C postive patient with suspect allo anti-C

[Yanxia]

I have encountered a patienT.

Femal , suspect IDA , have been transfusioned.

The antibody screen is suspect anti-C, her Rh phenotype is CCDee, her DAT is neg both anti-IgG and anti-C3.

We crossmatch C neg blood is compatible and C pos blood is incompatible.

The C antigen of this patient have not mix field , the reaction is 3+.

I suspect maybe her is partial C,but I search in google and all my books , but I can't find anything, the only one about partial C is weak than normal, but this one is not weak.

:oPlease help me!

Edited March 21, 2011 by shily
correct the error

[Yanxia]

I use 2 pos and 2 neg C antigen cells to identify it, and it is anit-C.

[Malcolm Needs ☆]

I must admit that I am a bit foxed by this one.

Have you tried enzyme treating the autologous red cells, to see if they are compatible or incompatible with "self" plasma?

[SMW]

I would suggest you submit a sample for molecular testing. Some partial C's test weakly positive in serologic antigen testing while others do not.

[Marilyn Plett]

Here's a link to an article in Transfusion about the partial C antigen in blacks:

http://onlinelibrary.wiley.com/doi/10.1111/j.1537-2995.2009.02382.x/abstract

I'm now retired, but seem to remember that Immucor's anti-C also reacts with r's but Ortho's does not. Check the package insert for the specifications of your antisera. I agree that molecular testing might be useful. We did see a number of black donors who appeared to be C negative with molecular testing, but C positive with antisera. I have no idea whether or not this could be an issue in your patient population.

[John Eggington]

Could the antibody be anti-Ce, rather than anti-C? The patient could have the CeS (can't manage superscript!) geno/phenotype, but it would mean that this patient would have to be 'homozygous' (sorry, Malcolm) for this rare type or carry a Rh 'deletion' as well as CeS (as the patient typed C+c-), which seems a bit unlikley! We encountered a CeS patient, and her family, some years ago that through up some odd 'probable genotypes', but all would have been C+c+ (the patient also had anti-E, anti-CE and anti-Jkb).

Edited March 22, 2011 by John Eggington
Added own experince of CeS

[Malcolm Needs ☆]

That did sort of cross my mind too John, but the patient is R1R1 (or, at least, that is the "most probable" genotype), and that would mean a very strange actual genotype (which was why I said I was foxed).

[David Saikin]

I think the molecular availability is a wonderful thing but the prices at this time appear to be prohibitive for routine use by the community hospitals.

I would suggest you submit a sample for molecular testing. Some partial C's test weakly positive in serologic antigen testing while others do not.

[clmergen]

I agree with David about the cost of molecular testing at this time. I am not sure what my current reference lab charges but my previous one was pricy. The few cases we agreed to have tested each had a bill over $2k and we didn't gain that much information. Although on one we did prove to the reference lab thar the patient had an allo Anti-D not an auto ( in addition to other antibodies).

[John Eggington]

That did sort of cross my mind too John, but the patient is R1R1 (or, at least, that is the "most probable" genotype), and that would mean a very strange actual genotype (which was why I said I was foxed).

I agree that, as I said, the reported phenotypes do make it less likely (our family were reported as being Mum 'CdeS/cDe', Dad 'CDe/cDe' and Baby 'CdeS/cDe').

[Malcolm Needs ☆]

I agree that, as I said, the reported phenotypes do make it less likely (our family were reported as being Mum 'CdeS/cDe', Dad 'CDe/cDe' and Baby 'CdeS/cDe').

Good Lord!!!!!!!!!!!!!

[John Eggington]

Good Lord!!!!!!!!!!!!!

This interpretation came from the 'highest authority' (I didn't come up with it myself!)

:eyepoppin

[Malcolm Needs ☆]

This interpretation came from the 'highest authority' (I didn't come up with it myself!)

:eyepoppin

Oh, I wasn't disputing it. I presume Joyce Poole, Louise Tilley and Geoff Daniels had something to do with it?????????????!!!!!!!!!!!!!!!!

[John Eggington]

Oh, I wasn't disputing it. I presume Joyce Poole, Louise Tilley and Geoff Daniels had something to do with it?????????????!!!!!!!!!!!!!!!!

Don't worry, Malcolm, I know you weren't disputing...and your presumption is correct.

[Yanxia]

Here's a link to an article in Transfusion about the partial C antigen in blacks:

http://onlinelibrary.wiley.com/doi/10.1111/j.1537-2995.2009.02382.x/abstract

I'm now retired, but seem to remember that Immucor's anti-C also reacts with r's but Ortho's does not. Check the package insert for the specifications of your antisera. I agree that molecular testing might be useful. We did see a number of black donors who appeared to be C negative with molecular testing, but C positive with antisera. I have no idea whether or not this could be an issue in your patient population.

Today, I finally get access to this useful article, it is wonderful. I think the Rh is so complex that I feel headache to meet it, and it is so interesting, always give me surprise. I have a new question from this article now.What is RN and/or the ©ces haplotypes?

[Malcolm Needs ☆]

Today, I finally get access to this useful article, it is wonderful. I think the Rh is so complex that I feel headache to meet it, and it is so interesting, always give me surprise. I have a new question from this article now.What is RN and/or the ©ces haplotypes?

There are, at least, two different genetic backgrounds to RN.

The first has its fourth RHCE exon replaced by an RHD exon, with position 226 being Alanine for the e antigen.

The second also has this substitution, also with position 226 being Alanine for the e antigen, but, in addition, there is a further point mutation of Asparagine instead of Threonine at position 152.

©ceS has Cysteine at position 16 (for C), but Valine instead of Leucine at position 245, and Cysteine instead of Glycine at position336. It is V-, VS+.

Don't know if this helps?

:confuse::confuse: