Anti-f

[Losmeister]

recently our lab rec'd a specimen for Ab ID on a patient who was known to have an anti-K. This time, however, she also had a strong COLD AGGLUTININ and 2+ coombs

( Igg ++, POLY ++ C3-)

So... a REST adsorption was perfomed and it looked to me that she had developed an anti-f to go along w/ her previous anti-K. ( clearcut rxns in 10/16 panel cells,a homozygous c+ cell was NOT reactive)

Now, the patient is O pos, C+, E-, c-, e+ , and this gave me pause, but my understanding of the Anti-f antibody is as follows-

the epitope is created of the juxtaposition

( cis position) of the c and e antigens,

thus Dce/DCE WILL react, while DcE/DCe will NOT.

So, my question is whether or not the literature, and collective experience dictates that a patient MUST be negative for BOTH c and e for a patient to develop an anti-f.

My understanding tells me my call is reasonable while the senior tech and our technical advisor wish for the report to be changed.

( Call it an anti-c)

Either way our recommendation was for IAT crossmatch compatible blood lacking the K and c antigens.

Edited August 18, 2010 by Losmeister
schpellink

[Losmeister]

An adendum...

Perhaps the way I phrased the latter portion

of the above may make one reluctant to respond.

Its most expressly NOT MY WISH to create an adversarial relation with my colleagues, or put anyone on this forum in an in-between position.

A recent search yielded the following article...

Anti-f in a 24 yr old male...

http://findarticles.com/p/articles/mi_qa3890/is_201004/ai_n53930552/?tag=content;col1

in this case the patient expresses c, but not e.

" Then the antibody identification process was completed by antigen typing the patient's red blood cells for c and e antigens. The cells were c-positive and e-nagtive as shown on Table 3."

(for a reason unknown to me none of the tables cited in this online version are viewable)

Can the conclusion be drawn that it is therefore possible

for a patient who lacks the c antigen but expresses the e antigen

to form an anti-f antibody?

Edited August 20, 2010 by Losmeister
typos

[Losmeister]

The article answered my question.

Forum adminstrator can feel free to delete thread.

[Yanxia]

:juggle::juggle:This paper is wonderful, but I find an error in it"Qualitative differences have also been reported with anti-f produced by CdelcDE individuals compared to anti-f produced by cDelcDE individuals"

According the author cDelcDE individuals can produce f antigen not anti-f except autoantibody.

So I am suspicion about this paper.

Malcolm , you are not here many days, are you very busy , can you help us to explain this? Thanks!

[Losmeister]

"According the author cDe/cDE individuals can produce f antigen not anti-f except autoantibody."

I think cDe/cDE EXPRESS the f antigen,

therefore can only produce an auto ANTIBODY.

[Yanxia]

"According the author cDe/cDE individuals can produce f antigen not anti-f except autoantibody."

I think cDe/cDE EXPRESS the f antigen,

therefore can only produce an auto ANTIBODY.

But autoantibody is almost panagglutinate, I don't think there is compatibility between those two kind of anti-f.

[Losmeister]

"According the author cDe/cDE individuals can produce f antigen not anti-f except autoantibody."

[Liz]

The article answered my question.

Forum adminstrator can feel free to delete thread.

Your post and reply are most helpful to others and to me included. This is how the situation of posters can help. I certainly don’t think the administrator would wish to delete this helpful thread.

Thanks

Liz

[BSIPHERD]

Most patient with anti-f that we see are CcDEe and they would be CDe/cDE so that c and e are not together. While CCDee and ccDEE patients can form anti-f, most also have anti-c and/or anti-e and that masks the anti-f. But that's not important since patients with anti-c will get c negative blood which is also f negative and patients with anti-e will get e negative blood which is also f negative.

[Losmeister]

Indeed, the phenotypes you describe were the crux of the original post.

Neither the current Harmening's Modern BB and Transfusion Parctices, nor the current AABB manual

made any mention of the original ID in 1953 nor listed all the potential phenotypes

that could make allo-anti-f. My understanding of the way the "compound" antigen functions

in the end proven sound.

The article also points out how there are cases where the f antigen is expressed WITHOUT the presence of e.

[Malcolm Needs ☆]

All the above posts sound excellent to me.

Most cases of anti-f (anti-ce) that we see in our Reference Laboratory are auto-antibodies.

We do, on occasion, see a true alloanti-f, but they are quite rare. We know that they are true alloantibodies, because they are made in patients that are of the probable Rh genotype R1R1 or R2R2.

Almost all examples of alloanti-f are not clinically significant, BUT, the emphasis is on the word ALMOST. I, for one, would never transfuse, or recommend the transfusion of ce+ blood to an individual with anti-f, just in case. Indeed, I would not even recommend the transfusion of R1R2 in such a situation, just in case the donor is of the rare Rh type Rzr or RzRo.

In the case of an obvious auto-anti-f, however, such as in the case of a rr patient, I would have no such hesitation.

Incidentally, and as an aside, anti-f was originally thought to be anti-d (although this fact is not mentioned in the original paper).

:):)

[Yanxia]

I am very happy to see your post Malcolm.

One question: What is anti-d, d antigen is not exist,is it true?

[Malcolm Needs ☆]

I am very happy to see your post Malcolm.

One question: What is anti-d, d antigen is not exist,is it true?

Sorry to confuse you shily; that is entirely my fault.

What I meant was that the original anti-f (or anti-ce, as it is sometimes written) reacted very strongly with cde/cde (rr) red cells, but was originally thought to be anti-d, before they realised that it was actually reacting with the ce antigens, and not, as you so correctly say, with the non-existent d antigen.

:D:D:D:D

[jbattani]

The important issue is to be sure that you give your patient e neg or c neg crosmatch compatible blood. I totally agree with the above.

[kmt]

If the c and e antigen are in the cis position (the f antigen) the patient can't make anti-f.

If the c and e are in the cis position (f antigen negative) the patient can make the f antigen.

I am f antigen negative....I am most probably a R1R2.

[Malcolm Needs ☆]

If the c and e antigen are in the cis position (the f antigen) the patient can't make anti-f.

If the c and e are in the cis position (f antigen negative) the patient can make the f antigen.

I am f antigen negative....I am most probably a R1R2.

Sorry kmt, but I think, possibly, you mean, "if the c and e antigens are in the trans position (f antigen negative) the patient can make anti-f"?

:confused::confused:

[kmt]

ooops.....what I get for trying to write this while taking my break.

Yes I meant trans the second time.

I even teach this telling my staff.....remember cis as same to help them remember it's positioning.

Thank you Malcolm!!!!

[Yanxia]

The important issue is to be sure that you give your patient e neg or c neg crosmatch compatible blood. I totally agree with the above.

I think it is e and c neg blood that is f neg.