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May 2024 Challenge

alloanti D in D positive patient

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Malcolm Needs Grand Master

Malcolm Needs ☆

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A multiparous female G6P5 with 5 previous C/S

Blood Group A Rh-Positive

Alloantibodies identified ant-D (titer 1: 256) and anti-C (titer 1:32)

Phenotype : Dce

please commint

Assuming that the patient is of Black ethnic origin, and that her D antigen reacts normally with all examples of anti-D, I would strongly suggest that she is partial D III.

Are my assumptions correct?

If not, I'll have to re-think.

:confused::confused::confused::confused::confused:

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Malcolm Needs Grand Master

Malcolm Needs ☆

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Any possibility this could be anti-G?

It could be, but it is unlikely on two counts.

Firstly, the anti-C titre is lower than the anti-D titre, and you would expect the opposite for an anti-G.

Secondly, although there are some partial D types that are G-, most are G+, which would mean it would be an auto-antibody, and so you would expect a positive DAT and reaction between the patient's own red cells and their own plasma in the auto control.

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Malcolm Needs Grand Master

Malcolm Needs ☆

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i ve a quiry.....we had a pt with anti E and anti Lea previosly,but now Lea is not visible on doing the penal ,shall we still give bloo NEGATIVE FOR Lea ....THANKS

No. To be honest, I doubt if I would have worried much about the anti-Lea when it was detectable.

Lewis antibodies (and antigens come to that) are strange in that they change over time, and this is because Lewis antigens are really plasma antigens that are adsorbed onto the surface of the red cell, rather than being an integral part of the red cell membrane.

A baby usually starts off as an Le(a-b-) and then, if they are eventually to become an Le(a-b+), will go through the stages of Le(a+b-), Le(a+b+) and then Le(a-b+) as the fucosyl transferase enzymes mature. However, an individual may not remain as an Le(a-b+) throughout their lives. A pregnant lady, who is usually Le(a-b+) can become Le(a-b-) during her pregnancy, and even produce anti-Lea and/or anti-Leb, but will lose the antibody after childbirth and revert to being Le(a-b+).

I certainly would not go hunting for E-, Le(a-b-) blood if the anti-Lea is no longer detectable (remember, Le(a-b+) blood has a little bit of Le(a+b-) or Le(a+b+) in it).

On the other hand, if the anti-E were to disappear, I would most certainly continue to give E- blood.

:):):)

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LaraT23 Rising Star

LaraT23

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Definitely parital D, perhaps D III or what about the D V if the patient is black? Just a thought. Maybe need some molecular typing to sort it out.

As for the Lea, sometimes I wish we didn't have to report those. I have a heck of a time convincing our docs that they really don't need Lea neg units. So much so that our reference lab does offer antigen neg Lea units for a price. Of course any antibody can one day decide not to show up. The Lea, just does't make a real difference either way, as most likely the transfused cells will take on the Le type of the patient once they are in vivo.

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L106 Mentor

L106

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As for the Lea, sometimes I wish we didn't have to report those. I have a heck of a time convincing our docs that they really don't need Lea neg units.

Unfortunately, I don't think the physicians ever read our reports!! We frequently have patients who have had numerous previous reports identifying their unexpected antibody(ies), and then one day the physician sends the patient in for a "Type & Screen" (instead of crossmatches.)

However, we are fortunate that our local Oncologists (and their staff) are wonderful in recognizing which patients need extensive testing & require extra time for us to find compatible donor units. We send them a list of know "problem" patients and they actually pay attention to that information. Ahhh, maybe there is hope.......

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jcdayaz Rising Star

jcdayaz

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Definitely parital D, perhaps D III or what about the D V if the patient is black? Just a thought. Maybe need some molecular typing to sort it out.

As for the Lea, sometimes I wish we didn't have to report those. I have a heck of a time convincing our docs that they really don't need Lea neg units. So much so that our reference lab does offer antigen neg Lea units for a price. Of course any antibody can one day decide not to show up. The Lea, just does't make a real difference either way, as most likely the transfused cells will take on the Le type of the patient once they are in vivo.

We do the same at our facility. We no longer antigen type donor units for M, P1, Lewis's, and more I am not remembering right now because I should still be in bed. We give AHG compatible units for those antibodies.

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jcdayaz Rising Star

jcdayaz

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its not satisfying me to write Rh phenotype as CDE/cde or cde/cde when ........ /..d.. is not existing can you help me please

Refer to Malcolm's post. It is indeed true there is no such antigen as d. d, to my knowledge, is defined as the absence of D. Since it is so defined, I don't have any problem using d in my terminology.

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jcdayaz Rising Star

jcdayaz

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Unfortunately, I don't think the physicians ever read our reports!! We frequently have patients who have had numerous previous reports identifying their unexpected antibody(ies), and then one day the physician sends the patient in for a "Type & Screen" (instead of crossmatches.)

It is policy at our hospital to automatically crossmatch 2 units if an antibody is detected. Regardless of whether a type/screen or type/crossmatch was ordered by the DR.

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