Passively acquired Rh antibodies?

[jalomahe]

We are all familiar with detecting passively acquired anti-D due to RhIg administration. But as methods become more sensitive, has anyone experienced detecting other Rh antibodies in patients who have received RhIg? How would you know if it was passively acquired or an antibody being actively produced by the patient? How would you explain it to the physician if the patient had an anti-E at the end of her last pregnancy but then never has it during the current pregnancy?

Anyone using TANGO, Galileo, Echo ever experience this?

[Malcolm Needs ☆]

We are all familiar with detecting passively acquired anti-D due to RhIg administration. But as methods become more sensitive, has anyone experienced detecting other Rh antibodies in patients who have received RhIg? How would you know if it was passively acquired or an antibody being actively produced by the patient? How would you explain it to the physician if the patient had an anti-E at the end of her last pregnancy but then never has it during the current pregnancy?

Anyone using TANGO, Galileo, Echo ever experience this?

I have experienced this in the fairly distant past, when they seemed to bung any old plasma/serum into a pool, as long as it had a strong anti-D. We used even to see the odd anti-K.

Now, though, I thought that regulations had tightened, and that they only put monospecific plasma containing anti-D into RhIg. Am I wrong (I haven't worked in a Hospital Blood Bank for something just over a decade)?

:confused::confused:

[yolis76]

I've seen Anti-E and Anti-C in WinRho and IVIG. But I don't think I've seen it from RhIg...

[LaraT23]

Yes, I have personally found three different instances of persons with Anti-E in particular with not know or obvious stimulus, much less a pregnancy!

In the blood group antigen facts book by Marion E. Reid and Christine Lomas-Francis, Anti-E antigen is listed as having naturally occuring antibodies they can be auto or allo in nature. It also causes only mild HDN if at all. (pg104 ed yr - 1997)

In short, tell the doc to watch the patient and evaluate the status of the newborn and decide if he/she is symtomatic, although it should be mild.

So that is my two cents.

[Malcolm Needs ☆]

Yes, I have personally found three different instances of persons with Anti-E in particular with not know or obvious stimulus, much less a pregnancy!

In the blood group antigen facts book by Marion E. Reid and Christine Lomas-Francis, Anti-E antigen is listed as having naturally occuring antibodies they can be auto or allo in nature. It also causes only mild HDN if at all. (pg104 ed yr - 1997)

In short, tell the doc to watch the patient and evaluate the status of the newborn and decide if he/she is symtomatic, although it should be mild.

So that is my two cents.

Good to see you back Lara.

:D:D:D:D

[adiescast]

Also, it is possible that the patient developed a real allo anti-E in the previous pregnancy which is now not detectable and the current fetus is E negative and not stimulating her to increase production. I admit that anti-E is not as prone to doing a quick disappearance act like anti-Jka, but it is possible.

On the other hand, with human source injectable antibody it is never a good idea to assume that it will be completely "pure" and without other contaminating antibodies (whether to red cell antigens or other antigens).

[cplatt36]

You could test the patient using PEG. Instead of solid phase or gel. I have seen many E's be picked up using PEG tube and missed with solid phase or gel.