Anti-Rh17?

[silverblood]

Had an interesting case at our hospital. Female patient came in for some type of gyne. surgery. Her three cell screen was positive in all cells and on two different panels all cells were positive except the autocontrol. We ended up sending this to our reference lab. for resolution and they called today to say that this patient has an anti-Rh17. Has anyone else out there encountered this? Apparently it is exceeding rare and these patients have to get blood from the 'rare donor' network if needed or siblings or use autologous blood. This patient is A pos. and is negative for E, e, C, and c. Fortunately this patient di dnot need blood-this time!

[Malcolm Needs ☆]

Hi silverblood,

Unless mine is the Reference Laboratory to which you refer (I'm not sure from where you come), then yes, we've had one also this week.

It was in a lady with a novel genetic background to the D--/D-- phenotype?genotype, who had originally only made an anti-E detected by IAT and with enzyme-treated red cells.

This time, however, she seems to have sprouted an anti-Rh17 detected only with enzyme-treated red cells (at the moment), although this has been sent away to the IBGRL for confirmation. As the auto is negative, as were five examples of D--/D-- red cells and one example of Rhnull, I cannot think what else it would be.

We provided 4 units of cryopreserved red cells to cover an ERPC following an IUD (which had nothing to do with the lady's antibodies).

Unusual to get two cases of anti-Rh17 active at once, to say the least!

:):)

[Marilyn Plett]

Even a rare donor program has trouble providing blood for these patients. Please encourage this patient to donate blood: either autologous blood for her surgery or preferably volunteer blood that can be frozen for other patients. Also try to test close relatives, especially siblings. We've had no luck converting our patient into a blood donor, but all of us have to encourage these very rare people to donate..

[Malcolm Needs ☆]

Even a rare donor program has trouble providing blood for these patients. Please encourage this patient to donate blood: either autologous blood for her surgery or preferably volunteer blood that can be frozen for other patients. Also try to test close relatives, especially siblings. We've had no luck converting our patient into a blood donor, but all of us have to encourage these very rare people to donate..

Unfortunately, in our case, the patient has other clinical problems (this was at least her second IUT) and would probably not be eligible to become a donor, but I do agree wholeheartedly with what you say Marilyn.

:):)

[silverblood]

Thanks Malcolm for your reply. I am in the state of Illinois and our reference lab is in the Chicago area so this is probably not the same patient. Our reference lab is also sending this patient's samples to a different reference lab for more verification and confirmation. How interesting this all is! Don't know where this will go from here-we have informed her physician about the recommendations of the reference lab to have her give autologous blood that can be frozen and getting siblings to do the same and to get her involved in a rare donor program. Imagine this-the physician did not originally even want us to have this patient worked-up as she was sure the pateint would not be needing blood! We did it on our own as we felt it was necessary for the patient's well-being.

[Malcolm Needs ☆]

Thanks Malcolm for your reply. I am in the state of Illinois and our reference lab is in the Chicago area so this is probably not the same patient. Our reference lab is also sending this patient's samples to a different reference lab for more verification and confirmation. How interesting this all is! Don't know where this will go from here-we have informed her physician about the recommendations of the reference lab to have her give autologous blood that can be frozen and getting siblings to do the same and to get her involved in a rare donor program. Imagine this-the physician did not originally even want us to have this patient worked-up as she was sure the pateint would not be needing blood! We did it on our own as we felt it was necessary for the patient's well-being.

Well no! Given that I work in the outskirts of London, I have very grave doubts that it is the same patient!!!!!!!!!!

The problem with giving autologous, or relatives' blood in these cases is that often, although by no means every case, there is evidence of consanguinuity (if that is the correct word) in many cases of D--/D-- (or other Rh deletions) that are capable of producing an anti-Rh17, and so, as often, the potential donors are excluded on different grounds.

Let's hope this is not the case with your patient.

Of course, the problem in the UK is compounded by the fact that, if the patient has been transfused, the Law states that they can no longer be donors (even autologous donors without a medical concession - damn silly Law) because of the fact that we have vCJD in our country. The really daft thing about the Law is, if the patient has already got latent vCJD, giving them their own blood is not going to make the situation worse; but giving them no blood, because no other is available, could be fatal an awful lot quicker!

I agree with your (tacit) condemnation of the physician, who did not want to work up this patient, but I also have a certain amount of sympathy with him/her, because they are just not taught the problems that may occur with rare bloods. All they need to be taught is that, in all cases where there is the slightest chance that a transfusion may be required, it is worth checking for potential problems, or, to put it another way, they are not experts in everything (as is nobody, including we who work in blood transfusion!), but we are experts in our own field.

In almost all cases, the reason we have to send samples off to other Laboratories is nothing to do with a lack of knowledge; it is almost always to do with the lack of reagent red cells, reagent antisera, reagents, such as, enzymes, and a lack of time.

I know that in the US, things are different in terms of charging for tests, but even so, a simple group and save for a surgical procedure should be done in circumstanes where a transfusion is even an outside chance.

Thanks for your response.

Malcolm

:):)

[TimOz]

Hi,

What ethicity is the patient? The D--/D-- phenotype is found in significant incidence in some ethnicities. For example the Bidayu are an aboriginal group from Borneo that have anti-Rh17 sometimes and they are a problem to deal with. Checking family members and also members of the community of the patient has a defined and unusual ethnicity may be useful.

[Malcolm Needs ☆]

Hi,

What ethicity is the patient? The D--/D-- phenotype is found in significant incidence in some ethnicities. For example the Bidayu are an aboriginal group from Borneo that have anti-Rh17 sometimes and they are a problem to deal with. Checking family members and also members of the community of the patient has a defined and unusual ethnicity may be useful.

Our one is quite definitely English.

:)

[David Saikin]

We discovered an anti-Rh17 about 2 years ago . . . actually, we knew we could not ID it and had to send it to the Red Cross reference lab. The pt had a 5 Hgb and was tachycardic. She got the only 2 units in the US, which weren't even licensed units, but they were in the rare donor registry.

[Steven Jeff]

A recent article in Transfusion Medcine has been published about a case in China where the least compatible blood was transfused to the baby of a mother with Anti-Rh17:

Exchange transfusion of least incompatible blood for severe hemolytic disease of the newborn due to anti-Rh17

Bi-juan Li, 1 Yuan-jun Jiang, 1 Fen Yuan, 1 & Hong-xing Ye 1 1 Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, Hunan, China 410008

Correspondence to Dr. Bi-juan Li, Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, Hunan, China 410008.

Tel.: 86-731-4327436; fax: 86-731-4327436

e-mail: jyjysh@163.com

Regards

Steve

:)

[Malcolm Needs ☆]

A recent article in Transfusion Medcine has been published about a case in China where the least compatible blood was transfused to the baby of a mother with Anti-Rh17:

Exchange transfusion of least incompatible blood for severe hemolytic disease of the newborn due to anti-Rh17

Bi-juan Li, 1 Yuan-jun Jiang, 1 Fen Yuan, 1 & Hong-xing Ye 1 1 Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, Hunan, China 410008

Correspondence to Dr. Bi-juan Li, Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, Hunan, China 410008.

Tel.: 86-731-4327436; fax: 86-731-4327436

e-mail: jyjysh@163.com

Regards

Steve

:)

Yes, I read that Steven. An excellent recommendation on your part.

:D:D:D

[Steven Jeff]

Some of it well out of my depth Malcolm, but at least I know it exists!! I read it on the train yesterday when I was making my way to the London Regional Transfusion Committee and education afternoon.

Regards

Steve

:)