Rh Enigma.

[Malcolm Needs ☆]

I'm off on annual leave at the moment (I'm painting and decorating my son's bedroom) but a case has been brought to my attention by one of my staff members.

We have a mum (mom) who is R1R1. Her baby is R2R2.

1) Any ideas about this? I have a few.

2) Any ideas about how to get emulsion and gloss paint out of the hair of a 12-year-old son who should not have been in the area in the first place, and has just about avoided justifiable homicide???????????????????????

:shakefist:shakefist:shakefist:shakefist:shakefist

[Bill]

Cut the hair--brush cuts are great in the summer!

[Malcolm Needs ☆]

Nice idea, but I think that he would have to end up bald, and possibly even become a skin donor to get it all off his scalp! I still favour "son-o-cide"!!!!!!!!!!!!!

[John Eggington]

I'll start;

Assuming all controls, etc., have worked correctly

1) Mom is CDe/-D-, Dad would be R2/? so baby could be R2/-D- (or .D., complete deletion, etc.)

2) Baby is the product of a donated egg

3) Swapped at birth (it happens, I've seen the Omen!)

4) Mislabelled/mismatched samples

[jill]

It's real possibility that the baby's phenotype is a result from donated eggs. Recently, I typed a cord

blood as Group AB and the mom was Group O. The RN taking care of the mother said that she had IVF

with donor eggs.

[adiescast]

On the killing of sons, remember your childhood and be merciful. It is very difficult to be a highly intelligent (surely your son is!) and quizzical being with few internal controls and no interest in obedience (if he is 12, he isn't even close to the point of making some of these logical connections without object lessons). Let him wear the paint for awhile until it grows to the point you can cut it. Alternately, you can apply some paint thinner judiciously and possibly get most of it out with that and a shampoo and brushing. There is a lesson in everything.

[Malcolm Needs ☆]

I'll start;

Assuming all controls, etc., have worked correctly

1) Mom is CDe/-D-, Dad would be R2/? so baby could be R2/-D- (or .D., complete deletion, etc.)

2) Baby is the product of a donated egg

3) Swapped at birth (it happens, I've seen the Omen!)

4) Mislabelled/mismatched samples

Hi John,

Yes, those were my thoughts.

1) is what I am hoping for (only because it is so rare). I am going to ask the troops to try typing Mum and Baby with some human-derived IgG anti-D reagents with no potentiators, to see if the D antigen is stronger than normal, and, if not, then I would suspect an amorphic type --- haplotype for Mum and Baby.

2) is what I suspect.

3) could also be true (although, as far as I know, the Baby has not got cloven hooves or a 666 birthmark).

I'll get the troops to fully type down to Jk(, to see if Mum can be excluded with any other typing (for both 2 and 3).

4) you never know - but it will, of course, be denied!!!

:judge::judge::judge::judge::judge:

[Malcolm Needs ☆]

On the killing of sons, remember your childhood and be merciful. It is very difficult to be a highly intelligent (surely your son is!) and quizzical being with few internal controls and no interest in obedience (if he is 12, he isn't even close to the point of making some of these logical connections without object lessons). Let him wear the paint for awhile until it grows to the point you can cut it. Alternately, you can apply some paint thinner judiciously and possibly get most of it out with that and a shampoo and brushing. There is a lesson in everything.

I will not deny that Harry is clever (in fact, he won a prize at his first school for science and one for religeous education, and is fantastic at art and design), but I defy anyone to be anywhere near me when I am wealding a paint brush and to be called intelligent!!!!!!!!!

Thank you for your suggestions. I will try them (but I still favour cutting the offending bit off - at the neck)!!!!!!!!!!!

:rofl::rofl:

[mjshepherd]

Malcom, I have no other ideas for the RH enigma than those that have been posted. However as a hobby painter with my own lovely monsters I can make a suggestion for the paint in hair delimma. Mineral oil always seems to work for me. Saturate the hair and then put a shower or bathing cap on for about an hour.

[Malcolm Needs ☆]

Thanks mjshepherd. I will try that too (but I bet I'll look really stupid with a shower or bathing cap on my head!!!!!!!!!).

[John Eggington]

Rather than try and remove the odd splash, you could go the whole hog and give him a couple of coats...

[Malcolm Needs ☆]

Right then, it turns out that I know a bit more about this case than at first I thought.

We have been following this lady throughout her pregnancy, because she has an anti-E. BUT, she typed as C+, c-, E-, e+, D Weak; in other words, an apparent R1R1 with a Weak D antigen that could only be explained by her being homozygous for the same Weak RHD gene, heterozygous for two different Weak RHD genes, heterozygous for a Weak RHD gene and a Partial RHD gene, or heterozygous for two different Partial RHD genes. Much more likely, however, or, at least, much more likely until the baby was born, was that the Mum was an R1r', and that the r' haplotype was causing the weakened expression of the D antigen due to the Ceppellini effect.

With me so far?

It now turns out, however, that Dad is C-, c+, D+ (normal) E+, e-, and that the baby has a positive DAT and that anti-D can be eluted from the baby's red cells! In addition, although I was originally told that the baby was grouping as R2R2, the baby actually groups either as an r"r", or as an R2 with an extemely weak D antigen.

This means that Dad is, most probably NOT an R2r (as might be expected), but an Ror" (head aching yet?), or an R2R2, with one of the R2 haplotypes expressing an extremely weak D, or a Partial D.

I think that this one is only going to be solved with molecular work.

We are getting more samples tomorrow. Let's hope that these samples type as the first samples did, otherwise the whole case could be blown out of the water (but the fact that we can elute anti-E from the baby's red cells mitigates against a baby swap or a mix-up in samples - although we still have to rule out a donation of an ovum, but this seems unlikely, as the Mum, Dad and hospital have been asked, and the answer is no, and they are allowing the baby to be bled again).

I will keep everyone posted.

Can you tell yet that I am quite excited about this case?????????????!!!!!!!!!!!!

:wow::wow:

[Malcolm Needs ☆]

Rather than try and remove the odd splash, you could go the whole hog and give him a couple of coats...

Good idea John.

Now that it is Spring (and unseasonably hot), it may just clog up his sweat glands and kill him off slowly - the little pest!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[jcdayaz]

I will not deny that Harry is clever but I defy anyone to be anywhere near me when I am wealding a paint brush and to be called intelligent!!!!!!!!!

I still favour cutting the offending bit off - at the neck!!!!!!!!!!!

:rofl::rofl:

When you're done cutting Harry's "offending bit" off, I have a couple of my own clever ones for you to take care of....

[galvania]

Malcolm - what have I missed. Dad is grouping C-, c+, D+ (normal) E+, e-, so how could he even possibly be considered to be an R2r? Could Mum not actually be a C(D)e/--- with dad being a normal R2R2. The baby could then be R2/-. The D-antigen strength could be weakened by the DAT blocking available D-antigen sites (I don't know how strong the DAT is). But if you can elute anti-D from the baby's red cells, it must be D+ - and it can't have inherited that from mum, otherwise it would be in conjunction with a C, wouldn't it?

[galvania]

Me again - was mum given anti-D because she is D weak? (Here it's policy to treat Dweak mums who are anything other than types 1, 2 or 3 as D- - and yes, that could start a whole new thread!!) And could it have crossed the placenta enough to cause the baby's positive DAT due to anti-D?

[Malcolm Needs ☆]

Malcolm - what have I missed. Dad is grouping C-, c+, D+ (normal) E+, e-, so how could he even possibly be considered to be an R2r? Could Mum not actually be a C(D)e/--- with dad being a normal R2R2. The baby could then be R2/-. The D-antigen strength could be weakened by the DAT blocking available D-antigen sites (I don't know how strong the DAT is). But if you can elute anti-D from the baby's red cells, it must be D+ - and it can't have inherited that from mum, otherwise it would be in conjunction with a C, wouldn't it?

No Anna, you have missed nothing. It is entirely my fault. I should have posted in the morning, rather than quite late at night, following a hard day's painting and decorating!!!!! I made TWO typos. I don't think that the last vat of wine helped either! I'm sorry.

The first was that the Dad was e+, and not e-, and the second was that we could elute anti-E from the baby's red cells, and not anti-D.

No, the Mum would not have received anti-D immunoglobulin. Her Weak D was weak, but not that weak that it would be likely to be anything other than Weak D Type 1.

:surrender:surrender:surrender:surrender:surrender:zombie::zombie::zombie:

[AMcCord]

I'm off on annual leave at the moment (I'm painting and decorating my son's bedroom) but a case has been brought to my attention by one of my staff members.

2) Any ideas about how to get emulsion and gloss paint out of the hair of a 12-year-old son who should not have been in the area in the first place, and has just about avoided justifiable homicide???????????????????????

:shakefist:shakefist:shakefist:shakefist:shakefist

Leave the paint in the hair - it's kind of in style right now.

[Malcolm Needs ☆]

Ah, the trouble is, the paint is blue, and so he looks a bit like an Ancient Briton, covered in woad, and about to take on the Roman Legions!!!!!!!!!!!

[AMcCord]

Very interesting case, by the way...keep us posted.

[AMcCord]

Ah, the trouble is, the paint is blue, and so he looks a bit like an Ancient Briton, covered in woad, and about to take on the Roman Legions!!!!!!!!!!!

Add a few tattos and his 'look' would be complete.

[Malcolm Needs ☆]

Will do.

That was "will do" to keeping you informed - not the tattoos!!!!!!!!!!!!!!!!!!!!!!

Edited April 28, 2011 by Malcolm Needs

[galvania]

Well Malcolm, faced with a case like that (either the kids OR this Rh puzzle) - I think a vat of wine is more than reasonable. I'm really looking forward to the results of the molecular biology! Incidentally, where do the parents come from?

[galvania]

Me again again

Malcolm, is that right that mum is C+c-? If so she either has to be homozygous C or have a deletion on the other side. If baby really is C-c+ then it has to be a deletion

[Malcolm Needs ☆]

Well Malcolm, faced with a case like that (either the kids OR this Rh puzzle) - I think a vat of wine is more than reasonable. I'm really looking forward to the results of the molecular biology! Incidentally, where do the parents come from?

As far as I know (and I am on leave at present), Mum comes from Kent. I don't know about Dad. I will confirm this next Tuesday.