How anti-c in a D- patient prompted lifesaving work between a transfusion service and a blood center reference laboratory.

This case report showcases an extraordinary collaboration to support the transfusion needs of a patient with a rare phenotype and long-standing anemia due to gastrointestinal bleeding. This report describes the Immunohematology Reference Laboratory testing and logistics of rare blood provision over an 11-year period, as well as a summary of the hematologic, gastroenterologic, and surgical interventions. This case illustrates how a strong collaboration among the clinical team, laboratory, blood center, and the rare donor community facilitated successful management of this patient's anemia until the patient could receive life-changing treatment.

AIR SAC TREMATODES (CYCLOCOELIDAE STOSSICH, 1902) INFECTING BIRDS IN ZOOLOGICAL INSTITUTIONS IN THE UNITED STATES.

Air sac trematodes (Digenea: Cyclocoelidae) were detected in 23 avian species from eight aviaries in the United States. Most of the infected host species were passeriform birds, but a few species in other orders also were infected. Four species of adult flukes were encountered: Circumvitellatrema momota, Morishitium sp., Psophiatrema greineri, and Szidatitrema yamagutii. Findings from retrospective review of medical records, necropsy records, and author observations are presented. Potential terrestrial snail intermediate hosts were collected from three indoor aviaries. A high prevalence (47%) of larval trematode infections was demonstrated in one species of nonnative snail (Prosopeas achatinacea); one larva was isolated and matched to the adult species (C. momota) from birds using PCR. Problems with introducing potentially infected wild-caught birds into aviaries, and exchanging captive individuals between aviaries where they potentially may carry infections, are discussed.

PARASITES OF THE BLUE IGUANA (CYCLURA LEWISI) FROM GRAND CAYMAN ISLAND.

Feces (n = 226; 2004-2015) from healthy captive and wild blue iguanas (Cyclura lewisi) from Grand Cayman, Cayman Islands, were examined for endoparasites. Parasites identified included Nyctotherus sp. and Entamoeba sp. cysts and trophozoites, trichomonad trophozoites, and oxyurid and trichostrongylid eggs. Endoparasites from postmortem examinations (n = 13) included adult and larval nematodes: Ozolaimus megatyphlon, Ozolaimus monhystera, Alaeuris travassosi, Atractis mega, and an unidentified species of Oswaldocruzia. Entamoeba spp. were more likely in captive juveniles of both sexes than captive or wild adults of either sex; Entamoeba spp. were more likely in captive adult females than captive adult males; trichomonad trophozoites were more likely in adult captive and wild iguanas of both sexes than in captive juveniles of either sex; and Nyctotherus spp. were more likely in juvenile captive males than captive adult males or females and more likely in adult wild males than captive juvenile males. Trichostrongylid eggs were more likely in adult wild females than adult captive females and more likely in captive and wild adults of both sexes than in captive juveniles of both sexes. Oxyurid eggs were more likely in adult captive and wild iguanas of both sexes than captive juveniles of either sex. Blue iguanas have a variety of endoparasites regardless of age, sex, or captive vs wild status, with no type found exclusively in either captive or wild populations. Ectoparasites from wild adults included adult ticks (Amblyomma torrei) and a single adult mite (Hirstiella trombidiformis). All are new host records for this species and Grand Cayman. Knowledge of parasite status of captive and wild populations is important to evaluate the relative risk of introduction of captive animals into wild populations.

A DOB allele encoding an amino acid substitution (Phe62Ser) resulting in a Dombrock null phenotype.

BACKGROUND: The gene polymorphisms responsible for the antigens Doa, Dob, Hy, and Joa in the Dombrock (Do) blood group system have been identified. Four different mutations have been reported to cause the Dombrock null [Gy(a-)] phenotype. These include splice mutations, an eight-nucleotide deletion, and insertion of a stop codon. Here a Dombrock null caused by a single-amino-acid substitution in the full-length protein is reported. STUDY DESIGN AND METHODS: DOA and DOB were determined by polymerase chain reaction-restriction fragment length polymorphism, and DO (ART4) exons and flanking regions were sequenced from genomic DNA. Expression analysis was performed by transfection of wild-type and mutant cDNAs into HEK 293T cells followed by flow cytometry and immunoblotting. Homology modeling was used to map the mutation on the protein structure. RESULTS: The patient's sample carried nt 793G/G, indicating a DOB/DOB background. Exon 2 sequencing showed the sample carried a new mutation, nt 185T>C, causing a Phe62Ser substitution. This variant Do was not expressed on the surface of transfected HEK 293T cells. The mutation maps to a highly conserved FDDQY motif located between the beta1-strand and alpha1-helix near the COOH terminus in the native molecule. CONCLUSIONS: The Dombrock null reported here is due to a single Phe62Ser mutation. The expression data confirmed that 62Ser is responsible for lack of cell surface Do, and protein modeling suggests the mutation disrupts important aromatic side chain interactions between Phe62 and His160. Production of an antibody to a high prevalence Dombrock antigen (anti-Gya) in this patient was consistent with complete absence of Dombrock/ART4 protein.

Anti-Vel reactivity diminished by adsorption with rabbit RBC stroma.

BACKGROUND: An anti-Vel, nearly missed in antibody identification studies, and the effect of a commercially available rabbit RBC stroma (RESt, Immucor) adsorptions on eight anti-Vel sera are reported. Anti-Vel is an antibody to an antigen of high prevalence. CASE REPORT: A 48-year-old woman with chronic vaginal bleeding presented with a Hct of 14.7 percent. The transfusion service was not informed of her history of anti-Vel when she was transferred from another institution. Studies performed on an emergency request for transfusion were interpreted as a cold autoantibody as adsorption with a commercial source of RESt eliminated the reactivity. Stored anti-Vel sera were tested by titration studies before and after adsorption with commercial RESt. RESULTS: Serum from the index case did not react after adsorption with RESt at the transfusion service. Studies with the stored anti-Vel indicated antibody adsorption with four of four samples at immediate spin (IS) and room temperature (RT) phases, four of eight samples at 37 degrees C in albumin (ALB) phase, and four of eight samples at ALB-IgG-AGT phase. Variations in antibody reactivity were observed in the samples tested, but RESt adsorption diminished antibody reactivity in most samples. All eight stored sera demonstrated some reactivity in at least one phase after adsorption with RESt. CONCLUSION: Anti-Vel was completely or partially adsorbed by RESt. Caution should be used when interpreting cold agglutinins with this method. The manufacturer warns that uncommon alloantibodies may be adsorbed.