Patient is D-C+c-E-e+, Hb of 70g/L. Llikely to need on going transfusion support. The patient has had one previous transfusion episode (when no antibodies were detected), about 3 weeks ago. They now have anti-c, anti-Fyb and anti-M (the anti-M is reacting at 37C, but only with M+N- cells, at the moment). There are 2 frozen units that are r'r' Fy(b-) M+N+, after that there are no more r'r' Fy(b-) units. Do you transfuse R1R1 Fy(b-) M- that are fairly easily found, or use the r'r' Fy(b-) M+N+ units?

Edited October 18, 201410 yr by John Eggington

I would go for the r'r', because that gives us time to get in more r'r' donors.  If you give R1R1, sounds like the patient will make an anti-D (as they appear to be a strong responder), and then we could be in trouble.  Have you tried any other frozen blood banks other than ours John?  Amsterdam?

Not tried other blood banks, yet. There appear to be only 5 r'r' Fy(b-) K- (all M+) UK donors, all eligible to donate now (most haven't donated since last year). To 'complicate' matters, the patient appears to be a partial D, rather than straight forward D-. The strong DAT pos (eluted anti-c and anti-Fyb), made the ALBA panel results a little difficult to interpret (haven't CD treated cells, just sent it straight to IBGRL). ALBA results make it appear to be a DVI, but (limited) genotyping of D gene, looking for D exons, 1, 5, and 10, shows all 3 are present. So if it is a DVI, it's not a straight foward one! I guess the real problem is, how will transfusion support be managed in the longer term. Maybe it'll turn out there are 2 variant genes, and one is a weak D type 1, 2 or 3 (with even weaker antigen expression because of the 2 Ce genes)!

Edited October 18, 201410 yr by John Eggington

Are there any family members who can be tested?

The best way to describe this a 'Friday afternoon case', so I'm sure that option will be looked in to. The problem here is that it doesn't involve the usual type of rare problem, like a high frequency negative phenotype or a null phenotype, where family members are likely to be good candidates for having the same phenotype.

Having said that; of course, you are right, testing any siblings would be a good place to start.

This is way out of my league but if you avoid exposing him to the D antigen (and he is negative or partial D) then you always have that as a backup plan if he is ever in a life-threatening emergency.  Once he has made anti-D, in an emergency, you would just have to choose which antibody the blood you give him would be incompatible with.  The main problem with this logic is that I have almost never seen my chronic transfusion patients become traumas or bleeding emergencies.  The one exception was a guy who got stress ulcers and started GI bleeding right before he died after years of transfusion support. Fortunately he had only an anti-Chido as I recall.

What did you end up giving him?

No transfusion, so far. I believe that EPO is being administered. It does seem likely the patient will need transfusion at some point, the clinicians have a bit more time to think about it. Still awaiting full resolution of the D type for 'fully informed' decision. Hopefully we'll have all the information in place before transfusion is required.

On 18/10/2014 at 6:30 PM, John Eggington said:

The strong DAT pos (eluted anti-c and anti-Fyb), made the ALBA panel results a little difficult to interpret (haven't CD treated cells, just sent it straight to IBGRL).

Can anyone explain what the CD treated cell test is ? Thanks

On 2/3/2018 at 11:11 AM, Tabbie said:

Can anyone explain what the CD treated cell test is ? Thanks

CD = chloroquine diphosphate. A chemical treatment to remove immunoglobulins from red cells, in the hope of getting a negative DAT, thereby allowing the use of antiglobulin-reactive antisera without interference from a positive DAT.

as this case has been resurrected, did you ever get to the bottom of this guy's Rh phenotype?  My guess is an R1r' with the D being a weak D.

On 2/5/2018 at 5:03 AM, galvania said:

as this case has been resurrected, did you ever get to the bottom of this guy's Rh phenotype?  My guess is an R1r' with the D being a weak D.

What about genomic D typing this patient to see if he is Weak D type1,2 or 3? If he is, transfuse R1R1 units?