Auto-anti D antibody in a multiply transfused thalassaemia patient at Universiti Kebangsaan Malaysia Medical Centre: A case report

Rabeya Yousuf, Yee Loong Tang, Suria Abdul Aziz, Nurasyikin Yusof, Nor Fadzliana Abdullah Thalith, Leong Chooi Fun

Research output: Contribution to journalArticle

Abstract

Objective: A rare case of autoantibody against D-antigen is reported here. A 15-year-Malay girl, diagnosed as Hb E/ ?-thalassaemia at the age of one and underwent splenectomy at the age of seven presented to Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for anaemia. Results: Investigations showed her blood group as O-RhD-positive with possible R1R1genotype. Her antibody screening was positive and antibody identification confirmed an anti-D antibody. Repeated RhD grouping with monoclonal IgM/IgG anti-D typing reagent showed strong reactions which excluded the partial-D status as IgM-monoclonal anti-D component directly agglutinates RhD-positive RBC and most types of Du except Dvivariant. The Dvivariant has been excluded by testing with ID-Card "DiaClon ABO/D+reverse grouping for patients". The direct antiglobulin test was positive and eluate showed presence of anti-D antibody. A differential-diagnosis of auto-anti-D or anti-LW was considered. Further investigation was performed to exclude anti-LW by testing patient's serum and eluate with RhD-positive and RhD-negative cord blood cells. Both the patient's serum and eluate showed positive reactions with only RhD-positive cord-blood cells but not with RhD-negative cells; indicating the antibody is of anti-D specificity and not anti-LW. As the patient's serum and eluate showed an anti-D antibody but patient's red-cell confirmed the presence of D-antigen, a diagnosis of autoanti-D was made and crossmatched compatible group O-RhD-negative packed cell released for transfusion. Conclusion: We would like to highlight two important aspects from this case i) it is very important to determine the RhD-phenotype especially for patients at child bearing age ii) auto-anti-D must be differentiated from anti-LW antibody as weak anti-LW may be confused with anti-D.

Original languageEnglish
Pages (from-to)596-597
Number of pages2
JournalInternational Medical Journal
Volume23
Issue number5
Publication statusPublished - 2016

Fingerprint

Thalassemia
Malaysia
Anti-Idiotypic Antibodies
Fetal Blood
Immunoglobulin M
Antibodies
Blood Cells
Serum
RHO(D) antibody
Coombs Test
Antigens
Splenectomy
Blood Group Antigens
Autoantibodies
Anemia
Differential Diagnosis
Immunoglobulin G
Phenotype

Keywords

  • Anti-LW
  • Auto-antiD
  • Multiply-transfused patient
  • Partial-D

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{9efd82b858184c00abbe7647430d7151,
title = "Auto-anti D antibody in a multiply transfused thalassaemia patient at Universiti Kebangsaan Malaysia Medical Centre: A case report",
abstract = "Objective: A rare case of autoantibody against D-antigen is reported here. A 15-year-Malay girl, diagnosed as Hb E/ ?-thalassaemia at the age of one and underwent splenectomy at the age of seven presented to Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for anaemia. Results: Investigations showed her blood group as O-RhD-positive with possible R1R1genotype. Her antibody screening was positive and antibody identification confirmed an anti-D antibody. Repeated RhD grouping with monoclonal IgM/IgG anti-D typing reagent showed strong reactions which excluded the partial-D status as IgM-monoclonal anti-D component directly agglutinates RhD-positive RBC and most types of Du except Dvivariant. The Dvivariant has been excluded by testing with ID-Card {"}DiaClon ABO/D+reverse grouping for patients{"}. The direct antiglobulin test was positive and eluate showed presence of anti-D antibody. A differential-diagnosis of auto-anti-D or anti-LW was considered. Further investigation was performed to exclude anti-LW by testing patient's serum and eluate with RhD-positive and RhD-negative cord blood cells. Both the patient's serum and eluate showed positive reactions with only RhD-positive cord-blood cells but not with RhD-negative cells; indicating the antibody is of anti-D specificity and not anti-LW. As the patient's serum and eluate showed an anti-D antibody but patient's red-cell confirmed the presence of D-antigen, a diagnosis of autoanti-D was made and crossmatched compatible group O-RhD-negative packed cell released for transfusion. Conclusion: We would like to highlight two important aspects from this case i) it is very important to determine the RhD-phenotype especially for patients at child bearing age ii) auto-anti-D must be differentiated from anti-LW antibody as weak anti-LW may be confused with anti-D.",
keywords = "Anti-LW, Auto-antiD, Multiply-transfused patient, Partial-D",
author = "Rabeya Yousuf and Tang, {Yee Loong} and {Abdul Aziz}, Suria and Nurasyikin Yusof and Thalith, {Nor Fadzliana Abdullah} and {Chooi Fun}, Leong",
year = "2016",
language = "English",
volume = "23",
pages = "596--597",
journal = "International Medical Journal",
issn = "1341-2051",
publisher = "Japan International Cultural Exchange Foundation",
number = "5",

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TY - JOUR

T1 - Auto-anti D antibody in a multiply transfused thalassaemia patient at Universiti Kebangsaan Malaysia Medical Centre

T2 - A case report

AU - Yousuf, Rabeya

AU - Tang, Yee Loong

AU - Abdul Aziz, Suria

AU - Yusof, Nurasyikin

AU - Thalith, Nor Fadzliana Abdullah

AU - Chooi Fun, Leong

PY - 2016

Y1 - 2016

N2 - Objective: A rare case of autoantibody against D-antigen is reported here. A 15-year-Malay girl, diagnosed as Hb E/ ?-thalassaemia at the age of one and underwent splenectomy at the age of seven presented to Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for anaemia. Results: Investigations showed her blood group as O-RhD-positive with possible R1R1genotype. Her antibody screening was positive and antibody identification confirmed an anti-D antibody. Repeated RhD grouping with monoclonal IgM/IgG anti-D typing reagent showed strong reactions which excluded the partial-D status as IgM-monoclonal anti-D component directly agglutinates RhD-positive RBC and most types of Du except Dvivariant. The Dvivariant has been excluded by testing with ID-Card "DiaClon ABO/D+reverse grouping for patients". The direct antiglobulin test was positive and eluate showed presence of anti-D antibody. A differential-diagnosis of auto-anti-D or anti-LW was considered. Further investigation was performed to exclude anti-LW by testing patient's serum and eluate with RhD-positive and RhD-negative cord blood cells. Both the patient's serum and eluate showed positive reactions with only RhD-positive cord-blood cells but not with RhD-negative cells; indicating the antibody is of anti-D specificity and not anti-LW. As the patient's serum and eluate showed an anti-D antibody but patient's red-cell confirmed the presence of D-antigen, a diagnosis of autoanti-D was made and crossmatched compatible group O-RhD-negative packed cell released for transfusion. Conclusion: We would like to highlight two important aspects from this case i) it is very important to determine the RhD-phenotype especially for patients at child bearing age ii) auto-anti-D must be differentiated from anti-LW antibody as weak anti-LW may be confused with anti-D.

AB - Objective: A rare case of autoantibody against D-antigen is reported here. A 15-year-Malay girl, diagnosed as Hb E/ ?-thalassaemia at the age of one and underwent splenectomy at the age of seven presented to Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for anaemia. Results: Investigations showed her blood group as O-RhD-positive with possible R1R1genotype. Her antibody screening was positive and antibody identification confirmed an anti-D antibody. Repeated RhD grouping with monoclonal IgM/IgG anti-D typing reagent showed strong reactions which excluded the partial-D status as IgM-monoclonal anti-D component directly agglutinates RhD-positive RBC and most types of Du except Dvivariant. The Dvivariant has been excluded by testing with ID-Card "DiaClon ABO/D+reverse grouping for patients". The direct antiglobulin test was positive and eluate showed presence of anti-D antibody. A differential-diagnosis of auto-anti-D or anti-LW was considered. Further investigation was performed to exclude anti-LW by testing patient's serum and eluate with RhD-positive and RhD-negative cord blood cells. Both the patient's serum and eluate showed positive reactions with only RhD-positive cord-blood cells but not with RhD-negative cells; indicating the antibody is of anti-D specificity and not anti-LW. As the patient's serum and eluate showed an anti-D antibody but patient's red-cell confirmed the presence of D-antigen, a diagnosis of autoanti-D was made and crossmatched compatible group O-RhD-negative packed cell released for transfusion. Conclusion: We would like to highlight two important aspects from this case i) it is very important to determine the RhD-phenotype especially for patients at child bearing age ii) auto-anti-D must be differentiated from anti-LW antibody as weak anti-LW may be confused with anti-D.

KW - Anti-LW

KW - Auto-antiD

KW - Multiply-transfused patient

KW - Partial-D

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