Posted by My OB said WHAT?!?.
Dec
30
Posted by My OB said WHAT?!?.
“…Your Blood Type Can Change You Know.”
“You need to have this test even if you had it with your last pregnancy. Your blood type can change you know.” – Midwife to mother, explaining why she needed her blood type determined again.
There are 42 comments to this post.
wow…. where do I even start with this? Well I’d probably start by getting up and walking out because I wouldn’t trust that midwife not to expect the baby to come out of my ear, that would be fitting with her apparent lack of all medical knowledge.
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mommymichelle had this to say,
Dec 30, 2011 @ 11:29 am (Quote)
Ok – so I know that it sounds really far-fetched, and I do not think it can happen from pregnancy to pregnancy – but I have medical records from when I was a small child, including hospital records from when I was in the hospital for pneumonia, and on all of the records it has me listed as A+. When my type was done for my first pregnancy, it was o+. I had it redone because I was sure it was wrong, but it came back o+ as well. Not sure what the deal is, but just sayin’ – the idea may not be as far-fetched as we are inclined to think.
\
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Dreamy Reply:
December 30th, 2011 at 12:09 pm (Quote)
Is there some reason you have to believe that it wasn’t a medical error or mistake in documentation when you were a child? Is that not far more likely than that your blood type changed?
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Selia Reply:
December 30th, 2011 at 12:47 pm (Quote)
I agree with Dreamy. Blood type is encoded in your genes, it doesn’t just change. The only case of this happening is when someone has a bone marrow transplant (which is where the red cells are made) and the new DNA code for blood type from that takes over and a new type is produced. And even then it is rare.
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Lexie Reply:
December 30th, 2011 at 2:24 pm (Quote)
I have records from Sick kids hospital in Toronto from a surgery I had as a child that has me down as O- but when I had the blood work done from my first preg. it came back as B+. I had it tested twice more before I could believe it since all these years even the red cross was calling me to donate because of the desperate need for O- donors. I would have a hard time believing that the original hospital screwed up since I got blood products from them.
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jaed Reply:
December 30th, 2011 at 5:27 pm (Quote)
It is possible, because O negative is the most restricted recipient type but is universal donor. (In other words, you can put O negative blood into anyone, but if you’re O negative yourself, you can only get O negative blood – any other type can cause problems for you.)
Because of this, if they thought you were O negative, they would have given you O negative blood, and O negative blood doesn’t cause problems for other blood types, so it was a “safe” mistake to make. (They usually do try to match types exactly, but it’s safe to give O negative to other types.)
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maegan Reply:
March 22nd, 2012 at 5:21 pm (Quote)
i was born in oregon i was o+ then i was hit by a car when i was 12 in washington i was tested o+ then in cali i had surgery i was o+ then i had a tuble in las vegas and i was o+. then i got pregnent and i was o- and with my 2end child i was o-. so i think your blood type can change.
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Jessica had this to say,
Dec 30, 2011 @ 11:52 am (Quote)
If that was the case it wouldn’t matter what blood type anyone is then. At least not for documentation purposes. If she was really just typing the blood it only needs a finger prick so if the midwife whipped out a vial I’d think something else was up.
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From what a surgeon told me, during prep for a procedure, they always have to type and cross match because “what the record says” is often wrong. Human error being the culprit, better tests and awareness of more blood groups being the other.
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Laurel had this to say,
Dec 30, 2011 @ 12:16 pm (Quote)
Wow, I’m surprised by all the negative reactions here. So harsh! Actually, it’s rare but it does happen that blood gets mistyped, especially with weak A subgroups. Plus, there’s the whole Rh factor issue can can change from negative to positive.
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jaed Reply:
December 30th, 2011 at 2:08 pm (Quote)
It might get mistyped, but the midwife didn’t say “Maybe your records are wrong”; she said “Your blood type can change.” No. It can’t. That’s flat wrong.
(And no, Rhesus factor status doesn’t change from negative to positive either.)
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jaed Reply:
December 30th, 2011 at 5:34 pm (Quote)
I should clarify that. When an Rh negative mother is carrying an Rh positive baby, it’s possible for their blood to mix. If that happens, she can start producing antibodies to the Rh factor – because as Rh negative, she doesn’t have it, so her body recognizes the Rh factor from the baby as something “foreign” and her immune system reacts. This can cause trouble in future pregnancies with another Rh positive baby, since if the blood mixes this time, she’s already producing those antibodies and they can attack the baby’s blood cells.
So her antibody status – whether her immune system is producing antibodies to Rh factor – can change. But her Rh-factor type doesn’t.
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This was when I was pregnant with my second son.
I’d had a REALLY crappy experience with my eldest son’s birth which was posted a couple of weeks ago —-> http://myobsaidwhat.com/2011/12/09/i-am-telling-you-that-you-are-not-in-labor/
So I was considering UCing… I only had 1 appointment with this midwife and it REALLY helped me decide that unassisted was the way to go for me! She wanted to draw blood to do a few tests, I had already been tested for STIs not long before this appointment and I didn’t want to test for Downs Syndrome or anything like that as whatever the result I would keep the baby and I already had an ultrasound booked for 20 weeks. So she said this to me. At first I laughed, then when I saw how serious she looked about it I just kind of looked confused at her.
So she wrote something on my notes about me refusing testing and moved on to talking about the birth. I told her about how awful my last birth had been at the hospital and that I really wanted to just birth at home and that I’d already bought a birth pool and was looking forward to it. She just raised 1 eyebrow and said “Hmmmm, we’ll see…” and wrote on my notes “HOPES for a home birth” with “HOPES” in caps and underlined a couple of times.
Ugh, I walked out of there and never went back. I had my beautiful UC. It was amazing.
I’m in the UK where you just get given a midwife who works from your local doctor’s surgery and so technically, even though I didn’t have any more appointments I was still under her “care” and she phoned me a couple of days before my son was born to tell me unassisted birth is illegal and I wasn’t allowed to do it. I told her to go check up on that and get back to me. She called me back the day after my son was born (he came 10 days early) to tell me it isn’t illegal and when he was born to just let the hospital know so I could register the birth (for some reason you need an NHS number to register births).
When I replied “Oh, he was born yesterday” and told her how well it had gone she actually got really excited and said “Well done” and I actually told her that her being so unsupportive of my plans for a homebirth helped me decide to UC which she took quite well so hopefully she isn’t so snarky to her patients now!
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Hallie had this to say,
Dec 30, 2011 @ 1:54 pm (Quote)
So the cheapest, easiest way to determine blood type is with these little index cards that have been pretreated with enzymes. They have three circles with enzymes in them – anti-a which will cause any a type blood to clot up, anti- b which will for the same thing to b type blood, and one for the RH factor. You prick a finger and put a drop in each circle and stir it around and see what clots. If A and RH both clot, you’re a+. If they all three clot, you’re ab +. If none clot, you’re o-.
Anyway, these circles are like right next to eachother, so it’s easy to cross contaminate in the stirring process, plus A can sometimes take a really long time to react, so if you read it too early, you’ll get a wrong result. This is where most of the stories of “changing bloodtypes” come from.
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jaed Reply:
December 30th, 2011 at 5:37 pm (Quote)
Interesting. Is that the most common way they do typing if you send the blood to a lab? Or is it more used in blood drives, etc.?
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(Of course, that was
I got these from Wikipedia (citations–I take Wiki with a lump of salt, but this was a very well written entry):
1. Dean, Laura. “The ABO blood group”. Blood Groups and Red Cell Antigens. online: NCBI. “A number of illnesses may alter a person’s ABO phenotype.”
2. Stayboldt C, Rearden A, Lane TA (1987). “B antigen acquired by normal A1 red cells exposed to a patient’s serum”. Transfusion 27 (1): 41–4. doi:10.1046/j.1537-2995.1987.27187121471.x. PMID 3810822.
3. Matsushita S, Imamura T, Mizuta T, Hanada M (November 1983). “Acquired B antigen and polyagglutination in a patient with gastric cancer”. The Japanese Journal of Surgery 13 (6): 540–2. doi:10.1007/BF02469500. PMID 6672386.
Blood type changes are EXTREMELY rare according to these journals (all 3 of which seem to be refereed).
To quote, “Almost always, an individual has the same blood group for life, but very rarely an individual’s blood type changes through addition or suppression of an antigen in infection, malignancy, or autoimmune disease. Another more common cause in blood type change is a bone marrow transplant. Bone-marrow transplants are performed for many leukemias and lymphomas, among other diseases. If a person receives bone marrow from someone who is a different ABO type (e.g., a type A patient receives a type O bone marrow), the patient’s blood type will eventually convert to the donor’s type.”
So unless a mom has had any of those events, which may not even cause the rare change (it’s just a possibility for some), I can’t see why a blood test ONLY for type is needed. I could see it if I were going into major surgery where blood loss/chance of a transfusion was a good possibility, just to make sure the correct blood match (not just type) was on hand, but that’s very different from the OP’s situation, sounds like.
And Btw, congrats on your successful UCB!! Happy for you!
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Susan Peterson had this to say,
Dec 30, 2011 @ 5:02 pm (Quote)
When they actually crossmatch blood in the hospital, they don’ t just test for ABO and Rh + or -. They test for a whole lot of other antigens in the blood which can cause reactions with donor blood. People who have had a lot of blood transfusions build up a lot of these so that it is difficult to find compatible donors for them. They tend to have transfusion reactions, although sometimes only mild ones like a slight fever; sometimes they get tylenol and benedryl to get them through a transfusion. This doesn’t represent an actual change of blood type, but it does represent a change in which units of blood would be compatible. This is usually done, though, right before a transfusion.
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Given that any of the rare and dramatic causes of a blood type change would surely be noted in a medical history, I really hope what this midwife meant was, “Your previous blood type test could have returned an erroneous result, you know.” :-/
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Brittany had this to say,
Dec 31, 2011 @ 3:33 pm (Quote)
Like mommymichelle, I was in the hospital a lot as a child. Every hospital typed me as A+ but during both my first pregnancy and now with my second, I’m O+ yet I have never had any transfusions or anything. I chalked it up to numerous hospital errors (different hospitals, different countries). But that definitely worries me about how much harm could be done accidentally if every one of my blood type tests before age 23 came back A+ but everyone since then has come back O+.
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*headdesk*
Someone should NOT have passed uni…
on the aside, your blood type cannot change, however your antibody profile can… this affects your blood crossmatch, and can exclude you from otherwise ABO(Rh) compatible blood. I have a regular patient at work who comes in for packed cell transfusions, and we have to get his blood up from Sydney because he has such a difficult antibody profile to get a good match.
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A few years ago I would have been disgusted by this comment, but now I wonder if I think I know where she might have been coming from. As an ER nurse I am frequently teaching patients about any number of medical/health issues and sometimes my phrases get boiled down into “not quite right” statements. Granted, I work in a population that is, on average, not very well educated, so I’m often speaking to a third grade education. It’s easy to boil down statements into something that ends up not being exactly right. Like when we’re checking someone’s potassium level and it comes back low so they need a pill to increase their levels. I explain that potassium is like a vitamin and theirs is a little low and the pill will bring that vitamin level back up. I don’t get into mineral or electrolyte with them, so now I’m speaking of K being a vitamin, which is wrong. I constantly do little things like this that get the point across but aren’t actually true.
I can see needing the need for a new type and screen because you may have antibodies develop whether Rh or others (bunches are tested). And I can now see myself saying something like “your blood type could change”, because I’m boiling down the blood bank screening process into a statement that ends up not quite right. Should I instead explain exactly what I mean, the antibody generation process and also point out that errors do occur, so it’s best to recheck no matter what for something as important as a potential complication during pregnancy and later blood transfusion (if you’re willing to go down that road at all in the first place)? Yeah, but between getting used to, well, dumbing things down a bit and a fast pace, that doesn’t always happen. Doesn’t make it a good thing, but it could explain why she said something so ridiculous. Or, she could be an idiot. :/ There’s certainly enough of that, too.
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Serene Reply:
January 3rd, 2012 at 7:10 am (Quote)
Thats pretty much what I said above, except I refuse to not attempt to educate them properly. If I can tell them that “the amount of mineral potassium in your blood is a little low” as opposed to having them thinking they need Vitamin K (or P for those who dont know chemistry) instead of potassium, I will. I go out of my way to do that. So yes, you should explain exactly what you mean. You mean that the body can begin to generate new antibodies, and we do need to check if there is any chance you will need a transfusion because its one of those things that *can* happen. If you want to go down that road at all.
Sorry, im not trying to reprimand you here, but i refuse to treat my patients like idiots and it means that at the end of the day, they have a little more understanding of what their doctor is talking about. Im having trouble making it sound better… its 2am here.
I know what you mean, but this woman was just an idiot.
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Tracy Reply:
January 3rd, 2012 at 10:25 am (Quote)
Believe me, I’m huge on patient education and really try to educate to their level. The K issue (and no, I would never use the word “K” with a patient unless they were a HCP, and when I type “K” I don’t hear anything “K” and only hear “potassium”. Force of habit to type in medical abbreviations. I usually catch them but must have zoned out on that one.) is just one example and I’m sure there are better ones. 2 AM for you, but 9 AM after working a night shift and needing some sleep for me. 
Every patient is different and like I said, I do try to educate to an appropriate level. In my field, there are patients who probably couldn’t handle too much of the antibody discussion, but are able to comprehend “blood type”. You may disagree, but you also don’t know all of my patients. I would like to think that I would explain a little better than “your blood type can change”, but…at the end of the shift when my belligerent drunk GI bleed patient is questioning why we have to draw even more blood if he’s already bleeding and he knows his &#)@% bloodtype already so why don’t you &*^#*(& &*^*(# just give him some blood like they did last week and let him get outta there because this isn’t a @(#*& jail and I have right to do whatever I want”, etc. etc., yeah, I might say something as plainly stupid as “your blood type can change.” I’d like to think not, but I’m sure over the years I have said some really stupid things to patients.
Now I would like to hope the above situation is a little more extreme than a routine prenatal visit with a midwife that should include thorough education, but, well, I guess I’m trying to give someone the benefit of the doubt of saying something horribly stupid when they were thinking “your type and screen results can change” and instead said “your blood type can change” (since that’s what most people think of when we’re doing any sort of test related to any transfusion services anyway).
But yes, I still agree, this woman might have just been an idiot.
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Details Reply:
January 3rd, 2012 at 6:21 pm (Quote)
And yet it doesn’t freaking matter to get the correct blood type during a prenatal. It only matters when they are hauling you off to surgery. Believe me I got to wait the 45 minutes in labor with a breech while my tests came back. There is just as much likelihood of human error during the prenatal testing phase as there is with the previous pregnancy. There is NO POINT in doing a typing test prior to 20 weeks. NO POINT what-so-ever unless you are planning on having a car accident that afternoon! They will re-type you again if you head of to surgery. The test is redundant at best. True one size fits all, and I must check off all my boxes BS! So just give it up!
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Tracy Reply:
January 4th, 2012 at 5:34 am (Quote)
If you want me to “just give it up” re: prenatal testing, I’m not even a midwife, so there’s no need. And somewhere in one of my replies I said something about “if you’re going to go down that road at all” and I was attempting to refer to the idea of whether or not you were going to go down the road of prenatal testing at all, but wasn’t focused on those details and didn’t elaborate.
I somewhat agree that it isn’t particularly useful to have the information ahead of time for a lot of folks. If someone is Rh- and there are certain complications or they choose amnio then it’s good to know ahead of time if they want to take an offer of Rhogam. And, there can be some very unlikely benefit of finding out that they have some very rare antibodies and that they may be difficult to crossmatch. I’ve had some patients over the years that had that scenario and knowing ahead of time about that status helped us move a little faster in getting blood sooner rather than later. Sometimes that hour can make a little difference. Unlikely scenario, but possibly of benefit, and again, the Rh status probably could be of benefit for a lot of patients.
Should the patient be able to refuse that test along with any others and along with any interventions? Sure. But offering it, explaining risks and benefits, educating properly about it, and hopefully not misspeaking and/or being so stupid as to say your blood type can change I still think is okay and a good thing.
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Details Reply:
January 4th, 2012 at 5:54 am (Quote)
By “just give it up” I meant your dog with a bone defense of a midwife who “might have just been boiling it down too much.” And as far as “Should I instead explain exactly what I mean, the antibody generation process” – No you should just say they check for several other factors just in case you’ve been exposed to something out of the ordinary. And then you should move on. Nobody wants to be lied to – it kills trust to be told that your blood type might have changed, but nobody wants a lecture on biochemistry either. There is a place in the middle. Perhaps going through this verbal excerise has helped you find it.
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Tracy Reply:
January 4th, 2012 at 12:30 pm (Quote)
Yes, there’s a place in the middle, of course. Like I said numerous times, I try my very best to educate to my patient’s education level. I also kept my “dog with a bone defense” that perhaps she blurted out something stupid (bad day? No sleep? Just explained a bad outcome to a patient and is distraught? Got bad news herself? Whatever.) and isn’t inherently an idiot. I also hold that she might be an idiot who thinks blood type (ABO) actually changes.
Yes, there’s middle ground: she might not be an absolute idiot nor think her patient is an absolute idiot. Perhaps going through this verbal exercise has helped you find this aspect of the middle ground as well.
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Wow. Just wow. Someone needs a better medical education.
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