A 10month A pos baby with anti- A

[yan xia]

I have encountered a case, there was a 10 month baby boy, he was A type, but there was anti-A in his serum and on his red cells we also eluated anti-A.

His mom was A type with auto anti-A.

1.I remember the books say maternal origin antibodies will disappear 6 monthes after birth, maybe the books are lying😃 or there are some other reasons. He was breast feeded.

2.His mom looks healthy even with auto anti-A, but the baby developed hemolysis, why?

Thanks in advance for your help.

 

[SbbPerson ★]

The mom is probably a subgroup of Group A, perhaps she is A2 type. If so, she probably has Anti-A1. Subgroup A cells will react with Anti-A reagents. 

From first read of your post, I was thinking maybe the Anti-A1 was passed through the breast milk. But if I am not mistaken, Anti-A1 is an IgM antibody, and those don't usually get passed through breastmilk. Let me dig further into this and see what I can find. Good luck.

[yan xia]

Thanks, sbbguy. At first I thought maybe the mom is A2 type, too. But she is A1 type with pos DAT due to IgG. I feel so confused.

[Cliff]

Has the baby had any infusions / transfusion?  Plasma, platelets, IVIG?

[yan xia]

12 hours ago, Cliff said:

Has the baby had any infusions / transfusion?  Plasma, platelets, IVIG?

No,  He has got nothing above. I guess the antobodies come from the mom, maybe from breast breeding , but have not heard about it before.  Will the milk origined  anotibodies come into the blood stream and be IgG?

[Malcolm Needs ★]

Sorry to ask this yan xia, as I have great respect for your knowledge, but are you absolutely certain that it is anti-A (or anti-A1), and not a rare case of anti-FORS1?

[yan xia]

3 hours ago, Malcolm Needs said:

Sorry to ask this yan xia, as I have great respect for your knowledge, but are you absolutely certain that it is anti-A (or anti-A1), and not a rare case of anti-FORS1?

Thanks, Malcom.

1. I am not sure it is.anti-A, not.anti-A1. I mathed 5 A donors with the patient and the reactions.are all positive(Maybe they all A1). It is my fault, I need to add A2 cells to make sure about it.

2. I searched about the FORS1 online, there are few papers I can find. I will try my books tomorrow. This.is the.first time I read this antigen. Is there any cross reaction between it and A( or A1) antigen?

3. There is an idea just poped on my mind, it maybe Tn. But I don't know if Tn can give so strong reaction with monoconal anti-A reagent.

[Malcolm Needs ★]

What you say has made me doubt it is anti-FORS1, as the FORS1 antigen is relatively rare in a human, so being positive with all five cases of group A would be highly unusual.  I just wondered, but I think I am wrong.

I doubt that it is Tn.  It may be, but you can test this by using Dolichos biflorus, which would be positive with Tn activated red cells, while human-derived anti-A1 would be negative.

Come what may, it is a VERY interesting case.  THANK YOU for sharing it.

[Arno]

Here is an interesting paper showing that antibodies to red cell/platelet... may be transmitted via breast milk indeed, causing prolonged HDFN. Milk contains mostly IgA but IgM and IgG may be present of course and IgGs can cross the different barriers up to blood circulation (not on the same model - not actively -  as the placenta though). The surprizing part here is the mother and baby are group A, A antigen is ubiquitous so the anti-A titer in breast milk should high enough to interfer with reverse group despite the adsorption of anti-A on various tissues.     

https://pubmed.ncbi.nlm.nih.gov/30720868/

[yan xia]

Thank you very much, Arno. 

Only one question left, why does the mom  asymptomatic even with auto anti-A. We have encountered another case of auto anti-A, that one need transfusion.

 

[Arno]

When you say asymptomatic, does it mean she is not anemic? What about the reticulocyte count, bilirubin, LDH, haptoglobin? May be the mother has a compensated hemolytic anemia?

[yan xia]

She is still breast feeding the baby,  and looks healthy. 

[yan xia]

The baby is discharged now, we cannot test the mother anymore, what a pity.

[yan xia]

Here is a follow up. The baby had tested with anti-A on 27, April  and transfused with O washed cells the same day, but on 10, May she had no anti-A and received A type packed red cells with no transfusion reaction. She has stoped feeding on her mother's milk for 14 days.

I tried to persuade her mother to do some tests. The results came out and she has no anemia, with normal reticulocyte count and percentage. Her bilirubin and LDH are normal too. But she has not tested her haptoglobin.

She has not received any blood transfusion and IVIG.  She just diagnosed with slight anemia during pregnancy and after birth.  She had taken iron supplements during pregnancy,.

This is her eventh pregnancies and the third baby, she had several miscarriages. She told me her case seems like a mystery both to her and the doctors she know. She just want to know if she is ok and the baby will be healthy in the future.

 

Edited May 12, 2022 by yan xia

[SbbPerson ★]

Thank you for update 👍 

On 5/11/2022 at 11:20 PM, yan xia said:

Here is a follow up. The baby had tested with anti-A on 27, April  and transfused with O washed cells the same day, but on 10, May she had no anti-A and received A type packed red cells with no transfusion reaction. She has stoped feeding on her mother's milk for 14 days.

I tried to persuade her mother to do some tests. The results came out and she has no anemia, with normal reticulocyte count and percentage. Her bilirubin and LDH are normal too. But she has not tested her haptoglobin.

She has not received any blood transfusion and IVIG.  She just diagnosed with slight anemia during pregnancy and after birth.  She had taken iron supplements during pregnancy,.

This is her eventh pregnancies and the third baby, she had several miscarriages. She told me her case seems like a mystery both to her and the doctors she know. She just want to know if she is ok and the baby will be healthy in the future.

 

 

Edited May 14, 2022 by SbbPerson