Patient's Rh System Phenotype: C, E, c, e, K, k, Kpa, Jsa, Fya, Fyb, Jka, Jkb, Lea, Leb, S, s, M, N, P1, I, H, A1.

10 rr 0 0 0 + + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0 + 0 + + 0 + 10 0

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11 R1R1 + + 0 0 + 0 + + 0 + 0 + 0 + 0 + 0 0 + + + + 0 + 0 + 11 0

Patien t AC

Antigen Phenotype

Rh system Kell Duffy Kidd Lewis MN Ss

C E c e K k Kpa Jsa Fya Fyb Jka Jkb Lea Leb S s M N P1 I H A1

Patien t 0 2+

Pos contro l 2+ 2+

Neg Contro l 0 0

Titration

ANTIBODY: Anti-Fya EDC: Tech: Date tested: Sample dilution, Reaction strength at AHG phase: Sample date: 1 2 4 8 16 32 64 128 256 512 1024 2048 4096 8192 Titer

Old:

New 2+ 1+ w+ vw+ 0 0 0 0 0

Cell type: R1R1, Fy(a+, b+) Manufacturer: Lot number: Comment:

HDN ABID CASE # 1

Is the antibody identity of the outside laboratory confirmed? If not, what is the phenotype of the additional cells you would like to test?

The identity of the antibody by the outside laboratory is not confirmed. The phenotype of the additional cells that I would like to test is Fy(a+, b_).

Does this antibody cause hemolytic transfusion reactions? Hemolytic disease of the newborn?

Yes, the antibody to the Duffy Fya antigen (i.e. anti-Fya) is capable of causing both hemolytic transfusions and hemolytic disease of the newborn.

What is the titer? Is anti-Fya of this titer likely to cause anemia in the fetus?

The antibody titer is 1:8. This titer is not likely to cause anemia in the fetus (the cut-off titer is 1:32).

What is the probable source of the immunizing stimulus in this case?

The blood transfusion that she received when she was 8 years old.

Is there any further testing that could be performed to evaluate the possibility of HDN? (Hint: could the fetus be antigen negative?)

A PCR assay of fetal DNA obtained by amniocentesis or chorionic villus sampling could be carried out. In addition, direct antiglobulin test could be done in the newborn immediately after delivery.

What percentage of Caucasian donors are expected to be compatible with this recipient? African-American donors?

34% of Caucasian donors are expected to be compatible with this recipient. These donors have the phenotype Fy(a_b+).

90% of African-American donors are expected to be compatible with this recipient. Of the 90%, 68% are Duffy null (i.e. Fy(a- b-) phenotype) and the other 22% are the Fy(a- b+) phenotype.