Observations of the number of available G (rhG, Rh12) antigen sites on red cells

Approach to a Pregnant Woman with Anti D + Anti C Reactivity Pattern: A Diagnostic Conundrum

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.

Development of Anti-G, Anti-C and Anti-Jk(b) in a 22-Year-Old Mother during Her Fourth Pregnancy

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.

Evidence that the c, D and E epitopes of the human Rh blood group system are on separate polypeptide molecules

The distribution of the epitopes, c, D, E and G of the human Rh system on red cells has been investigated using both 125I-labelled and fluorescently-labelled MAbs. There is a very wide range in the density of each epitope on individual red cells and the numbers of c, D and E epitopes on each cell are independent of each other. These observations taken together with the finding that there is no steric hindrance to binding between the antibodies, anti-c, anti-D and anti-E indicate that these epitopes are on separate Rh polypeptide molecules. The observations are taken to indicate that the total amount of Rh polypeptide on a single red cell is constant but that there is considerable heterogeneity between cells in the amount of each separate polypeptide carrying the different epitopes. In contrast, there was a mutual inhibition of binding of anti-G and anti-D monoclonals and direct positive correlation between the number of G and D sites on individual cells, indicating that the G and D epitopes are probably on the same Rh polypeptide.

Characterization of the D, c, E and G antigens of the Rh blood group system with human monoclonal antibodies

The human MAbs, anti-D, -c, -E and -G of the Rh blood group system, produced by Epstein-Barr virus transformed B-cell lines, were purified by protein A-Sepharose chromatography and used to characterize the Rh antigens of human red cells. Scatchard plot analyses performed with the radiolabelled MABs indicated that each R2R2 red cell carries 0.43, 0.32 and 0.38 x 10(5) D, c and E binding sites, respectively. About half this number of antigen sites are present on erythrocytes from heterozygote individuals using the appropriate antibody. We found, however, that only 0.18 x 10(5)G antigenic sites were present on each R1R1 red cell. The affinity constants of the anti-D, -E and -G were similar varying from 0.6 to 1.5 x 10(8) M-1 whereas that of the anti-c was much lower (0.035 x 10(8) M-1). The blood group specificity and binding properties indicate that the MAbs behave like the polyclonal anti-Rh reagents. Immunoprecipitation experiments carried out with membranes from R2R2 red cells show that a 30-32 kDa component can be identified whatever the antibody used. The immune complexes involving anti-c, -E or -G antibodies could be formed with the detergent lysates from red cell membranes. In contrast, membrane integrity was a prerequisite for the binding of the anti-D antibodies. Finally, from extraction studies of immunocomplexes with non-ionic detergents it was concluded that all the Rh-active components are bound to the membrane skeleton, suggesting that these molecules may have important function for maintaining red cell shape and viability.