A 5-month old baby girl was recently admitted to our hospital for transfusion. Her antibody screen and panel cells were all positive as well as the auto control. Mother's antibody screen was negative when the baby was born and the baby was healthy. Further investigation revealed that when she was 4 months of age, she was admitted to another local hospital with a very low hemoglobin. Her antibody screen was positive and all panel cells were positive. The DAT was positive for anti-IgG. Her sample was sent to a reference lab who found anti-E and anti-Jka in the eluate. She had never received a blood transfusion. How can this be? Could these really be warm auto-antibodies that are appearing with a specificity of anti-E and anti-Jka, perhaps "pseudo" antibodies? We had to transfuse so of course gave her E and Jka negative blood. She did fine and was discharged. Any ideas?

Have she receive immunoglobulin or plasma? What about the disease?

i would strongly recommend the mother's ab screen and the infant's tranfusion history be re-evaluated.

I would entirely agree with BrianD.

What is the underlying disease?

i would strongly recommend the mother's ab screen and the infant's tranfusion history be re-evaluated.

... ditto....

I have a question: how long of the IgG's lifespan which the infant received from the mother when she/he is in the uterus?

And the baby can develop his/her own IgG antibodies when it is 3 month old, so I think this antibodies is passive received after birth or the baby's own developed.

Edited January 25, 201114 yr by shily
Grammer correction

I would agree to get more history on this situation.

However, being one who has always loved the zebras as well as the horses- I guess the mother could have bleed into the fetus giving the baby a normal to elevated HCT at birth. As time went by, infant's immune status became sound allowing it to mount a response to the maternal cells present. Was any of the typing mixed field?

I have a question: how long of the IgG's lifespan which the infant received from the mother when she/he is in the uterus?

And the baby can develop his/her own IgG antibodies when it is 3 month old, so I think this antibodies is passive received after birth or the baby's own developed.

The half life of IgG is 23 days, so every 23 days the titre of the passively derived maternal will half. So how long the maternal IgG is detectable will really depend on the titre of the maternal IgG antibodies. I agree with all the posts about re-checking the history.

Colin

Here is an assay about mother's anti-A and anti-B in the baby's blood circulation, I think other blood group antibodies will be easier cleaned from the blood stream than those antibodies.

1537.pdf

I can state from much experience, in the PEDIATRIC world you must be tenacious in obtaining the history directly from each and every hospital that the baby set foot into. So far you have the birth hospital and one hospital to investigate. Maybe dad took her to another hospital and no-one bothered to ask him?!! I would be calling each hospital's Blood Bank ( please know as BABY names can change several times with each admission to each hospital, confirmatory identification of your patient is your biggest battle).

Key point to check in her pre transfusion specimen: antigen typing for E and Jka/ were these + or MF? That would be pivotal information to know. You mentioned the E and Jba in eluate...hmmm....what did they ID in plasma...nothing.....something else...hmmmm???

Out there ideas : IVIG/Vaccinations cause all sort of funkyness/autoImmune disease state

Hope this is helpful

Elizabeth.

A 5-month old baby girl was recently admitted to our hospital for transfusion. Her antibody screen and panel cells were all positive as well as the auto control. Mother's antibody screen was negative when the baby was born and the baby was healthy. Further investigation revealed that when she was 4 months of age, she was admitted to another local hospital with a very low hemoglobin. Her antibody screen was positive and all panel cells were positive. The DAT was positive for anti-IgG. Her sample was sent to a reference lab who found anti-E and anti-Jka in the eluate. She had never received a blood transfusion. How can this be? Could these really be warm auto-antibodies that are appearing with a specificity of anti-E and anti-Jka, perhaps "pseudo" antibodies? We had to transfuse so of course gave her E and Jka negative blood. She did fine and was discharged. Any ideas?

Did you repeat everything yourself as recommended, if so what were your results?

At our children's hosptial we once had an infant 3 months of age who presented with a strongly positive DAT and 3 gm Hgb. Antibody identified in the plasma as Anti-U. Both partents and the baby were heterozygous for S. We called it an auto with U specificity. The infant required transfusion. We used U neg RBC. Baby had a rip-roaring CMV infection. Once the infection cleared up, so did the antibody.

If the baby had a hemolytic anemia they might have treated with IVIg which has been known to contain red cell antibodies. Was the baby antigen negative for the E & Jka or was she transfused prior at the other hospital so you couldn't type her?