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Duete ÚR, Brunetta DM, Araujo Júnior E, Tonni G, Carvalho FHC. Maternal-fetal alloimmunization: perinatal outcomes in a reference hospital in Northeastern Brazil. REVISTA DA ASSOCIAÇÃO MÉDICA BRASILEIRA 2022; 68:670-674. [DOI: 10.1590/1806-9282.20220047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/01/2022] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Edward Araujo Júnior
- Universidade Federal de São Paulo, Brazil; Universidade Municipal de São Caetano do Sul, Brazil
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2
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A case of mild HDFN caused by anti-C, anti-D, and anti-G: Diagnostic strategy and clinical significance of distinguishing anti-G from anti-D and anti-C. Transfus Apher Sci 2019; 59:102602. [PMID: 31303507 DOI: 10.1016/j.transci.2019.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/04/2019] [Accepted: 06/12/2019] [Indexed: 11/24/2022]
Abstract
Anti-G is commonly present with anti-D and anti-C and can confuse serological investigations. The differentiation of anti-G from anti-D and anti-C is particularly essential for the accurate diagnosis of hemolytic disease of the fetus and newborn (HDFN) and appropriate administration of anti-D immunoglobulin prophylaxis in Rhesus (Rh) negative women. We reported a rare case of anti-G together with anti-D and anti-C in a pregnant woman and her female neonate. The titers of IgG anti-D, anti-C, and anti-G in the woman were 256, 128, and 32, respectively. While the titers of IgG anti-D, anti-C, and anti-G in the neonate were 16, 8, and 4, respectively. The neonate experienced mild HDFN and only received phototherapy during hospitalization. This report discusses the diagnostic strategy and clinical significance of differentiating anti-G from anti-D and anti-C.
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Rai P, Sharma G, Singh D, Garg J. Approach to a Pregnant Woman with Anti D + Anti C Reactivity Pattern: A Diagnostic Conundrum. J Clin Diagn Res 2017; 11:ED06-ED08. [PMID: 29207719 DOI: 10.7860/jcdr/2017/27902.10550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/08/2017] [Indexed: 11/24/2022]
Abstract
The Rhesus G antigen is present on all RBCs that are C+ and also on most D+ RBCs. Due to this co-distribution of G with either C or D antigen, it mimics a reactivity pattern of anti C + anti D on Indirect Antiglobulin Test (IAT), though the role of Anti G in causing Hemolytic Disease of Newborn (HDN) is controversial. The differentiation of anti D, anti C, and anti G is essential particularly in pregnant females. We hereby report a rare case of anti G with anti D and anti C in a pregnant woman with emphasis on approach to identify anti D+C+G and its implications.
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Affiliation(s)
- Preeti Rai
- Associate Professor, Department of Pathology, Lady Hardinge Medical College, New Delhi, India
| | - Geetika Sharma
- Assistant Professor, Department of Pathology, Lady Hardinge Medical College, New Delhi, India
| | - Deeksha Singh
- Senior Resident, Department of Pathology, Lady Hardinge Medical College, New Delhi, India
| | - Jyoti Garg
- Senior Resident, Department of Pathology, Lady Hardinge Medical college, New Delhi, India
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Yousuf R, Mustafa AN, Ho SL, Tang YL, Leong CF. Anti-G with concomitant anti-C and anti-D: A case report in a pregnant woman. Asian J Transfus Sci 2017; 11:62-64. [PMID: 28316444 PMCID: PMC5345285 DOI: 10.4103/0973-6247.200770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The G antigen of Rh blood group system is present in almost all D-positive or C-positive red cells but absent from red cells lacking D and C antigens. The differentiation of anti-D and anti-C from anti-G is not necessary for routine transfusion; however, during pregnancy, it is important because anti-G can masquerade as anti-D and anti-C with initial antibody testing. The false presence of anti-D will exclude the patient from receiving anti-D immunoglobulin (RhIG) when the patient actually is a candidate for RhIG prophylaxis. Moreover, patients with positive anti-D or anti-G are at risk of developing hemolytic disease of the fetus and newborn and need close monitoring. Thus, proper identification allows the clinicians to manage patients properly. This case report highlights a rare case of anti-G together with anti-D and anti-C in a pregnant woman. This report disseminates knowledge on identification of anti-G and its importance in pregnant women.
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Affiliation(s)
- Rabeya Yousuf
- Department of Pathology, Blood Bank Unit, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Ahmad Nasirudin Mustafa
- Department of Pathology, Blood Bank Unit, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Siew-Ling Ho
- Department of Pathology, Blood Bank Unit, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Yee-Loong Tang
- Department of Pathology, Blood Bank Unit, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Chooi-Fun Leong
- Department of Pathology, Blood Bank Unit, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
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What is it really? Anti-G or Anti-D plus Anti-C: Clinical Significance in Antenatal Mothers. Indian J Hematol Blood Transfus 2016; 33:259-263. [PMID: 28596661 DOI: 10.1007/s12288-016-0729-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022] Open
Abstract
G antigen of Rh blood group system is present either along with D and/or C positive red cells. Hence, [serologically anti-G presents with the similar picture as that of multiple antibodies (anti-D + anti-C). Differentiating them is important as anti-D + anti-C causes severe hemolytic disease of the fetus and newborn than anti-G. In pregnancies with anti-G alone, alloimmunization due to D antigen could be prevented by prophylactic administration of RhIg. Differentiating between anti-D + C from anti-G in alloimmunized pregnant mothers becomes essential. Sera from antenatal mothers, whose antibody identification by 11-cell panel gave a pattern for anti-D and anti-C were selected. Extended phenotyping for Rh system was performed for these antenatal cases. Differential adsorption and elution testing using R2R2 cells initially and r'r cells subsequently were performed to distinguish anit-G from anti-D + anti-C. Antibody titers of these antibodies were determined and their clinical outcome in the newborn was followed. A pattern suggestive of anti D and anti C on antibody identification were observed in six antenatal cases. On further workup 50 % of them confirmed to have anti G. Antibody titers of anti-G and anti-C were lower than that of Anti-D. All newborns were sensitized in vivo and the antibody specificity in them were confirmed with elution studies. The mothers who had only anti-G were subsequently administered with an appropriate dose of RhIg.Differential adsorption and elution studies help in identifying anti-G and distinguishing it from anti-D plus anti-C, thus helping in better patient management.
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6
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Welsh KJ, Bai Y. Pathology Consultation on Patients With a Large Rh Immune Globulin Dose Requirement. Am J Clin Pathol 2016; 145:744-51. [PMID: 27267375 DOI: 10.1093/ajcp/aqw051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To review the differential diagnosis and laboratory issues for women with a large calculated dose of Rh immune globulin (RhIG). METHODS A case-based approach is used to review the differential diagnosis of patients with a large calculated dose of RhIG, RhIG dosing for women with baseline elevations in hemoglobin F, the formulations of RhIG, and issues for the transfusion medicine service with the release of large doses of RhIG. RESULTS A large fetomaternal bleed after delivery requiring multiple doses of RhIG is rare. Such patients may require intravenous RhIG to avoid multiple injections. Patients with a large percentage of circulating fetal RBCs should be evaluated for a disorder of hemoglobin synthesis and, if present, should have quantification of the circulating fetal RBCs by flow cytometry. CONCLUSIONS Accurate laboratory evaluation of women with large fetomaternal bleeds is essential for appropriate RhIG administration.
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Affiliation(s)
- Kerry J Welsh
- From the Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston
| | - Yu Bai
- From the Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston.
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Baía F, Correia F, Alves B, Martinez F, Koch C, Carneiro A, Araújo F. Phenotyping Rh/Kell and risk of alloimmunization in haematological patients. Transfus Med 2016; 26:34-8. [PMID: 26751829 DOI: 10.1111/tme.12271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/19/2015] [Accepted: 12/12/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND One of the biggest concerns in transfusion medicine is to avoid red blood cell alloimmunization. We evaluated the rate of alloimmunization in two groups of chronically transfused patients (A - not phenotyped and B - phenotyped for Rh/K antigens before the first transfusion) with primary haematological disorders and its distribution among the main haematological diseases, in order to adopt an efficient transfusional strategy. STUDY DESIGN AND METHODS As methodology, we used the SIBAS and SAM databases for the retrospective study of all patients with primary haematological disorder between January 2011 and April 2013. RESULTS A statistical difference in the rate of alloimmunization comparing groups A and B was found (P <0·0001). We also observed that alloimmunization was not homogeneously distributed in all primary haematological diseases. CONCLUSIONS The Rh/K phenotype should be performed on all patients diagnosed with bone marrow failure, plasma cell dyscrasia and myelodysplastic syndrome in order to avoid alloimmunization. In patients with acute leukaemia and lymphoma it seems not necessary to perform it. In patients with haemoglobinopathy and myeloproliferative disorders, a larger group of patients is needed to decide its efficacy.
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Affiliation(s)
- F Baía
- Serviço de Imunohemoterapia, Laboratório de Imuno-hematologia, Transfusion Medicine Department and Blood Bank, Centro Hospitalar São João
| | - F Correia
- Serviço de Imunohemoterapia, Laboratório de Imuno-hematologia, Transfusion Medicine Department and Blood Bank, Centro Hospitalar São João
| | - B Alves
- Serviço de Imunohemoterapia, Laboratório de Imuno-hematologia, Transfusion Medicine Department and Blood Bank, Centro Hospitalar São João
| | - F Martinez
- Serviço de Imunohemoterapia, Laboratório de Imuno-hematologia, Transfusion Medicine Department and Blood Bank, Centro Hospitalar São João
| | - C Koch
- Serviço de Imunohemoterapia, Laboratório de Imuno-hematologia, Transfusion Medicine Department and Blood Bank, Centro Hospitalar São João
| | - A Carneiro
- Department of Haematology, São João University Hospital, Porto, Portugal
| | - F Araújo
- Serviço de Imunohemoterapia, Laboratório de Imuno-hematologia, Transfusion Medicine Department and Blood Bank, Centro Hospitalar São João
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Makroo RN, Kaul A, Bhatia A, Agrawal S, Singh C, Karna P. Anti-G antibody in alloimmunized pregnant women: Report of two cases. Asian J Transfus Sci 2015; 9:210-2. [PMID: 26420948 PMCID: PMC4562149 DOI: 10.4103/0973-6247.162724] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Anti-G has been reported as a possible cause of hemolytic disease of the fetus and newborn (HDFN), either independently or in association with anti-D, anti-C or both. The antibody mimics the pattern of anti-C and anti-D reactivity in the identification panel and is often present along with either or both of these antibodies. The differentiation of anti-D, -C and-G in routine pretransfusion workup is particularly essential in antenatal cases. We report two antenatal cases where anti-G was identified on advanced immunohematological workup, in addition to other alloantibodies.
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Affiliation(s)
- Raj Nath Makroo
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Anita Kaul
- Department of Foetal Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Aakanksha Bhatia
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Soma Agrawal
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Chanchal Singh
- Department of Foetal Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Prashant Karna
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
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Verduin EP, Brand A, van de Watering LMG, Claas FHJ, Oepkes D, Lopriore E, Doxiadis IIN, Schonewille H. Factors associated with persistence of red blood cell antibodies in woman after pregnancies complicated by fetal alloimmune haemolytic disease treated with intrauterine transfusions. Br J Haematol 2014; 168:443-51. [DOI: 10.1111/bjh.13130] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 08/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Esther P. Verduin
- Centre for Clinical Transfusion Research; Sanquin Research; Leiden the Netherlands
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Centre; Leiden the Netherlands
- Jon J van Rood Centre for Clinical Transfusion Research; Sanquin-Leiden University Medical Centre; Leiden the Netherlands
| | - Anneke Brand
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Centre; Leiden the Netherlands
- Jon J van Rood Centre for Clinical Transfusion Research; Sanquin-Leiden University Medical Centre; Leiden the Netherlands
| | - Leo M. G. van de Watering
- Centre for Clinical Transfusion Research; Sanquin Research; Leiden the Netherlands
- Jon J van Rood Centre for Clinical Transfusion Research; Sanquin-Leiden University Medical Centre; Leiden the Netherlands
| | - Frans H. J. Claas
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Centre; Leiden the Netherlands
| | - Dick Oepkes
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
| | - Enrico Lopriore
- Division of Neonatology; Department of Pediatrics; Leiden University Medical Centre; Leiden The Netherlands
| | - Ilias I. N. Doxiadis
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Centre; Leiden the Netherlands
| | - Henk Schonewille
- Centre for Clinical Transfusion Research; Sanquin Research; Leiden the Netherlands
- Jon J van Rood Centre for Clinical Transfusion Research; Sanquin-Leiden University Medical Centre; Leiden the Netherlands
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Schulze TJ, Goebel M, Scharberg EA, Bugert P, Janetzko K. Development of Anti-G, Anti-C and Anti-Jk(b) in a 22-Year-Old Mother during Her Fourth Pregnancy. ACTA ACUST UNITED AC 2013; 40:207-9. [PMID: 23921643 DOI: 10.1159/000351518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 11/07/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anti-G antibodies are rarely found since anti-D, in combination with anti-C, are difficult to discriminate from anti-G antibodies in routine testing. CASE REPORT A 22-year-old, gravida-3, para-1, woman with blood group A Rh D neg ccddee and known antibody anti-Jk(b), gave birth to her second child. While anti-Jk(b) could not be detected at birth, a new anti-C was found. Antibody screening tests (IAT) were performed using gel cards and rare G positive rGr erythrocytes. Genotyping for RHD and RHCE was performed using PCR-SSP. RESULTS The child's blood group was A Rh D neg Ccddee. Genotyping revealed Cde/cde haplotypes. The erythrocytes of the new-born showed a positive direct antiglobulin test with IgG; anti-D and anti-C could be eluted. Erythrocytes with the rare phenotype rGr were reactive with the serum of the mother. CONCLUSION The presence of anti-D and anti-C in the eluate from then newborn's Ccddee erythrocytes proved anti-G or anti-G in combination with anti-D. When anti-C and anti-D are seen during a pregnancy, possibly anti-G is present. This observation is of relevance since women with anti-G can still develop anti-D and require rhesus prophylaxis.
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Affiliation(s)
- Torsten J Schulze
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany
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11
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A simple approach to confirm the presence of anti-D in sera with presumed anti-D+C specificity. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11:449-51. [PMID: 23399363 DOI: 10.2450/2012.0192-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 11/14/2012] [Indexed: 11/21/2022]
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12
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Muller CL, Schucker JL, Boctor FN. When anti-G and anti-C antibodies masquerade as anti-D antibody. J Matern Fetal Neonatal Med 2010; 24:193-4. [PMID: 20807156 DOI: 10.3109/14767058.2010.482616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We describe a case of a pregnant woman with anti-C/anti-G antibodies masquerading as anti-D antibodies. Further, confirmation of anti-D antibody is recommended with adsorption-elution studies to confirm the true antibody status. This will avoid the consequence of withholding Rh immunoglobulin prophylaxis in cases when anti-D antibodies are not present.
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Affiliation(s)
- Corinna L Muller
- Division of Maternal-Fetal Medicine, Geisinger Medical Center, Danville, PA 17822, USA
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Dohmen SE, Verhagen OJHM, Muit J, Ligthart PC, van der Schoot CE. The restricted use of IGHV3 superspecies genes in anti-Rh is not limited to hyperimmunized anti-D donors. Transfusion 2007; 46:2162-8. [PMID: 17176330 DOI: 10.1111/j.1537-2995.2006.01047.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Antibodies produced against the D antigen make use of IGHV genes restricted to the IGHV3 superfamily. These findings are based on the IGHV gene analysis in anti-D-producing B cells from hyperimmunized donors, however, and therefore the restriction might be due to the hyperimmunization. In this study the IGHV gene usage of anti-Rh-producing B cells in a woman who was immunized in the last trimester of her pregnancy was analyzed. STUDY DESIGN AND METHODS Serologic analysis was performed by absorption and elution. Antibody-dependent cellular cytotoxicity (ADCC) of the different anti-Rh was determined. A phage display library was constructed from 2.2 x 10(6) isolated B cells and pannings were performed with red cells of the r'r, R1R1, and R2R2 phenotype. RESULTS A plasma sample of the immunized person showed high levels of both anti-D and anti-G and low levels of anti-C. Anti-D and anti-G contributed equally strong to the ADCC whereas anti-C did not. Eighteen anti-D-, 5 anti-G-, and 1 anti-C-specific phage clones were found, of which 16, 2, and 1 used the IGHV3s genes, respectively. CONCLUSION For the first time a restriction to the IGHV3s genes in anti-D in a naturally immunized pregnant woman is shown. Moreover, the use of IGHV3s genes appears to be present in anti-C and anti-G as well. Therefore, it is concluded that restricted IGHV3s gene usage in anti-D is not due to hyperimmunization but due to characteristics of the Rh antigens and the intrinsic binding capacities of IGHV3s genes, supporting the common Rh footprint hypothesis.
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Affiliation(s)
- Serge E Dohmen
- Sanquin Research at CLB and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Pasha RPK, Bahrami ZS, Niroomanesh S, Ramzi F, Razavi AR, Shokri F. Specificity and isotype of Rh specific antibodies produced by human B-cell lines established from alloimmunized Rh negative women. Transfus Apher Sci 2005; 33:119-27. [PMID: 16103012 DOI: 10.1016/j.transci.2005.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2004] [Revised: 01/09/2005] [Accepted: 03/21/2005] [Indexed: 11/30/2022]
Abstract
Despite the successful outcome of anti-D prophylaxis program, alloimmunization still occurs. The aim of this study was to examine the specificity and isotype of anti-Rh antibodies in plasma samples of Rh negative alloimmunized individuals and to study the same parameters in lymphoblastoid cell lines (LCLs) generated from the same donors. Specificity of anti-Rh antibodies was determined in plasma of nine alloimmunized subjects by direct hemagglutination using a panel of known RBC genotypes and isotype of specific antibodies were identified by an antigen specific ELISA. Similar methods were employed to determine specificity and isotype of antibodies produced by Rh specific LCLs established from four donors. LCLs were generated by Epstein-Barr virus transformation of peripheral blood mononuclear cells isolated from each donor followed by their culture over a feeder of human fetal fibroblasts. Upon emergence of lymphoblastoid cells, culture supernatants were assayed for presence of Rh specific antibody by hemagglutination assay. Anti-D was the predominant antibody in both plasma samples and among the 128 established LCLs; however, antibodies to other Rh specificities namely C and E were also produced. The isotype of anti-Rh antibody in all plasma samples was found to be IgG, predominantly IgG1, combined in 7 samples with IgM. Similarly 76%, 9.2% and 14.8% of LCLs were determined to produce antibody of IgG, IgM and of both isotypes, respectively. The data supported that the D antigen is the immunodominant component of the Rh system as indicated by the in vitro and in vivo profiles of Rh specificities in our alloimmunized subjects.
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