Auntie-D Posted October 13, 2014 Share Posted October 13, 2014 Had an interesting one today - Antenatal lady 36W- Booking bloods A+, negative antibody screen- Missed 28w screen- 2nd pregnancy, plus transfused 2 A+ units on delivery of first child- Came into maternity at 36w with high blood pressure And the results APos with 4+ reaction strength in both D clonesPostitve 3 cell screen in cells one and 2Confirmatory D - negativePanel shows anti-D strongly reactingDCT is negPhenotype is C+E-c+e+K- There is no evidence of her being given Rhophylac in error (though this wouldn't show up as a positive antibody screen in a Rh+ woman, but a pos DCT??) My first thought was maybe an anti-f but as the phenotype is c+e+ this blew this theory out of the water. So the question is - is there a D subgroup that shows 4+ reactivity but illicits an allo-D? I'm confuddled... goodchild 1 Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted October 13, 2014 Share Posted October 13, 2014 Yes, there are quite a few. Could you tell us the lady's ethnic background please? Link to comment Share on other sites More sharing options...
Auntie-D Posted October 13, 2014 Author Share Posted October 13, 2014 She is caucasian according to her haemoglobinopathy questionnaire. The lady has now been induced so we will have baby to deal with very shortly. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted October 13, 2014 Share Posted October 13, 2014 Then it could be Partial D IIIb or IIIc, or it could be a Weak D Type 33. Good luck with the baby! Link to comment Share on other sites More sharing options...
Auntie-D Posted October 13, 2014 Author Share Posted October 13, 2014 Thanks Maclolm Link to comment Share on other sites More sharing options...
Auntie-D Posted October 14, 2014 Author Share Posted October 14, 2014 Update: Baby has been born and had IUGR. The baby results were Bilirubin 30 and no Hb obtained as the sample was clotted. The DCT was 3+ and the baby has been given immunoglobulins and phototherapy. The sample that was sent to Liverpool has beaten them and they have forwarded the sample to Bristol - so it looks like it is possibly something quite novel. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted October 14, 2014 Share Posted October 14, 2014 Not necessarily beaten! RCI at NHSBT-Speke Centre, in common with all other NHSBT RCI Departments can do wonders, but they can't do RHD gene sequencing, which is what is probably required here. This would need to be done by the IBGRL. John Eggington 1 Link to comment Share on other sites More sharing options...
Auntie-D Posted October 14, 2014 Author Share Posted October 14, 2014 Ha ha yes, perhaps being a bit flip there... This case has piqued my interest though Link to comment Share on other sites More sharing options...
goodchild Posted October 14, 2014 Share Posted October 14, 2014 APos with 4+ reaction strength in both D clonesConfirmatory D - negative I don't know what Rh testing protocol you follow there so pardon my ignorance. You routinely use two different anti-D clones for Rh typing, which ones are they?When you say confirmatory D - negative, does that mean you tried a third anti-D reagent which was negative? If so, which clone is that reagent? Very curious to hear what you say, we're still working on our policy relating to this situation. Link to comment Share on other sites More sharing options...
John Eggington Posted October 14, 2014 Share Posted October 14, 2014 We, at Liverpool, suspect mother is DIII but, as Malcolm said, we will need some (sequencing) help from IBGRL to 'pin it down'! Auntie-D and Malcolm Needs 2 Link to comment Share on other sites More sharing options...
Auntie-D Posted October 15, 2014 Author Share Posted October 15, 2014 I don't know what Rh testing protocol you follow there so pardon my ignorance. You routinely use two different anti-D clones for Rh typing, which ones are they?When you say confirmatory D - negative, does that mean you tried a third anti-D reagent which was negative? If so, which clone is that reagent? Very curious to hear what you say, we're still working on our policy relating to this situation. I'm in a new lab now so I'm not sure what the clones are as of yet (though I will find out). There is more than one clone per well. The confirmatory-D is our quick screen to determine if the antibody is Rh - to help with prophylaxis ID rather than doing a full 11-cell panel. It is just a 3 cell screen without the Rh antigens(rr). If this is negative we know we have an Anti-D (or E or C). We, at Liverpool, suspect mother is DIII but, as Malcolm said, we will need some (sequencing) help from IBGRL to 'pin it down'! Hi John *waves* I'm trying to organise a sweep on what D it is - would it be cheating if I changed my guess now?? John Eggington 1 Link to comment Share on other sites More sharing options...
galvania Posted October 15, 2014 Share Posted October 15, 2014 I'm going for1. DIV2. DVII3. DNBIn that order....Anna But - daft question probably. Did you elute anti-D off the baby's red cells? Could be something nothing to do with D at all.......... Link to comment Share on other sites More sharing options...
Auntie-D Posted October 15, 2014 Author Share Posted October 15, 2014 (edited) Anna - yes we did and baby is Rh positive. I can't recall if they are the same ABO though. What else are you thinking that would give an apparent Anti-D in a panel? Edited October 15, 2014 by Auntie-D Link to comment Share on other sites More sharing options...
goodchild Posted October 15, 2014 Share Posted October 15, 2014 anti-LW? Yanxia 1 Link to comment Share on other sites More sharing options...
John Eggington Posted October 15, 2014 Share Posted October 15, 2014 Resasonably sure it's not DVI or DVII Link to comment Share on other sites More sharing options...
John Eggington Posted October 15, 2014 Share Posted October 15, 2014 Sorry, meant DIV! Link to comment Share on other sites More sharing options...
Auntie-D Posted October 15, 2014 Author Share Posted October 15, 2014 Sorry, meant DIV! Ha ha yer div! *said in the most pathetic Scouse accent* Malcolm Needs 1 Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted October 16, 2014 Share Posted October 16, 2014 Well Mr Egg, she's got you bang to rights there!!!!!!!!!!!!!!!!!!! Link to comment Share on other sites More sharing options...
galvania Posted October 16, 2014 Share Posted October 16, 2014 What else are you thinking that would give an apparent Anti-D in a panel? I was thinking that maybe the mother had another antibody too. That's why I asked about the eluate. (Unlikely I know) To John - why are you sure it's not DIV or DVII? Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted October 16, 2014 Share Posted October 16, 2014 He probably used the Albaclone anti-D panel Anna. We all use it in RCI in NHSBT. John Eggington 1 Link to comment Share on other sites More sharing options...
galvania Posted October 16, 2014 Share Posted October 16, 2014 Ah - well that changes things. So, Auntie-D - you want to organise a sweep and you withold vital information , huh!!!! Link to comment Share on other sites More sharing options...
John Eggington Posted October 16, 2014 Share Posted October 16, 2014 Malcom is correct,we have used the 'ALBA' panel of monoclonal anti-Ds. So we've (hopefully) ruled out a few things already.As for my scouse accent; anyone whose had the pleasure to her my voice will know I haven't managed to pick one up in the 30 odd years I've lived here (although I do have a 'lecky' meter) Malcolm Needs 1 Link to comment Share on other sites More sharing options...
Yanxia Posted October 17, 2014 Share Posted October 17, 2014 (edited) It maybe not anti-LW, but I don't know why it can not be anti-LW. Because some D pos iS Lw neg. Edited October 17, 2014 by shily Link to comment Share on other sites More sharing options...
John Eggington Posted December 24, 2014 Share Posted December 24, 2014 The patient is a DIIIc D variant. The variant gene controlling this expression of the antigen has D gene exons 1, 2, 4-10, but has exon 3 of the CE gene. So it's a hybrid of the D and CE genes. Malcolm Needs and Yanxia 2 Link to comment Share on other sites More sharing options...
AMcCord Posted December 24, 2014 Share Posted December 24, 2014 Interesting case. Malcolm Needs 1 Link to comment Share on other sites More sharing options...
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