Dual red cell alloimmunization with anti-c and anti-E antibodies: A systematic approach to workup and transfusion management in different clinical scenarios in resource-limited settings

Abstract

Background and Objectives: Alloimmunization can lead to difficulty in arranging compatible, antigen-negative blood units for the patients. Alloimmunization by coexisting “c” and “E” antibodies, though common, is frequently missed. Both “c” and “E” antigens are highly immunogenic and have the potential to cause hemolytic disease of newborn and hemolytic transfusion reactions. The objective of this study is to discuss different clinical scenarios of concomitant and singular presence of anti-c and anti-E along with the diagnostic approach and transfusion management in resource-limited settings. Methods: Column agglutination gel technology in low ionic strength solution phase was used for initial antibody identification. Detailed immunohematological workup was done by the use of select cells (c+, E− and c−, E+) and adsorption elution studies using a commercially available acid elution kit. Results: Out of 16 patients, detailed immunohematological workup was available for 14 patients, whereas two patients were lost to follow-up. Among 14 patients, 12 had CCDee (R1R1) phenotype, whereas two patients had CcDee phenotype (possible R1r) with anti-E antibody. In 12 patients with R1R1 phenotype, 6/12 (50%) had dual coexisting anti-c and E, whereas 3/12 (25%) had only anti-c and 3/12 (25%) had only anti-E. In R1R1 patients having anti-E, coexisting anti-c was found in 6/9 (66.66%) of patients. Conclusion: The study emphasizes the use of both “c” and “E” negative red cells (R1R1) in R1R1 patients having either anti-c or anti-E. Thus, in India, there is a need to develop our own red cell panels having an adequate representation of indigenous antigens and phenotypes.

Keywords

• anti-c
• anti-e antibody
• dual alloimmunization