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A delayed and acute hemolytic transfusion reaction mediated by anti-c in a patient with variant RH alleles
Tiffany K Walters1, Thomas Lightfoot2
1Director, Immunohematology Reference Laboratory, American Red Cross, Carolinas Charlotte, Carolinas Durham, River Valley, Tennessee Valley, and South Carolinas Regions.
Conclusions:
The Rh system is the most complex of the human blood groups. Of the 55 antigens that have been characterized, the system's principal antigens D, C, E, c, and e are responsible for the majority of clinically significant Rh antibodies. In the last few years, advancements in molecular testing have provided a wealth of information on the genetic diversity of the Rh locus. This case report describes a patient with variant RHD*DAR alleles inherited in conjunction with two compound heterozygote RHCE*ceEK/RHCE*ceAR alleles. The patient was previously alloimmunized to D, C, and E and possibly hrS. Further transfusion of D-C-E-K- RBCs resulted in a suspected acute hemolytic transfusion reaction and the subsequent identification of anti-c. Monocyte monolayer assay testing suggests clinical significance with a range of 29.5-38.5 percent reactive monocytes.
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