EP, a 26-year-old Caucasian female student, tested her own blood during a student lab on antibody...
EP, a 26-year-old Caucasian female student, tested her own blood during a student lab on antibody identification. She had two uneventful prior pregnancies and deliveries. She was told that she had a red cell antibody of “undetermined specificity.” A panel tested with LISS demonstrated the following reactions.
|
Rh |
MNSs |
P1 |
Lewis |
Lutheran |
Kell |
Duffy |
Kidd |
LISS |
|||||||||||||||||
|
Cell |
D |
C |
E |
c |
e |
f |
CW |
M |
N |
S |
s |
P1 |
Lea |
Leb |
Lua |
Lub |
K |
k |
Fya |
Fyb |
Jka |
Jkb |
is |
37 |
AHG |
|
1 R1R1 |
+ |
+ |
0 |
0 |
+ |
0 |
0 |
+ |
+ |
+ |
0 |
+ |
0 |
+ |
0 |
+ |
+ |
+ |
0 |
+ |
+ |
0 |
0 |
0 |
2+ |
|
2 R1R1 |
+ |
+ |
0 |
0 |
+ |
0 |
+ |
+ |
0 |
0 |
+ |
+ |
0 |
+ |
0 |
+ |
0 |
+ |
0 |
+ |
+ |
+ |
0 |
0 |
2+ |
|
3 R2R2 |
+ |
0 |
+ |
+ |
0 |
0 |
0 |
0 |
+ |
0 |
+ |
+ |
+ |
0 |
0 |
+ |
+ |
+ |
0 |
0 |
+ |
+ |
0 |
0 |
2+ |
|
4 r’r |
0 |
+ |
0 |
+ |
+ |
+ |
0 |
+ |
0 |
+ |
+ |
+ |
0 |
+ |
0 |
+ |
0 |
+ |
+ |
0 |
+ |
+ |
0 |
0 |
2+ |
|
5 rr |
0 |
0 |
0 |
+ |
+ |
+ |
0 |
+ |
+ |
+ |
+ |
+ |
0 |
+ |
0 |
+ |
0 |
+ |
0 |
0 |
+ |
0 |
0 |
0 |
2+ |
|
6 rr |
0 |
0 |
0 |
+ |
+ |
+ |
0 |
+ |
+ |
+ |
+ |
+ |
+ |
0 |
0 |
+ |
0 |
+ |
+ |
0 |
+ |
+ |
0 |
0 |
2+ |
|
7 rr |
0 |
0 |
0 |
+ |
+ |
+ |
0 |
+ |
0 |
+ |
0 |
0 |
0 |
+ |
0 |
+ |
+ |
0 |
+ |
+ |
0 |
+ |
0 |
0 |
2+ |
|
8 rr |
0 |
0 |
0 |
+ |
+ |
+ |
0 |
+ |
0 |
+ |
+ |
+ |
0 |
0 |
0 |
+ |
0 |
+ |
0 |
+ |
0 |
+ |
0 |
0 |
2+ |
|
9 rr |
0 |
0 |
0 |
+ |
+ |
+ |
0 |
+ |
+ |
+ |
+ |
0 |
+ |
0 |
0 |
+ |
0 |
+ |
+ |
+ |
+ |
0 |
0 |
0 |
2+ |
|
10 R1R1 |
+ |
+ |
0 |
0 |
+ |
0 |
+ |
0 |
+ |
+ |
0 |
+ |
0 |
+ |
0 |
+ |
0 |
+ |
0 |
+ |
+ |
0 |
0 |
0 |
2+ |
|
Auto |
0 |
0 |
0 |
||||||||||||||||||||||
1. What type of antibody is suspected from the reactions observed on the panel?
2. In this case, panel cells were treated with DTT. The sample was retested. All reactions with the DTT-treated panel cells were negative following testing with LISS at AHG. What does this suggest about the specificity of this antibody?
Homework Answers
1. The dominant alleles R1R1/R2R2 show positive RhD while recessive alleles show negative RhD test. Also Lutheran antigen is also present in the blood sample. The antibody suspected in this case is IgG which recognizes the RhD or HDFN antigen on the fetal red cells and initiate Erythroblastosis fetalis.
2. After maternal exposure to RhD positive blood, B lymphocyte are formed that can recognize the antigen. The antibody here is a polyspecific/incomplete IgG which can form in a dose dependent manner to initiate maternal primary immune response which starts to potentiate in the form of IgM titre. This can result in secondary maternal immune (anti-D IgG) response in subsequent pregnancies.
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