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HDFN serum test


Yanxia

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One of my colleage tell me a case he just did few days before.

4 days newborn , A D pos , mother O D pos . The baby's DAT is neg both C3 and IgG;

 

free antibodies test with pooled A1 cells, B cells and O cells, all neg;

 

elution test with pooled A1 cells and O cells neg, with B cells pos.

 

We  can't explain the A baby's blood eluated out anti-B antibodies.

 

The same day he test 6 sample use the reagent , they all normal except this one.

 

Need your advice. Thanks!

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I'm not entirely sure I understand the question, so excuse me if I am not answering exactly what you asked...

 

It is perfectly normal for a baby's reverse group (the plasma reacted against known cells) to be unreactive due to the absence of antibodies, which don't develop until later in life. In our lab would would only do a forward group (patient cells reacted with antisera) for a baby younger than 3 months.

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How many examples of group B red cells did you use Yanxia?  Was it 1 or more than 1.

 

If it was 1, I am just wondering if the B red cells expressed an antigen of low prevalence that the father had passed on as a gene to the baby, and the mother just happened to have made an antibody.

 

Obviously, if it was more than 1, this blows my theory/idea right out of the water!

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I'm going with Matuhasi-Ogata because I can't think of another possibility. You would expect to also get anti-A at least since the baby has A antigen for it to attach to and most O moms could send at least a bit of IgG anti-A across the placenta.  Can you have the Matuhasi-Ogata phenomenon with getting only an unexpected antibody in the eluate?  

Here's a description of the phenomenon from bbguy.   http://www.bbguy.org/education/glossary/index.aspx?alphabet=M&id=184

 

Matuhasi-Ogata Phenomenon

This excellently named phenomenon is an immunohematologic term for a situation when an unexpected antibody shows up in an eluate. The best way to describe it is to give an example. Imagine a situation where you are investigating a possible transfusion reaction. The patient has a newly discovered anti-Fya, and as a result, has a positive direct antiglobulin test. When an eluate from these coated cells is analyzed, the anti-Fya is present, but an additional antibody, anti-E, is also present. At first glance, this makes no sense, because you discover in your workup that both the transfused cells and the patient are negative for the E antigen! The anti-E can be explained by the Matuhasi-Ogata phenomenon, which is likely "a nonspecific uptake of some IgG by red cells" in the presence of another antibody that is specifically targeted against antigens on those red cells (words in quotes from Issit and Anstee, Applied Blood Group Serology, 4th ed., pg 1132). In other words, in our scenario above, the anti-Fya has a good reason to be present on the Fya-positive red cells, but the anti-E is just nonspecifically along for the ride, because the RBCs lack E antigen! These antibodies are typically weakly reacting, and are usually easily explained.

- See more at: http://www.bbguy.org/education/glossary/index.aspx?alphabet=M&id=184#sthash.iQKEWqFD.dpuf

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