Fetal Loss Due to Anti‐Hro in a Lady Having Rare Genotype of Rh (D‐‐/D‐‐)

Abstract

Aim A lady of 30 years was referred to our Institute for investigations who had an obstetric history of one living child, followed by one still birth and then a termination of pregnancy due to suspected fetal ascitis. Method Blood grouping and Rh genotyping was done by us by standard serological procedures and patient’s serum was investigated for atypical antibodies by panel of cells. Fourteen family members were investigated for ABO grouping and Rh genotyping. Result Patient’s blood group was identified as O Rh Positive showing a rare Rh genotype D‐‐ with presence of only D antigen and absence of C, c, E and e antigens. Confirmation of this was done by absorption of patient’s red cells with anti‐C, anti‐c, anti‐E and anti ‐e antisera and testing the eluate reactivity for presence of the respective antigens. Patient’s serum reacted with all panel red cells of the common Rh genotypes and the antibody is anti – Hro which is the most potent antibody a D‐‐ individual produces. Amongst the family members of the propositus, seven probable heterozygote D‐‐ individuals were identified by testing with incomplete anti ‐D by saline technique. Conclusion The patient had a rare Rh genotype D‐‐/D‐‐ and had produced anti – Hro antibody due to fetomaternal leak during pregnancies and this must have been responsible for the fetal loss. No other family member exhibited this rare Rh genotype in homozygous form.

A profile of rare bloods in India and its impact in blood transfusion service

“…Alloantibody in her serum, causing problem in cross match test that lead to identification of her phenotype as -D-/-D-. [ 5 ] The fourth case was a multi-transfused cancer patient showing incompatibility in cross match test due to anti-Rh17.…”