely 30.

     

  • 03-27-2011 6:26 PM In reply to

    Re: Coombs Positive?

    If actually the reason for the problems with babies number 2 and 3 was that she is rhesus negative with antibodies against the rhesus factor, then there would only be one safe way to have another baby and that's if baby's dad was rhesus negative, because then it wouldbe guaranteed that baby would be rhesus negative as well, in which case the antibodies would mean no harm to it.

    However, from the description you gave of the case I think it is not absolutely clear that that was the reason, although it very much sounds like that was the reason.

    If they ever want to have another baby, they should get all the previous medical notes and read them together with a knowledgeable person who can make sense of it all.

    Nina Rinkes, homebirth midwife

    "Life shrinks and expands in relation to one's courage." Anais Nin
  • 03-27-2011 6:28 PM In reply to

    Re: Coombs Positive?

    Oops, I just remember you wrote she had her tubes tied. So anyways she would not have anymore babies... Forget about my last comment, sorry.

    Love,

    Nina

     

    Nina Rinkes, homebirth midwife

    "Life shrinks and expands in relation to one's courage." Anais Nin
  • 09-02-2013 9:25 AM In reply to

    Re: Coombs Positive?

    hi Nina..

    My wife is pregnant@28 weeks and  tested weakly positive in ICT..She is B-ve and I am B+ve. We have one baby 7 yrs old with B+ve....now what to do?

  • 10-25-2013 2:18 PM In reply to

    Re: Coombs Positive?

    hi nina 

    my name is becky im 14 and i was born with a minor form of coombes syndrome wich ment im highly enimic so have to eat alot of iron and have some form of vitamin deficiancy wich means i have really weak teeth and nails but im just wondering , will i be able to have healthy children cus my mum said if i dont have a shot then me and the baby could be harmed, i dont know whether any of this is true but im a bit confused about the long term affects of me having coombes syndrome.

     i am my mums 5th long term pregnancy but her first was a still birth with a seperate dad which is where i got the alien antibodies from.my mum has O-ive and my dad has A-ve, thats all i know at the minute so i was hoping you could elaborate for me please 

    thanks xxx

    from becky :)

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