A mimicking red blood cell autoantibody accompanying transfusion and alloimmunization

A patient with sickle cell disease who concomitantly developed red cell autoimmunity and alloimmunization is reported. The implied but 'wrong' specificity of the autoantibody mimicked one of the alloantibodies in the patient's serum. Although the patient's red blood cells phenotyped at Ro4, anti-rh" was eluted from them on several occasions. Absorption and secondary elution from selected cells proved the cell bound antibody had a unique and independent specificity from the anti-rh" in his serum. Standard antibody identification procedures did not distinguish these differences.