Incidental Discovery of Anti-IH in a Patient Planned for Caesarean Section and it’s Repercussions

Excerpt

A 27-year-old pregnant woman, 37 weeks pregnant, tested positive during antibody screening at Maternity and Child Healthcare Hospital. She had one child born by caesarian operation and no history of transfusions. She was referred to our blood center to reserve blood for caesarean operation. The blood groups of her and her husband are listed in Table 1. At room temperature (RT), forward grouping was A₁B group with D positive. Reverse grouping results were negative for A cells, weak agglutination (w +) for B cells and 2 + agglutination for O cells. Autocontrol and direct antiglobulin (IgG + C3d) test were both negative. Antibody screening results of the commercially available panel (Sanquin, Makropanal 16, Lot: 8000236600) are showed in Table 1. Further investigation revealed that by immediate spin, the antibody was strongly reactive against A₂ RBCs but not against O and B cord RBCs, suggesting that it is anti-IH. In order to identify whether the plasma contains other specific antibodies, we randomly selected five donors’ RBCs for each blood group of A, B and AB respectively and reacted with plasma: group AB donors’ RBCs were negative and group A and B donors’ RBCs were consistent with the agglutination intensity seen in reverse grouping. We treated the patient’s plasma with 2-mercaptoethanol (2-ME) and no agglutination was seen in panel cells with saline and antiglobulin media. Cross-match tests with seven randomly chosen group AB units were compatible with saline and antiglobulin media. Fortunately, caesarean operation was successful without blood transfusion and the child was healthy. …