David Saikin Posted June 26, 2014 Share Posted June 26, 2014 Prenatal patient I have been following since 2009, A Neg; all testing in gel. 8/2009: Ortho screening cell 2: 1+; abid: random reactivity, no specificity determined. 2/2010: Only reacts with Ortho R2R2 cells (1+), pt is E neg: other manufacturer's R2R2 cells are negative: reported anti-E and discussed with MD. 7/2013: Still only reacts with Ortho R2R2 cells (1+); rec'd RhIg after specimen collected. 5/2014: Ortho cells: 2/3 R2R2 (2+) one R2R2 neg; R1wr cell: 1+. 2 step Papain treatment: all cells 2+, R2R2 cells 4+, the R1wr cell is 4+, auto ct: neg. Quotient (Alba) panel: neat: all cells negative; 2 step papain treatment: all D+ cells are 2+mf. O Neg cord cell is neg neat and with enzyme pretreatment. 6/2014: Ortho panel and Quotient panel: both negative neat and all D+ cells 2+mf with enzyme pretreatment. My take is that what I thought was anti-E back in 2010 was really just the anti-D developing. Can't explain the panreactivity found in May. Is this anti-D clinically significant? Thought about anti-LW but had no Rh= cord cells to play with (besides, one was negative last month).. Go for it - any ideas, recommendations are welcome. No complications at delivery for mother and child. One delivery at a different institution. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted June 26, 2014 Share Posted June 26, 2014 One thought is that is, and always has been, a very low level anti-D. The number of D antigen sites on R2R2 red cells are the highest for all of the "normal" Rh phenotypes, and so these would react more strongly than would, for example, the R1wr red cell sample, although all D+ red cells will have a "range" of D sites (by that I mean that R2R2 red cells from one source might have 33, 000 D sites per red cell, whilst another may only have 25, 000 D sites per red cell. It could also be that one or more of the "R2R2" red cells are actually R2r", which would reduce the number of D sites per red cell. This is just by way of a "first pass" at an answer to your query! David Saikin, Yanxia, AuntiS and 1 other 4 Link to comment Share on other sites More sharing options...
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