Uploaded byArjuna Samaranayaka
Rh D Variants
This document summarizes two case studies presented at an immunohematology workshop on March 27, 2019. Case 1 involves a 28-year-old woman who experienced postpartum hemorrhaging. Testing found she was RhD positive with anti-D antibodies, indicating a previous sensitization event. Further testing identified her as R1r phenotype and a compatible blood unit was issued. Case 2 involves a 78-year-old man in need of surgery who was found to have a pan-reactive antibody. Phenotyping identified anti-Hr0 (Rh17), a rare antibody. Finding compatible blood was difficult as his phenotype was not found in his family. Autologous donation was suggested due to the r
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Rh D Variants
- 1. Immunohematology Workshop 27th of March 2019 Presentedby : - Dr. G.D.A. Samaranayaka Prepared by :- Dr. Susudu Jayanetti, Dr. Dineesha Subasinghe
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- 3. History • 28 yearsold lady • P4C1 • Managed for Pregnancy Induced Hypertension • Blood requested due to postpartum hemorrhage • No history of recent anti D prophylaxis • History of red cell transfusion >3 months)
- 4. Investigations done atthe local hospital • Full blood count • Hemoglobin - 10.4 g/dl • Platelet count - 201x109/l • WBC - 8.96x1011/l • Blood Bank investigations • Blood group - B Rh D positive • Direct Antiglobulin Test - Negative Anti A Anti AB Anti B Anti D A1 Cell B cell O cell 0 +4 +4 +4 +4 0 0
- 5. Investigations done atthe local hospital • Antibody Screening (LISS) S1 +2 S2 +2 S3 0 Auto 0
- 6. Investigations done atIHRL • Blood group: B Rh D positive • Direct Antiglobulin Test: Negative Anti A Anti AB Anti B Anti D A1 Cell B cell O cell 0 +4 +4 +4 +4 0 0
- 7. Investigations done atIHRL • Antibody Screening (LISS) • Probable antibodies; Anti D, Anti Fya, Anti Jka 37oC IAT Poly AHG CC cells S1 +1 +2 - S2 +1 +2 - S3 0 0 +2 Auto 0 0 +2 + cont(weak antiD + R1r) 0 +3 - - cont(inert AB + R1r) 0 0 +2
- 8. Investigations done atIHRL • Antibody identification (LISS) • Interpretation: Anti D detected • Possibility of technical errors were excluded
- 9. Investigations done atIHRL • Phenotyping • Interpretation • Most probable phenotype - R1r, Kell negative • (D+C+E-c+e+, K-k+) Rh phenotype Kell D C E c e K Patient +4 +4 0 +4 +4 0 + cont +4 +4 +4 +4 +4 +4 - cont 0 0 0 0 0 0 phenotype R1r Kell Neg
- 10. Investigations done atIHRL • Cross match (LISS): • Group B Rh D negative rr kell negative, 37 oC IAT cross match compatible blood unit was selected and issued • Antibody titer: 32 • Paternal Testing • Blood group :A Rh D positive • Probable Rh phenotype :R1R1 Kell negative • Baby’s investigations • Blood group :B Rh D positive • Direct Antiglobulin Test :Positive with IgG specificity • Probable Rh phenotype :R1r Kell negative • Elution Study :Anti D eluted
- 11. Variant D Confirmation •Monoclonal partial D typing kit • Molecular Rh D typing Molecular Biology of partial D and weak D: Implications for Blood Bank Practice WILLY A. FLEGEL, FRANZ F. WAGNER; Clin. Lab. 2002;48:53-59
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- 13. History • A 78years old male • Admitted to Teaching Hospital Jaffna with right side femoral neck fracture • awaiting surgery (proximal femoral nail) • History of transfusion in June 2017 following a snake bite.
- 14. Blood bank investigations •Blood group - B Rh D Positive • Direct Antiglobulin Test was negative Anti A Anti AB Anti B Anti D A1 Cell B cell O cell 0 +4 +4 +4 +4 0 0
- 15. Blood bank investigations •Antibody screening - positive • NISS IAT cross match 1 pack and strict 37 IAT cross match 6 packs were positive. S1 +2 S2 +2 S3 +2 Auto 0
- 16. Investigations done atIHRL • Blood group • Direct Antiglobulin Test Anti A Anti AB Anti B Anti D A1 Cells B cells O Cells 0 4+ 4+ 4+ 4+ 0 0 Poly Anti IgG Anti C3d Test 0 - - CC Cells 2+
- 17. Investigations done atIHRL • Antibody Screening RT 370C LISS IAT Pre Warm S1 0 2+ 3+ 4+ S2 0 2+ 3+ 4+ S3 0 2+ 3+ 4+ Auto 0 0 0 0
- 18. Investigations done atIHRL • Antibody Identification - Pan-reactive panel • Phenotyping Rh Kell Kidd Duffy MNSs Lewis D C E c e K k Jka Jkb Fya Fyb M N S s Lea Leb Patient +4 0 0 0 0 0 +4 +3 +3 +3 0 +4 0 0 +3 +3 0 + Control +4 +4 +4 +4 +4 +4 +4 +4 +4 +4 +4 +4 +4 +4 +4 +4 +4 - Control 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Phenotype D+C-E-c-e- K-k+ Jk(a+b+) Fy(a+b-) M+N-S-s+ Le(a+b-)
- 19. Management • Detected antibody- Anti Hr0/Anti Rh17 • Family screening was suggested • Patient was the last child in the family • older siblings and parents had passed away. • Rh phenotyping done on the four children - compatible phenotype was not found. • Pre deposit autologous donation was suggested. • Patient’s HGB was 9.7g/dl • started on Hematanics and Erythropoietin • conservative (non interventional) surgical management
- 20. Anti-Rh17 (anti-Hr0) • MonospecificIgG alloantibody • Reacts with a common determinant on the RhCE protein. • Incidence is rare - produced after immune stimulus • Designated as D- - and was first described by Race and Sanger in 1950. • Detected best with antiglobulin testing - react with both normal and enzyme-treated red blood cells. • Implicated in transfusion reactions & mild to severe HDFN • Compatible blood products - Rh deletion phenotype and lack RhCE antigens. • Extremely difficult to find Hr0 negative blood • Autologous donation.
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