October 2019 — Transfusion Medicine

A 32-year-old G1P0 woman has an initial type and screen at her first prenatal appointment. She is B positive and her antibody screen is negative. On subsequent ultrasound, she is found to be pregnant with trichorionic triamniotic triplets (2 boys and 1 girl). She has routine prenatal care and requires no transfusions during her pregnancy. She carries the pregnancy until 34 weeks gestation when she has premature rupture of membranes. Given the babies’ positions on ultrasound, she proceeds to have a Caesarian section performed to deliver the triplets. Another type and screen is collected just prior to her Caesarian section, but this time the antibody screen is strongly positive. Her initial antibody identification panel is shown in Figure 1 (top).

A cold autoantibody is suspected and further supported by a positive monospecific anti-C3 DAT and a negative monospecific anti-IgG DAT. To facilitate performing an alloadsorption with phenotypically similar RBCs, RBC antigen phenotyping is performed on the mother. The mother’s RBC antigen phenotype is shown in Figure 1 (bottom).

Following an alloadsorption with enzyme-treated phenotypically similar RBCs that adsorbs the cold autoantibody, a new alloantibody (anti-Fy3) is detected within the adsorbate. Hemolytic disease of the newborn (HDN) is now a possibility for her newly born children (each of which weighs ~2 kg). An initial ABORh typing on each of the triplets reveals one is B positive, one is AB positive, and one is A negative.

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Justin Juskewitch, M.D., Ph.D.
Fellow, Transfusion Medicine
Mayo Clinic
Instructor in Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science
Camille van Buskirk, M.D.
Consultant, Transfusion Medicine
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science

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This post was developed by our Education and Technical Publications Team.