HDN caused by anti-G+C or only anti-G?

Results: Mother D-, sérum reacting whit D+ and C+ (Anti-DC), DAT negative. Following the technique of double elution with RBCs dCe/dce (D+G+C-) cells to isolate anti-C and -G, then this eluate, which contains the anti-D, is adsorbed onto and eluted from Dce/dce (D+G+C-) to isolate anti-G showed positive results only for D+ erythrocytes panel, not reacting with C+ the second eluate.

Baby, D+, with Anti-DC serum (reaction 4+), eluate Anti-D (4+) but Anti-C (1+). Total bilirubin 7 hours after birth increased from 2 to 8. Hemoglobin dropped from 15 to 10.

Questions?

1. What is causing HDN?

2. Why the Anti-G did not react with RBCs C+?

3. Why in the eluate drink no difference in intensity between reactions with erythrocytes D+ and C+?

4. Suspect Anti-G+C, but there opniões different in my service, with the exams presented it is possible to conclude?

I'm not certain that I understand all of your post (probably my fault, rather than yours), but it sounds to me that the mother has got an anti-D, as well as probably an anti-C and, possibly, an anti-G.

This is based on, not only your results, but also the clinical condition of the baby. HDN due to either anti-C and/or anti-G tends to be quite mild (unless the titre is pretty high), but HDN due to anti-D can be very nasty. This baby has "lost" one third of his or her Hb and, although the Hb of babies falls naturally after birth, this does seem quite drastic.

Secondly, if the baby is D+, then the father MUST be D+, and it is very unusual for a mother to produce an anti-C+G or anti-G, without producing an anti-D in such circumstances.

That having been said, from the baby's clinical point-of-view (and, whilst I admire your enthusiasm with all the serological work you have done), does it matter? If the baby needs blood, you would obviously give compatible rr red cells.

On the other hand, it would be important to find out exactly what the mother has made, because this has a bearing on how future pregnancies are monitored and treated. This might be done more easily by splitting her palsma sample into two, adorbing one with r'r red cells and the other with Ro red cells, and then by testing the aliquot adsorbed with r'r red cells against Ro red cells, and that adsorbed with Ro red cells, against r'r red cells.

Dear Malcolm, I have the results are reported, the mother was discharged from the hospital and I have doubts on how to release the report, a likely anti-G is right, but how to demonstrate association with Anti-C and Anti-D?

As for the baby, had progressive improvement after exchange transfusion with red cells rr, no doubt.

Another question is how to release the report because depending on it may or may not be prophylaxis for future transfusions, likely think of releasing Anti-D, Anti-C and anti-G isolated after adsorption / elution.

This might be done more easily by splitting her palsma sample into two, adorbing one with r'r red cells and the other with Ro red cells, and then by testing the aliquot adsorbed with r'r red cells against Ro red cells, and that adsorbed with Ro red cells, against r'r red cells.

"This might be done more easily by splitting her palsma sample into two, adorbing one with r'r red cells and the other with Ro red cells, and then by testing the aliquot adsorbed with r'r red cells against Ro red cells, and that adsorbed with Ro red cells, against r'r red cells.

I will, but I'm in at work at the moment, so I'm a bit busy.

I'll TRY to do it either later tonight or tomorrow.

"This might be done more easily by splitting her palsma sample into two, adorbing one with r'r red cells and the other with Ro red cells, and then by testing the aliquot adsorbed with r'r red cells against Ro red cells, and that adsorbed with Ro red cells, against r'r red cells.

"

Please explain better. What identification will be possible?

Yes, very well indeed Emily, but you didn't say what it is if both are negative or both are positive.

If both are negative, then the only Rh antibody present is anti-G (as this would have been adsorbed out by both the r'r and Ro cells.

If both are positive, then both anti-D and anti-C are present - and anti-G may or may not be present, but that doesn't really matter at this stage.

I'll still try to post a PowerPoint later tonight or tomorrow - if I get time.

[ATTACH]686[/ATTACH]

here it is - I hope!

Thank you Malcolm and Emily, sorry for the difficulty to understand the writing, but the important thing is that this forum has helped me in the completion of the case, especially the poster in PowerPoint.

Don't you worry about the difficulty in understanding your post. That is definitely our problem and NOT yours!!!!!!!!!!!!!!

Glad we could help.