Warm autoimmune hemolytic anemia with mimicking anti-c and -E specificities

Abstract

An 18-month-old male was admitted to a hospital with a hemoglobin of 4.1 g/dL and a reticulocyte count of 53 percent. There was no history of prior transfusion. Serologic evaluation revealed the presence of both a positive direct antiglobulin test (DAT) and an indirect antiglobulin test (IAT). The patient's red blood cells (RBCs) typed as group A, C-D-E-c+e+ (cde/cde). Evaluation of the IAT revealed the presence of anti-c and anti-E. All other major antibodies were ruled out. Upon adsorption of the patient's serum with ficin-treated Cde/Cde RBCs, both antibody specificities were adsorbed; however, the antibodies were not adsorbed with native (untreated) Cde/Cde RBCs. Furthermore, the autoantibody was not adsorbed by Rh null cells, thereby suggesting Rh specificity. The serum was incompatible with cde/cde RBCs and compatible with Cde/Cde RBCs. The patient was successfully transfused with Cde/Cde RBCs followed by resolution of his anemia, as evidenced by an increased and stable hemoglobin. It was concluded that the autoantibody had mimicking anti-c and -E specificities. This is a report of an unusual case of autoimmune hemolytic anemia because the Rh autoantibody appeared to have dual mimicking specificities, and the patient's RBCs were antigen negative for one of the antibody specificities, i.e., anti-E.

Serological analysis of autoantibody mimicking anti-Rh(e) specificity: a case report

“…In clinical practice, an antigen-avoidance transfusion strategy is adopted to transfuse the corresponding antigen-negative RBCs, to achieve maximum blood transfusion compatibility, which is also applicable to patients with mimicking antibodies. 2,8 In our case, transfusion of matched ABO and Rh serological phenotype blood showed a poor transfusion effect, and Rh(e)-negative donor RBCs were eventually used for clinical transfusion. Type O ccDEE RBCs were then transfused and the patient's hemoglobin level increased, with no evidence of hemolytic transfusion reaction.…”

“…In most patients, autoantibodies react with all RBCs resulting in agglutination; however, some patients have autoantibodies with no apparent specificity in RBC panel tests, representing the most striking feature of mimicking antibodies. [1][2][3][4] In this study, we report the discovery of autoantibodies mimicking anti-Rh(e) specificity in a patient with suspected autoimmune hemolytic anemia. The mimicking antibody was detected in the patient's plasma and RBC eluate.…”

“…In most patients, autoantibodies react with all RBCs resulting in agglutination; however, some patients have autoantibodies with no apparent specificity in RBC panel tests, representing the most striking feature of mimicking antibodies. 1 – 4 …”