unusual Rh phenotype

[Mohandoss Murugesan]

we got a day5 old newborn blood sample for exchange transfusion,we did grouping of both the new born and mother- both were A1positive. we x-matched 2 A1pos PC with mother's sample, both were incompatible.

Babys DCT was positive

Mothers ICT was positive- panreactive 4+ with Diamed 3 cell and 11 cell panel

Mothers DCT was negative.Mother was multigravida with previous 2 child,no H/o Jaundice.

we phenotyped both the baby and mother

Baby: D+ C- E- c+ e+ K+ k+ Fya+ Fyb+ S+ s+

Mother: D+ C- E- c- e- K- k+ Fya+ Fyb- S+ s+

In mother :Is it possible to present only with D+ and neg for rest of the Rh antigen?

if so then can we suspect Anti f in this case?

with regards

Mohandoss

[Malcolm Needs ☆]

we got a day5 old newborn blood sample for exchange transfusion,we did grouping of both the new born and mother- both were A1positive. we x-matched 2 A1pos PC with mother's sample, both were incompatible.

Babys DCT was positive

Mothers ICT was positive- panreactive 4+ with Diamed 3 cell and 11 cell panel

Mothers DCT was negative.Mother was multigravida with previous 2 child,no H/o Jaundice.

we phenotyped both the baby and mother

Baby: D+ C- E- c+ e+ K+ k+ Fya+ Fyb+ S+ s+

Mother: D+ C- E- c- e- K- k+ Fya+ Fyb- S+ s+

In mother :Is it possible to present only with D+ and neg for rest of the Rh antigen?

if so then can we suspect Anti f in this case?

with regards

Mohandoss

It certainly is possible for an individual to be -D-/-D-, if highly unusual.

Basically, it means that, whilst the RHD gene is normal, and the RHD protein is expressed "normally" on the red cell surface, the RHCE gene is either missing entirely, or is mutated in such a way that the RHCE protein cannot be expressed on the red cell surface.

I say the the RHD protein is expressed "normally", but in such cases, there is normally exulted expression of the RHD antigen, to such an extent that the red cells can be agglutinated by some IgG anti-D reagents without the use of albumin, enzymes or AHG. In other words, saline suspended -D-/-D- red cells can be agglutinated by selected IgG anti-D reagents with no potentiation whatsoever.

Given that the baby is DAT positive, I would be very wary of the baby's typing, especially the K+.

However, I would be much more wary of your supposition that the specificity of the maternal antibody is anti-ce; it is much more likely to be anti-Rh17, and if this lady really does require transfusion, she would probably require blood from another -D-/-D- individual, or an Rhnull individual.

This case most certainly requires to be examined by a large Reference Laboratory.

:excited::excited::excited:

[John Eggington]

Are your typing reagents 'direct spin' or IAT?

[Mohandoss Murugesan]

Dear Malcom, thanks for your explanation. Exchange transfusion for the baby, we thought of bleeding mother for compatible blood, since she is pallor,we were left without option. As the baby is with kernicterus now, we gave incompatible blood for this baby.What other alternative can we do now for this patient?

We used direct spin reagent for phenotyping.

[Malcolm Needs ☆]

Dear Malcom, thanks for your explanation. Exchange transfusion for the baby, we thought of bleeding mother for compatible blood, since she is pallor,we were left without option. As the baby is with kernicterus now, we gave incompatible blood for this baby.What other alternative can we do now for this patient?

We used direct spin reagent for phenotyping.

Hi Mohandoss,

The fact that the baby is icteric makes me even more sure that your lady has made anti-Rh17, as it is extremely rare for anti-ce (anti-f) to cause clinically significant haemolytic disease of the newborn.

I'm not sure what other blood you could have given under the circumstances, as I presume this was an urgent transfusion, but there is a very good chance that the baby will require more transfusions, and it may be worthwhile asking for help from one of the International Frozen Blood Banks, where -D-/-D- or Rhnull blood may be available (the same applies for Mum, if she requires transfusion). Where abouts in the world are you?

The other thing you could try is looking for compatible blood amongst your lady's brothers and sisters, if she has any.

Even if your reagents are immediate spin, I would still worry about the results, in case they are ptoentiated IgG reagents, and giving false results because of the baby's positive DAT, rather than true IgM reagents.

:salute::salute:

[Yanxia]

Malcolm's explanation is wonderful. And Maybe her is D../D..

[Mohandoss Murugesan]

In pondicherry, India. Will try to find compatible blood among their relatives.....

[Malcolm Needs ☆]

In that case, you may be able to get help from the Mumbai frozen blood bank???????????????????????

[Mohandoss Murugesan]

we will try to contact blood bank in Mumbai ..

[rravkin@aol.com]

Mohandoss,

Thank you for this very interesting and educational case, and please post the outcome.

And, thank you Malcom for your sharing your expertise and your continued commitment to BB practice and education; it is always appreciated.

[Malcolm Needs ☆]

Thanks rravkin@aol.com, and from my point of view, I'm only too pleased to be of help if I can.

I couldn't do anything without other people posting such interesting cases.

[Mohandoss Murugesan]

Dear Malcom and rravkin, unfortunately the baby expired on 7th day , due to sepsis. We gave two incompatible exchange transfusion as a life saving measure, since the baby developed kernicterus.

We got the detailed history, the mother is of gravida 6, 3 live birth and 3 abortions and phenotyped one kid, father and maternal grandmother of kid. We contacted our referral center in Mumbai, before processing further ,baby expired..

[Malcolm Needs ☆]

That is a very sad situation Moandoss, but thank you for sharing it with us.

I would still be most grateful if you would consider sharing the results from your Rference Laboratory with us, so that we may know what antibody specificity the mother actually has, and so that we can learn more from this ragic case.

[L106]

How unfortunate, Mohandoss. Please do share the findings from your referral center with us.

[rravkin@aol.com]

Mohandoss,

I am saddened and at a loss for words; but as Malcolm and Donna have stated please share the followup results of your findings. Thank you.