Conference moira::parenting

    Leslie,
    isn't this standard procedure for the blood taken from the foot
    at birth? I can't remember at what point I knew, but that information
    was given to us (in no real official way, but I am sure it made it 
    to Charlotte's chart) the day Charlotte was born.
    
    Monica

Knowing it may be nice information, but I wonder about the practical 
importance of knowing a blood type.  I know mine (A+) but when I give blood, 
they check it anyway; I assume that's precautionary, and I think it's a good 
precaution.  If a person needs to receive blood, I'd guess that the same 
thing applies; they will test it anyway, even if the person or her/his 
parents know or think they know.  As you point out, the test is easy and 
quick, and in some cases the results of misinformation can be quite serious.

Clay

    On the blood-typing issue:
    
    All three of my children had their blood typed at birth and we were
    given a little card with their type.  As it turned out, my oldest son
    is A- (both my husband and I are +'s.)  So, I was glad to know that
    information.
    
    The kids were born in Concord (NH) Hospital.
    
    Linda
    

    Monica and Linda, it helps to know that some hospitals *do* test as
    crustimony proseedcake, er, customary procedure.  After reading the
    replies to me, I called the medical records dept. in the hospital where 
    Alex was born; at first they tried to blow me off.  "Well no!  There
    wouldn't be any reason to test unless there was some kind of
    complication.  There wasn't, was there?  She wasn't caesarian, was
    she?"  AHA!  I had her there.  Now the response was that all the
    records are in a warehouse somewhere, and they need me to send a
    request in writing.  My letter:
    
    *******
    
Medical Records Correspondence
<regional> Medical Center
<address>

Gentlemen:

My daughter, Alexandra Middleton Woolner, was born at <Hospital> 
on January 19, 1985 (2:30pm), by Caesarian section.

I'm writing to request a copy of the medical records from her 
birth (her records and mine, if they are separate).  If you need 
to contact me (for instance, if you charge a fee to reproduce 
complete records), please call <phone #>.

What prompted this was the pediatrician's assertion that Alex's 
blood type had never been tested.  I was told when I called the 
hospital <phone #> that the records are in a warehouse and you 
need my request in writing, so here it is.

Thanks in advance.

				       Very truly yours,
    **********
    
    I figure, what the heck, as long as I'm writing for records, I might as
    well get the COMPLETE records.  I mentioned the blood typing so they
    wouldn't think I was gearing up for some kind of law suit!
    
    This whole quest started when Alex and I saw "Made in America", in
    which the daughter types her blood in bio class, and Alex asked what
    her type was.  Later, and Clay you might be interested in this, I read
    one of the sordid tales in Reader's Digest (June '93, p. 94) wherein a
    construction worker managed to shoot himself with a nail gun through
    the heart... in the ER, [caps mine] 
    
    	"By now Spaulding had lost perhaps a quarter of his body's blood.
    	They didn't want to transfuse him because THERE HADN'T BEEN TIME TO
    	DETERMINE HIS BLOOD TYPE BEFORE RUSHING HIM TO SURGERY.  To compensate,
    	three large-bore I.V.s poured more than a gallon of clear fluids into
    	his veins.  An autotransfuser recycled the blood spilling into his 
    	chest cavity and returned it to his veins."
    
    Yes, the guy lived.  No, I don't plan on Alex losing dramatic amounts
    of blood rapidly.  But I want to be prepared, and apparently some ERs
    don't have the fast, easy test available when it's really needed.
    
    Leslie
    
    

	Leslie,

	FWIW, I'm not sure knowing your blood type helps much.  Every
	time I've been to the doctor and blood type was a question (ie, 
	RHOGAM shot), they've typed my blood first.  This has happened
	at least 4 times, even though I can tell them I'm A-.  I suppose
	if I had a card from some "authority", say the Red Cross, they
	might not feel the need.  I would assume a hospital would require
	verification of blood type prior to transfusion regardless of
	what a patient claimed his blood type was.  At least, I hope so!

	Karen

    Interesting thoughts so far.  The one thing that kept occuring to me is
    IF under pressure, COULD you really remember your child's blood type
    anyway?  Funny, I can remember my son's medical record number at Umass,
    but I'll be stuffed if I can remember, even now not under pressure, his
    blood type.  I do remember he got the TYPE from one of us and the
    RHfactor from the other of us.  I can't even remember my own at times!
    
    By the way, I had a c-section and I was typed routinely, even though in
    the maternity info packet I sent back to the hospital I had already
    told them my blood type.  By the way, all of this is in the category of
    "spinning wheels" anyway, there are universal types of blood that can
    be given in an emergency (is is O or AB?) or for that matter Plasma is
    a universal, no type required fluid for transfusion.  (grief it's been
    ages since High School biology!)
    
    I was always of the impression that if he had had a normal delivery,
    without a C-section, without his surgery at birth, that no typing would
    have been done.  This was Memorial in Worcester, which works closely
    with Umass Medical.
    
    Lyn

    If they DIDN'T check the blood type to verify it and someone got hurt
    because of an incorrect blood type record can you image the law suit
    that might result.  Malpractice?  
    
    They make sure its the right type and thats good.
    
    Jeff

    
    My daughter Anna was typed at birth at Burbank Hospital in Fitchburg.
    It was a routine birth. All I remember is that hers is different than
    both mine and my husbands (which are different from each other). I
    remember questioning if this was possible ( I never took biology) and
    they said it was very possible. I don't remember what her type was or
    what mine is.
    
    Patty

Another issue is if you could remember your child's blood type, would the 
hospital be willing to act on your assertion, or on something like a Red 
Cross donor card or a photocopy of a hospital record.  

>    there are universal types of blood that can
>    be given in an emergency (is is O or AB?) 

I think Type O can be given to anybody, but I don't believe that you can give 
Rh+ to an Rh- person or vice versa (someone please correct this if I'm 
wrong).  So O+ can be given to any person who is Rh+ and O- can be given to 
anyone who is Rh-.  I believe that it's AB- that is extremely rare, and many 
people with AB- blood type are "on call" in case blood is needed. 

The hospital in .40 has the common sense type of approach that is all too 
rare these days.  Even if there are people like me who doubt the practical 
value of knowing the blood type, there are people like Leslie who care.  So 
if I were to get such a card (especially if it contained other interesting 
information) I'd say that's nice and file it;  Leslie would keep it handy, 
and both of us would be happy, or at least not irritated.  I suppose I could 
understand it if the hospital didn't test blood type at all, but they DO have 
to do blood testing, and as has been mentioned, it's a cheap and simple test.

Clay

As I recall there is some dependence on the mother's blood type as a determining
factor in typing a child. I seem to remember the RH factor had something to do 
with this but my high school biology must be farther back than Lynn's :-) :-)

    There is an excellent note in the medical notes file on blood typing;
    how your type is determined and how the Rh factor is determined.  It's
    in VMSZOO::MEDICAL note 1320.1 if you're interested.  But, I'll try to
    paraphrase here.
    
    Everyone has 2 blood groups, (what you inherit from your parents) but
    type O (has neither A nor B antibodies) is masked out by A and B, so AA 
    looks the same as AO and BB looks the same as BO.  So, of the six possible 
    combinations of: AA, AO, BB, BO, AB and OO we get the 4 generic groups: 
    A, B, AB and O.
    
    parent 1   parent 2   child
    
    A          A          A OR O
    B          B          B OR O
    A          B          A, B, O OR AB
    A          O          A OR O
    B          O          B OR O 
    O          O          O
    AB         O          A OR B
    AB         A          A OR AB
    AB         B          B OR AB
    AB         AB         AB, A OR B
    
    With the Rh factor + always masks out -.  The only way to be Rh- is to 
    have BOTH of your parents contribute the Rh- factor to you.
    
    Pretty neat stuff, huh.
    
    Susan

    
    That was very interesting, thank you. That also explains my daughter.
    My husband and I are some combination of A, B, and AB (I don't
    remember) and my daughter is O, and that's what confused me. Your
    explanation tells me (in laymans terms) why. 
    
    Patty

    That makes a WHOLE lot of sense!
          My Dad - O+
          My Mom - A+
          My Bro - O+
    
              Me - A+
         
            Alan - A-
       Charlotte - A+
    
    Thanks!
    
    Monica
    

           <<< MOIRA::MOIRA$NOTES:[NOTES$LIBRARY]PARENTING.NOTE;1 >>>
                                 -< Parenting >-
================================================================================
Note 533.36                Advice on Changing doctors                   36 of 51
MCIS5::WOOLNER "Your dinner is in the supermarket"   28 lines  28-JUL-1993 12:25
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    Jeff,
    
    I know I can never think of snappy comebacks at the time I need them,
    but if my doctor had said that to me, I hope I would have said "No, but
    YOU are trained to EXPLAIN medical issues like these to PATIENTS LIKE
    ME who PAY YOU FOR YOUR TRAINING."
    
    While I'm all worked up on someone else's behalf  :-)  I've been
    meaning to ask the Parenting folks what they think of this.  Last time
    I took Alex for a checkup (she's 8.5), I told the pedi that I was
    embarrassed that I'd never asked before, but what was Alex's blood
    type?  Guess what, she DIDN'T KNOW.  She said it would only have been
    tested if one of the parents were RH- (we're not).
    
    Well, I was already steamed about some of their office admin procedures
    so I decided to bite my tongue, not having any *immediate* need for
    Alex's blood type.  But isn't that ODD?  They stick the newborn in the
    foot for one standard test that I know of; wouldn't it be logical to
    get an extra drop for the so-easy-you-can-do-it-in-freshman-biology-
    class test?  (Yeah, I know, if it's so easy why don't I do it?  'Cause
    I'm not a bio teacher and don't know where to get the test stuff.)
    
    So now I have a note in my daytimer to request a blood typing at Alex's
    next checkup, and I'm feeling like a cross between a Victim Patient and
    an anal retentive Problem Parent.  But dammit.... isn't blood typing
    "crustimony proseedcake" (as Pooh would say)?
    
    Leslie

           <<< MOIRA::MOIRA$NOTES:[NOTES$LIBRARY]PARENTING.NOTE;1 >>>
                                 -< Parenting >-
================================================================================
Note 533.41                   Blood and Blood Types                     41 of 51
SALEM::GILMAN                                        20 lines  28-JUL-1993 15:42
                                  -< Doctors >-
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    On the blood typing... if the need to give the child blood arises they
    will check the blood type anyway.  But, I know what you mean.  One
    would think ones' pediatrician would know everything about ones' child.
    Well, they don't unfortunately.  We just hope they know ENOUGH when we
    need them for our kids or selves.
    
    I already called the HMO and asked for a different referral.  They are
    going to get back to me they said.  I am after FIRST, a technically
    competent doctor.  The bedside manner is nice but not the most
    important consideration.  If you get both your in GOOD shape.
    
    The Dr. was constantly referring to my chart as we had the office
    visit.  I know that they see lots of patients and can't remember all
    the details about every patient... but I wondered at all the chart
    referral.  It was OBVIOUS he was doing ALL his catching up with my case
    as I sat in his office with him.  Is this ok?  All that catching up in
    front of me?  He seemed VERY rushed but seemed to cover all the bases
    on my case... as long as I didn't ask difficult questions.  Ha.
    
    Jeff

	Works for us, too.  We knew my husband was O, but didn't know
	the RH factor.  I'm A-, and Emily's A+.  When she was born, we
	figured out Dad must be O+.

	Karen

<    With the Rh factor + always masks out -.  The only way to be Rh- is to 
<    have BOTH of your parents contribute the Rh- factor to you.
    
We were told at Justin's birth that he is O-.  Shellie is O+ (as am I,
but that doesn't count.  :-)  )  She says the donor was also O+, and one
of her coworkers says that she is O- and both of her parents are O+.
I'm calling the doctors now to see if this is possible, or if someone
messed up Justin's tests  :-}

      Carol

I'm not sure if Rh factor works like normal genetic dominant/recessive genes, 
but if it does, it would be possible for two Rh+ biological parents to have 
an Rh- offspring.  In normal genetics, for example brown eyes are dominant 
over blue eyes.  If a person has one brown eyed gene and one blue eyed gene, 
they will have brown eyes.  But they might pass on the blue eyed gene to 
their offspring.  So two brown eyed parents can have a blue eyed child.  If 
Rh factor works the same way, it would be possible for two Rh+ parents to 
have an Rh- offspring -- just subsitute Rh+ for brown eyes and Rh- for blue 
eyes in the above example.

What I think would be impossible would be for two Rh- parents to have an Rh+ 
offspring.

Clay

    It is indeed possible for 2 Rh+ people to have Rh- children.  Myself
    and my other sister are perfect examples.  Mom is A+.  Dad is AB+
    I'm A- and my sister is B-.  I'm pretty sure my other sister is Rh- as
    well.  As it was explained to my mother, both she and my father must
    carry the Rh- recessive gene.  Like Clay said, it's impossible for two
    Rh- parents to have a Rh+ baby.  
    
    marianne
    

    Oops, I guess I should have been clearer on the Rh factor.  Yes, Clay
    is correct, you can have 2 Rh+ parents with an Rh- baby.  Example, my
    mom is O+, my dad is AB+ and my sister and I are both B-.  Therefore,
    my mom must be O +/- and my dad AB +/-.  My husband is O+ and our
    daughter is B+ (but with the - recessive gene, since I'm -).
    
    Susan

    I thought I'd let you know that the hospital came through with my (and
    Alex's) complete records.  Alex's blood type is A+... just like me!
    
    I realize that most of you probably think this was a fool's errand, but
    make a note that I was told by two medical professionals that the test
    had not been performed, when in fact it had and the results were on
    file.  The $11.75 they invoiced me is money well spent for that lesson.
    
    Leslie

    I just went to the Doctor on Friday for my 1st appointment.  I am 12
    weeks along.  He said that I would have to have a Rhogam shot in a few
    months because I am a certain blood type (I forgot which one he said 
    because I was nervous, new Doctor, etc.)   Why is the shot given?  
    Has anyone else had to have the shot?
    
    Thanks,
    
    Cheryl 

Since Rh+ is dominant, an Rh- woman has a 50% chance of having an Rh+ child if
the father is heterozygous Rh+, and a 100% chance if the father is homozygous.

Rh+ means that a particular marker protein is present on the blood cells.  Since
an Rh- woman does *not* have that marker in her own blood, her body will regard
blood cells that do have the marker as "foreign".

A very common scenario goes something like this:

	Rh- woman has an Rh+ baby.
	As a result of some bleeding during the delivery, a small amount of
	    the baby's blood enters the mother's bloodstream.
	The mother's immune system, encountering the Rh+ protein, recognizes
	    it as "foreign" and begins producing antibodies against it.
	The woman later becomes pregnant with another Rh+ baby.
	The mother's anti-Rh antibodies cross into the fetus and attack the
	    fetus's blood cells.

This happened in my family, for example.  My mother is Rh-; my father, my
brother, and I are all Rh+.  When my brother (the second) was born, he had to
have complete blood replacements.

In effect, the blood of the first baby "vaccinates" the mother against the
Rh protein, and her body is then all prepared to fight it when the second baby
comes along.

Anyways, Rhogam is a shot -- I think it's anti-Rh gamma globulin -- which, as I
recall, is given to an Rh- woman *after* she has given birth to an Rh+ baby. 
I'm not sure exactly how the immunology works (does the Rhogam clear the Rh
protein from the woman's system before her own immune system has time to become
sensitized to it?), but in any case, it inhibits the normal immune response, so
the woman does not become "immunized" against the Rh marker, and her immune
system won't attack her next baby.

That's the best of my recollection:  that it's a shot you get *after* your baby
is born (and that it would be disastrous to have it while you're pregnant, since
the Rhogam itself would presumably attack the blood of an Rh+ fetus).

	-Neil

	Anti-RH globulin is a specialized kind of protein. This protein
	effectively blocks the formation of the antibodies which the
	mother would normally develop if RH+ blood cells were introduced
	to her system.

	It is the antibodies that destroy the red blood cells of a fetus.

	Since RhoGAM prevents the antibodies that could form, it is not
	harmful to the red blood cells of the RH+ fetus.  

	RH- pregnant women are given RhoGAM at 28 weeks, then again within
	72 hours of birth (or termination of pregnancy).  The woman should
	be tested for the presence of the antibodies prior to the injection,
	as the injection is of no use if antibodies already exist.

	I assume the 28 week injection is to guard against a case where
	blood has been transferred to mother from fetus at some point 
	earlier in the pregnancy.  I'll have to ask my doctor about that
	shot.

	RH- women should receive the injection after any pregnancy, regardless
	of the pregnancy's duration or outcome.

	Much of the above is paraphrased from an info sheet I received after
	the birth of my daughter.

	Karen

    Myself, my sister, and my mother are all RH-, married to RH+ men, 
    so this is not an unfamiliar subject for me.  
    
    An RH- women should receive a shot of Rhogam at week 28, after
    delivery, after a miscarriage or even a *possible* miscarriage, and
    after an amniocentesis (when there is the slightest chance that 
    a drop of the fetus's blood could have crossed into the mother's
    bloodstream.)
    
    I've had 5 Rhogam shots for various reasons so far.  Each time, they
    first take a blood sample from me, but then immediately go on and give
    me the Rhogam shot without waiting for the blood to be analyzed.  I
    think the blood test before the Rhogam injection is purely to protect
    the doctor from malpractice or for insurance purposes or something.
    
    I've always had the blood test in the hospital lab, then they hand me
    the vial of Rhogam and tell me to carry it to my doctor's office, where
    the nurse injects it in my arm.  Again, just hospital policy about who
    is allowed to take blood and who is allowed to give injections. 
    Anyway, as I carry that precious vial up to the doctor's office, I
    always think how lucky I am to be living in a time when medical science
    can protect my future children.  I believe Rhogam was only discovered
    about 30 or so years ago, and am sad to think how many non-first-born
    children were miscarried or died because of the lack of Rhogam.  
    
    In any case, what I've always been told is it's better to be safe than
    sorry with Rhogam.  No harm in taking it if it wasn't really needed,
    but potentially disastrous if not taken when needed. 
    
    Jane                                                             

    I have an RH- Mother.  My sister and I are 8.5 years apart.  My mom had
    12 miscarriages between us due to the RH factor.  The dr. told her that
    the reason she was able to carry me to term (I'm the younger) was
    because her body had gotten rid of the antibodies and it thought I was
    a first time pregnancy.
    
    Linda

    Thanks for the information.  I don't remember having the shot with my
    firstborn.  But, I was young and stupid so maybe I didn't even ask what
    it was.  After all it was 13 years ago, I could have forgot about it.
    
    Thanks,
    
    Cheryl

    Well, I am Rh- and my husband is Rh+.  I have two A- (like myself)
    boys.  I was carefully followed during both pregnancies but don't
    remember ever having any injections for Rh factor.
    
    Cheryl

Re -1

I am also Rh -'ve and my husband is +'ve. I was told that I would only be given
the jab if I bled during the pregnancy but would receive it on delivery if the
baby was +'ve.

As I lost a twin early in the pregnancy, I was given the jab about 5 times over
the pregnancy, plus on delivery as we have no idea what blood group the lost
baby was. If I ever get pregnant again, I'll have to have the jabs again.

As both of -1's children are -'ve, then you would not have needed the jab unless
you bled at all whilst pregnant.

Yes the jab is a miracle drug. Several women in my family are Rh -'ve and many
who had their families in the '50's only had one because of the Rh factor.

        Celia

    I also had a miscarriage but it was a replacement doctor who did it so
    I guess I didn't get the jab because he didn't know my history. 
    Anyway, all's well that ends well.
    
    ccb