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Bombay H/H1?


SMILLER

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Is there a difference clinically between a patient with anti-H vs anti-H1?  The reason I ask is we have a patient who came in with an old Red Cross card from 1989.  There is a copy of a report attached that has "Duffya" and "H1" (or maybe "Hi")  on it.  The patient has a negative antibody screen.

Thanks, Scott

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Well, ANTI-HI is an antibody that is almost always an auto-antibody.  It is an antibody that will react with almost everyone's red cells, including the patient's own, because it reacts against a combination of the H antigen and the I antigen, in a similar way to anti-ALeb reacting with group A red cells that are also Le(b+), anti-BLeb reacting with group B red cells that are also Le(b+) and anti-LebH reacting preferentially with group O red cells that are Le(b+).

Anti-HI will react more strongly with group O "adult" red cells, than A, B or AB "adult" red cells, as group O red cells express more of the H antigen than do A, B or AB red cells (although the A, B and AB red cells will express at least some H antigen), but will NOT react with Oh "adult" red cells (or Oh "cord" or "neonatal" red cells, which are, essentially. I Negative), or red cells of any ABO type that are of the "Adult ii" type.

As an Oh individual, who is also has the "Adult ii" type, anti-HI is never an allo-antibody.

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If your patient doesn't type as O, then the old card can't mean anti-H.  And a Bombay patient wouldn't lose their anti-H and have a negative screen now either, I don't think.  Anti-HI (sometimes written IH) could likely have been identified back in the 80's when some places still did more room temperature testing.  Anti-HI might have interfered then but with a negative screen you needn't worry about it now. The anti-Fya needs to be honored, of course.

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Thanks for your responses.  It never occurred to me that the "HI" meant some type of compound antibody--I have never heard of one for H+I, but that is probably what was meant on the old Redcross card.  At the time their reference Lab may have had some interference from it if they were looking at IS screen results back in the last century.  

The patient is A Pos, I suppose they were thinking it was a cold auto-antibody.  They no longer have the records.  (We were never too worried about her current typings "missing something".)

Scott  

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