We have a patient that came to us 36 weeks pregnant. She moved to our area from another part of the country. She alerted the nursing staff of "problems" with her blood. We called the hospital that had seen her before and they reported that her sample had been sent to a reference lab with anti hrs and anti big E being identified and that the patient was probably a partial D. We sent her samples to our reference lab and they are saying that they think we are dealing with an anti Hro (their workup is not complete at this time). My question is what are the odds of finding compatible blood for mom or baby if needed? Should we consider having Mom donate blood that can be given to baby if needed? Any helpful comments will be appreciated.

We have a patient that came to us 36 weeks pregnant. She moved to our area from another part of the country. She alerted the nursing staff of "problems" with her blood. We called the hospital that had seen her before and they reported that her sample had been sent to a reference lab with anti hrs and anti big E being identified and that the patient was probably a partial D. We sent her samples to our reference lab and they are saying that they think we are dealing with an anti Hro (their workup is not complete at this time). My question is what are the odds of finding compatible blood for mom or baby if needed? Should we consider having Mom donate blood that can be given to baby if needed? Any helpful comments will be appreciated.

This all seems a bit strange, because pure (as a specificity) anti-Hro is made by patients who are -D-/-D-, whether or not they also produce anti-E.

However, what foxes me even more is the bit about a "partial D", as -D-/-D- individuals have an enhanced or elevated D (they have an enormous number of D antigen sites on their red cells - so much so that the red cells sometimes agglutinate in human-derived polyclonal IgG anti-D reagents with no enhancement - just by adding saline suspended cells to these reagents), which is almost the opposite of a partial D.

If all of the reports from your Reference Laboratories are correct (although they sound mutually exclusive!), then you probably will need -D-/-D- or Rhnull blood available for the mum and/or the baby. The chances are that such units will only be available in a frozen state from a Rare Blood Depository.

As I say though, the whole thing sounds very strange.

:confuse::confuse:

By the way, the situation is not helped by the fact that some anti-Hro sera from way back are not! They were wrongly classified, but may still be around (in a frozen state) as they are "too rare to throw away, or to confirm their specificity" (my, somewhat sarcastic, italics).

Thanks Malcolm,

The jury is still out on this one. Our Ref lab is doing molecular antigen typing, hopefully this will help?

It may do, but, as I say, I'd be very suprised if it were anti-Hro, and the lady did not have some sort of deletion with e and/or E.

Having said that, we've had a sickle cell disease patient recently who, genotypically, is S- and s+ (or the other way round - I'm posting this at home, and so relying on a very dodgy memory!) who, phenotypically, is S-, s-, U-, so, we already know that the Duffy genes can give "false positives", if the GATA-1 mutation is present in a homozygous state, and now this gives "false positive" results as well. In addition, Geoff Daniels cites an ABO false positive in his book Human Blood Groups (page 20 to 21, Suzuki et al). In addition, I have now seen three cases where the patient has the FYB gene, and GATA-1 gene in a homozygous state, where they have made anti-Fy3 (or an anti-Fy3-like) antibody, and so molecular methods are not the "be all, and end all".

The human genome, and human beings as a whole, never cease to spring suprises upon us.

Edited September 7, 201113 yr by Malcolm Needs

If the patient is homozygous for the hrs mutation she can make an anti hrs and an anti Hr (RH18). This anti Hr can been seen as an part of the anti Rh17 (anti Hr0) complex made bij -D- individuals, so maybe the reference lab sees the anti Hr as an anti Hr0. I can imagen that any will give a result of anti Hrs while there is no e antigen present, so the patient can not be -D-, so I agree with Malcolm. hrs negative can be found in combination with a RhD variant antigen (DAR for example).

For transfusion you will need -D-, if there is no anti D or Rh null. Autoloog is the best option I think (maybe family).

In addition of the genotype comment of Malcolm; We have also seen a few patients with an U neg fenotype that have a S or s allel, and patients that where S-s- on DNA also. The S-s- genotype samples are all U neg fenotypes, and the patients with an S or s allel are U variants. In these variant there is a part of the GPB gene but there is no product expression S or s.

The anti Fy3 is an other problem, we have also 2 or 3 patients with an anti Fy3 that are FYBB, GATA-1 mutant (homozygous), same as Malcolm. We think that the Fy3 antigen as expressed on epithelial cels is somewhat different from the one on erythrocytes, maybe somethink with the conformation of the protein.