title: Anti-D auto-immunization in a patient with weak D type 4.0.
abstract: We report the case of a 56-year-old patient with blood group O+C-c+E-e+K-, followed for a myelodysplasic syndrome and treated by regular pheno-identical and compatible (RBCs) transfusion since December 2007. In June 2009, a positive crossmatch was found with 2 RBCs O+C-c+E-e+K-. A positive anti-body screening with a positive autocontrol was detected and anti-D was unidentified in the patient's serum. The DAT was positive (IgG) and elution identified an anti-D. The following assumptions were then made: it could be a partial D phenotype with anti-D alloantibodies or RH: 1 phenotype with an anti-D auto-antibodies. Molecular analysis by multiplex PCR and sequencing have depisted a weak D type 4.0 phenotype. In October 2009, over three months of RH:-1 RBC transfusion, the antibody screening and DAT (IgG) remained positive, and an eluate made from the patient's erythrocytes contained an anti-D. All these funding confirmed the autoimmune nature of the anti-D. This case report illustrates the importance of a well-conducted and immunohematological laboratories test in order to distinguish between auto- or allo-immune of anti-D in a RH: 1 poly-transfused patients. This distinction is of great importance for transfusion support.
authors.affiliation: Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia.
authors.forename: M
authors.initials: M
authors.lastname: Ouchari
authors.affiliation: Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia.
authors.forename: T
authors.initials: T
authors.lastname: Chakroun
authors.affiliation: Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia.
authors.forename: S
authors.initials: S
authors.lastname: Abdelkefi
authors.affiliation: Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia.
authors.forename: H
authors.initials: H
authors.lastname: Romdhane
authors.affiliation: Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia.
authors.forename: B
authors.initials: B
authors.lastname: Houissa
authors.affiliation: Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia. Electronic address: saloua.jemni@rns.tn.
authors.forename: S
authors.initials: S
authors.lastname: Jemni Yacoub
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D012203:Rh Isoimmunization / Q000097:blood*; D018029:Rho(D) Immune Globulin
chemical_list: D007518:Isoantibodies; C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin
keywords: Auto anticorps; Genotypage RH; Génotypage RH; RAI; Test de Coombs; Transfusion