Analyzing Antenatal Test and Outcomes of Rh-negative Pregnant Women / 实用妇产科杂志

Objective:To study antenatal immunity test and outcomes of Rh-negative pregnant women.Methods:287cases(1.25％ in 22880 cases)of Rh-negative pregnant women delivered in Shanghai Sixth People hospital from January 1 st,2010 to December 31,2016 were retrospectively analyzed.Rh(D) blood group was identified by a micro column gel method,and the same as serum anti-D antibody.The Rh phenotype detection was done Serology method and the hemolytic disease of the newborn was used indirect antiglobulin test,serum free antibody test,absorption and elution test.Some Rh negative pregnant women were implemented autologous blood at 37 weeks of gestation.Results:Among 287 cases of Rh-negative,12 cases had anti-D antibody and the positive rate was 4.18％.Among the 12 cases of anti-D positive,their Rh phenotype were all ccdee and they all had history of childbearing.In 90 cases which had one history of birth,there were ten cases had anti-D antibody (11.11％),in 15 cases which had two history of birth,there were two cases had anti-D antibody(13.33％).287 Rh negative pregnant women had 290 child births,among which 8 newborn had neonatal hemolytic disease,the incidence rate was 2.75％ (8/290).In the 12 cases of anti-D positive,there were 1 case died because of fetal neonatal hemolytic disease and 7 cases were cured and 4 cases were normal with free of jaundice symptoms.There were 146 pregnant women implementation of autologous donation safely.According to the delivery way of childbirth,287 cases were divided by cesarean section and vaginal delivery,comparing postpartum haemorrhage amount with autologous donantion and unautologous donation,respectively,the result showed that they had no significant difference(P ＞0.05).Conclusions:It should be pay attention to the pregnant women who had childbearing history and whose Rh phenotype is ccee,which tend to produce anti-D immune antibody.However,this does not necessarily lead to hemolytic disease.Based on maternal and fetus conditions,autologous donation is safe and valuable in Rh-negative pregnant.

A Case of Primary Anti-D Alloimmunization by RHD (c.1227G>A) DEL Red Blood Cell Transfusion / 대한수혈학회지

The Rh blood group D antigen is the most immunogenic of all antigens, next to ABO antigens. Anti-D immunization is clinically important since it may cause clinical problems, such as severe hemolytic transfusion reactions and hemolytic disease of the newborn. DEL is an extremely weak D variant that cannot be detected by basic serologic typing and is typed as D-negative without the absorption-elution techniques and RHD genotyping. Of the DEL phenotype, RHD (c.1227G>A) allelic variant is the most common in Korea. The DEL phenotype has been considered to carry only a few D antigens to induce anti-D immunization, but a few cases have reported that this allelic variant is capable of inducing anti-D immunization in a D-negative recipient, for which it is clinical significant. Herein, we present a case of primary anti-D alloimmunization in a RhD negative patient after receiving RHD (c.1227G>A) DEL red cell transfusion identified by serological and molecular tests, including RHD genotyping.

Use of Staphylococcal Protein-A and Streptococcal Protein-G for Detection of Red Blood Cells (RBC) Antibodies and Comparison with Other Techniques.

Background: Detection of red blood cells antibodies is important for the diagnosis of autoimmune hemolytic anemia, hemolytic disease of newborn, pre-transfusion testing and other problems. The aim of this study was to use Staphylococcal protein A (SpA) and Streptococcal protein G (SpG) as reagents in immunological tests for detecting red blood cells (RBC) antibodies and to compare the method with other techniques. Study Design & Methods: Sera from 60 patients, comprising forty-four anti-D positive sera from pregnant women and 16 from healthy controls were, used for the study. The anti-globulin gel test and the standard Coombs’ test were used to determine RBC antibodies in these sera and the result were compared with that of protein A and protein G tests. Results: With various degree of agglutination all 4 techniques detected the presence of RBC antibodies (anti-D) in the sera from 44 pregnant women, and tested negative for the remaining 16 sera (from healthy controls). The sensitivity and the specificity of the 4 techniques was 100%. Conclusions: This preliminary study demonstrates that both SpA and SpG tests can be used for the detection of RBC antibodies and therefore requires more study and testing before they can become useful standard tests in transfusion medicine.

Primary anti-D Immunization by DEL Red Blood Cells / 대한진단검사의학회지

Extremely weak D variants called DEL are serologically detectable only by adsorption-elution techniques. A nucleotide change of exon 9 in RHD gene, RHD (K409K, 1227G>A) allelic variant is present in almost all the DEL individuals of East Asians. No DEL phenotype has yet been shown to induce a primary alloanti-D immunization in East Asia. A 68-yr-old D-negative Korean man was negative for anti-D at admission, and he developed alloanti-D after transfusion of red blood cells (RBC) from 4 apparently D-negative donors. Four donors who typed D-negative by routine serologic test were analyzed by real-time PCR for RHD gene and RHD (K409K). One donor was found to have RHD (K409K). This is the first case in which DEL RBCs with RHD (K409K) induced a primary alloanti-D immunization in Asian population. Because the DEL phenotype can induce an anti-D immunization in D-negative recipients, further discussion is needed whether RhD negative donors should be screened by molecular method and what an efficient genotyping method is for detecting the RHD gene carriers in Korea.

A Case of Autoimmune Hemolytic Anemia Caused by Anti-D and Anti-C in RhD Positive Patient / 대한수혈학회지

We report a case of autoimmune hemolytic anemia caused by anti-D and anti-C in an RhD positive patient with Epstein-Barr Virus (EBV) infection. The patient achieved complete response by transfusion, treatment with a cytotoxic drug and plasmapheresis. A 66-year-old male patient visited the local hospital for exertional dyspnea. Incompatible crossmatching resulted in the transfer of the patient to our institution for transfusion. Anti-D, C were identified as the autoantibodies causing hemolytic anemia by the use of a direct antiglobulin test, antibody screening test, adsorption and elusion test, and antibody titration in the serum and eluate. The auto IgG warm antibodies were thought to be associated with the EBV infection. This case demonstrates the importance of performing antibody screening and an identification test for transfusion. Transfusion in autoimmune hemolytic anemia is complicated by the presence of pan reactive IgG autoantibodies. However, in this case,the autoantibody was specific for a defined blood group, RhD and RhC antigens,and serocompatible blood was administered without difficulty. Not only transfusion, but also treatment with steroids, a cytotoxic drug and plasmapheresis were critical in the treatment of autoimmune hemolytic anemia.

The purification of anti-D antibody from IgG contained anti-D by the RhD positive red blood cell / 中国免疫学杂志

Objective:To investigate the purified methods of human anti-D antibody from IgG contained anti-D. Methods:The IgG was separated by the column ion-exchange chromatography(CIEC) from the plasma in which the content of anti-D was 0.814 ?g/ml. Then the IgG preparation contained anti-D was purified by the affinity chromatography(AC) with the O group, RhD positive red blood cell (genotype CCDee). Results:The content of non anti-D IgG were reduced about 90% by the method of AC and the proportion of anti-D could be significantly increased in the final preperation. The quality of final preparation attained reqirements of national standard of biologics. Conclusion:This method is able to purify anti-D from IgG contained anti-D and offer a reference for plasma products.