Acrobat
MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Antibody Screen Positive: Rh Disease and Other Atypical Antibodies
Sponsored by The Indian Health Service Clinical Support Center
6. Rh Disease and Other Atypical Antibodies
Step 6. Kell kills, Duffy dies, and Lewis lives?
Though not part of the Rh group, there are plethora of different antibodies reported back to clinicians. Let us highlight three commonly reported antibodies.
RE: ‘Kell kills’
One has to be careful with anti-Kell antibodies. This is a relatively common one, and potentially can cause quite severe hemolytic disease. Any titer may be significant here, even 1:2, not just your lab’s usual cut-offs for the other antibodies.
RE: ‘Duffy dies’
The carrier molecule of the Duffy blood group antigens is a multi-pass membrane glycoprotein. The antigens themselves have not yet been fully characterized. Anti-Fya can cause significant hemolytic transfusion reactions (HTR) as well as hemolytic disease of the newborn HDN). Anti-Fyb, on the other hand, is not commonly found, since the Fyb antigen is a poor immunogen. The antibody is usually produced in patients who have already been sensitized to multiple blood group antigens. HDN caused by anti-Fyb is rare and, when present, is mild in nature; anti-Fyb can occasionally cause HTRs. Anti-Fy5 is distinguished from anti-Fy3 by the fact that, unlike anti-Fy3, anti-Fy5 will not react with Rh null cells of common Duffy type.
HDN rarely occurs with either of these two antibodies. Significant transfusion reactions have occurred with anti-Fy3. Anti-Fy5 caused a mild, delayed HTR in one reported case. In the presence of either anti-Fy3 or anti-Fy5, Fy(a-b-) donor units should be transfused. Such units can be readily located by screening units from black donors
RE: Lewis lives
Compared to Kell and Duffy groups, the Lewis group is more frequently associated with self limited disease. Lewis antigens are absorbed onto the red cells from the plasma and are located on type 1 glycosphingolipids. Lewis antigens may disappear from red cells in infectious mononucleosis-associated hemolysis, severe alcohol-induced cirrhosis, or pancreatitis. The P1 antigen may be weakened in various types of carcinoma. Varied expression of both I and i have been associated with Tk polyagglutination, leukemia and other hemolytic conditions.
Anti-I is often the causative antibody responsible for chronic cold agglutinin disease, as well as the acute, self-limited hemolysis sometimes seen subsequent to mycoplasma pneumonia infection. Anti-i has been associated with hemolysis in conjunction with infectious mononucleosis and lymphoma.
