[Immunized pregnant woman with rare Rh fenotype--case report]

Rh blood group system is one of the most polymorphic systems of human blood and consists of 50 antigens. Antigen D is the most important antigen in the Rh system and next to ABO, is the most clinically significant in transfusion medicine. The aim of this paper was to present a case of a rare Rh phenotype ccDEE in an immunized pregnant woman, whose fourth pregnancy ended with birth of a female newborn infant with hemolytic disease of the lower level.

The history of a 42-year-old pregnant woman stated that she had had four pregnancies. She was transfused with 1500 ml of whole blood, three units of packed red cells and two units of fresh frozen plasma. Due to her high-risk pregnancy she was referred to the Clinic of Gynecology and Obstetrics in Novi Sad. Blood sample was tested in the Department of Prenatal Care of the Institute for Blood Transfusion Vojvodina. ABO and Rh were tested, antibody screening was done by indirect antiglobulin test and the detected antibodies were identified by gel technology. The results of testing were: O RhD positive, Rh phenotype ccDEE, positive screening for red blood cells antibodies by indirect antiglobulin test, alo anti-e antibody. According to the literature data, it is a very rare Rh phenotype whose incidence in the population ranges from 0.34% to 1.99%. The compatible blood products for the patient and her newborn were searched for on the basis of the immunoserology tests.

Two major problems within transfusion medicine have emerged in our case: the problem of immunization of pregnant woman with a rare blood type and the problem of finding compatible blood. Health care of pregnant women can be improved by following pregnancies according to the national antenatal testing algorithm and better teamwork of gynecologists and transfusions.