I have a referral patient - 74 yo male; R1R1; M:0, Fya: 0.  He has a history of anti-c, which is undetectable in gel both neat and with ficin pretreatment.  I have r/o every ab on the panel antigram with 2 different manufacturers' products (except Jsa and f).  Every rr cell is 1+ and 2+ with ficin pretreatment.  All the rr cells are M+, most homozygous, a few hetero but no reactivity is destroyed by enzyme (my ficin qc was right on).   The man is way up north in NH with a 5gm hgb.  I sent them 3u ABORh specific, c neg rbcs, ahgxm compatible.

 

Any notions on the rr reactivity.  I thought it was going to be anti-f but the guy is e+ - could it still be?  Any and all thoughts are welcome 'cuz I am stuck. 

 

Thanks in advance.

Edited April 9, 201411 yr by David Saikin

I have ABSOLUTELY no doubt that the antibody is anti-f.

Just because the patient is e+ in no way precludes him from making anti-f, the "other name" for which is anti-ce. In other words, it is a COMPOUND antibody that will only react when the RHc and RHe genes are in the cis position (but not in the trans position, and not when only one of the antigens (in this case, the e antigen) is expressed on the red cells of the antibody producer.

Thanks Malcolm - I was leaning there.  In fact I just called the hospital and told I was pretty certain it was anti-f.

Aren't those compound antigens fun?  We just referred a pregnant patient for antibody ID and titer with a history of anti-C, but we were getting additional reactions that we couldn't quite figure out.  Our reference lab had to refer it to a Level 1 reference lab because they couldn't figure it out either.  Turned out to actually be an anti-rhi AND an anti-e (overkill??).  Anti-C was excluded.  I looked back at our original panel on this patient and the reactivity did appeared to be an anti-C, even in hindsight.

It was pretty obvious but - I've been in the field over 40 yrs and this is the first anti-f for me.  It just made me uncomfortable but when I wrote out CDe/CDe instead of R1R1 I thought for sure that it could be anti-f.  Just needed some reassurance.

Well, I think they are BankerGirl, but then, I've always been considered a bit weird by my friends and colleagues!!!!!!!!!!!!!!!!!!!!!!

Yes, what Malcolm said.  We identify anti-f once or twice per year.  The majority of these patients are D+C+c+E+e+ so presumably R1R2 and therefore f negative.

Malcolm to the rescue once again.!