I have a pregnant patient that has had a Anti-E that isn't very strong. The last time we tested her she had a negative antibody screen. There is something in her history about a "cold autoantibody" but I'm not sure of the validity of that antibody. When I got a specimen on her today I decided to check everything at once. I did a modified cold panel which was negative. We use gel and have the "C" panels (panel A that has untreated and a ficin treated panel cells). The untreated results showed an Anti-E. The treated cells have an Anti-E with a posible Anti-c or an Anti-f. With the patient having an Anti-E, my only cell that differs a c from an f is that cell. It seems really wierd to me that a Anti-c would not show up in the untreated panel. I have only had 1 patient with an Anti-f. Has anyone had much experience with Anti-f? The patient is c negative.

Antrita

I've actually seen quite a few cases where the anti-E is strong enough to react by IAT and enzyme, but the anti-c only reacts by enzyme.

In the case of a pregnancy, I really wouldn't worry about the anti-c (or anti-ce), as, even if the antibody is IgG, it is insufficient in strength to cause clnically significant haemolytic disease of the newborn when it only reacts by enzyme etchnique.

From the information you have given us, the lady must be R1R1, R1r' or r'r'. Unless you really want to know for your own piece of mind, it doesn't matter one iota whether the specificity is anti-c or anti-ce, as you should be giving your pregnant lady R1R1 or r'r' transfusions anyway.

If you are really keen to find out, then what you could do is to adsorb the anti-c/anti-ce onto rr red cells (leaving the anti-E in the original plasma), then elute the antibody from the rr red cells, and then react the eluate against R2R2 and more rr red cells.

If the antibody is a monospecific anti-ce, the eluate will only react with the rr red cells.

If the antibody is an anti-c (or a mixture of anti-c and anti-ce) it will react with both the R2R2 and rr red cells.

All that having been said, it is a terribly fiddly thing to do, and would not get you any further in terms of what blood you would give!

:D:D:D:D

Thank you, I really don't want to go any farther. It is a little scary to know that we might be missing anti-c. Normally I don't go to using the ficin panel unless the untreated panel results are inconclusive.

Anti-f is usually made by people who are positive for C, E, c, and e (R1R2). The panel cells will be f negative if they're c or e negative, so this may be confusing. But if your patient is little c negative, then you are most probably dealing with anti-c.

Thank you, I'll turn it out as probable Anti-c.

Yes we have seen ssevera example of anti-c reacting only with enzyme treated panel. All examples had anti-E id'd with panel A. Some time anti-c reacted only with some of the c+ cells from panel A and when we used panel C untreated and treated, treated panel confirmed the presence of anti-c.

. Some time anti-c reacted only with some of the c+ cells from panel A ...

Maybe it contains anti-Ec Which only reacted when the E and c antigens on the same gene.

Anti-E is an antibody that requires special consideration. If the patient is also c negative, we always give E=c= (R1R1) blood. This is mentioned in the AABB Technical Manual Rh chapter, Concomitant antibodies. "An R1R1 patient with anti-E, has almost certainly been exposed to c as well. The anti-c may be weaker or undetectable"