title: [Difficulties of the care of public antigen alloimmunization].
abstract: Alloimmunization against high-frequency erythrocyte antigens is a problematic situation in terms of laboratory diagnosis, transfusion and obstetrical management. We report the case of a pregnant woman alloimmunized against public Ag. We detail the difficulties of alloantibody (Ab) identification and transfusion management of the deliveries. A 29-year-old pregnant woman was hospitalized in gynecology and obstetrics departments at 36 weeks of gestation for assessment of hydrops fetalis. Antibody identification test revealed the presence of a pan-reactive antibody. Investigations realized in CNRGS (Paris) concluded in anti-GE2+anti-RH3+autoantibody. The red cell phenotype was GE: -2,3. A therapeutic interruption of the pregnancy was indicated. A program of autologous transfusion was organized with withdrawal of 2 units of blood. The 2nd pregnancy took place normally. Before delivery, an autologous blood reserve consisting of 2 red cell packs and 2 fresh frozen plasma was withdrawn and transfused after delivery. The management of anti-public alloimmunization poses several problems. The first one is of diagnostic nature with, on the one hand, the difficulty of Ab identification by the available red cell panels and, on the other hand, the possible presence of alloantibodies of transfusional or obstetric interest masked by anti-public Ab. The second is represented by transfusional care of these patients. In the absence of a national reserve of frozen rare blood, the autologous transfusion remains the only alternative. However, it can answer only a limited number of indications and only in case of moderate blood loss.
authors.affiliation: CRTS de Sfax, 99/UR/08-33, université de Sfax, Sfax, Tunisie. Electronic address: ikbeam@yahoo.fr.
authors.forename: I
authors.initials: I
authors.lastname: Ben Amor
authors.affiliation: CRTS de Sfax, 99/UR/08-33, université de Sfax, Sfax, Tunisie.
authors.forename: T
authors.initials: T
authors.lastname: Rekik
authors.affiliation: CRTS de Sfax, 99/UR/08-33, université de Sfax, Sfax, Tunisie.
authors.forename: N
authors.initials: N
authors.lastname: Louati
authors.affiliation: CRTS de Sfax, 99/UR/08-33, université de Sfax, Sfax, Tunisie.
authors.forename: W
authors.initials: W
authors.lastname: Lahiani
authors.affiliation: CRTS de Sfax, 99/UR/08-33, université de Sfax, Sfax, Tunisie.
authors.forename: H
authors.initials: H
authors.lastname: Rekik
authors.affiliation: CNRGS, 75011 Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Peyrard
authors.affiliation: CRTS de Sfax, 99/UR/08-33, université de Sfax, Sfax, Tunisie.
authors.forename: H
authors.initials: H
authors.lastname: Menif
authors.affiliation: CRTS de Sfax, 99/UR/08-33, université de Sfax, Sfax, Tunisie.
authors.forename: J
authors.initials: J
authors.lastname: Gargouri
mesh_terms: D000032:Abortion, Therapeutic; D000328:Adult; D001789:Blood Group Antigens / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000097:blood / Q000175:diagnosis*; D001788:Blood Grouping and Crossmatching; D001804:Blood Transfusion, Autologous; D017707:Erythrocyte Transfusion; D005260:Female; D006021:Glycophorins / Q000235:genetics / Q000276:immunology*; D006801:Humans; D015160:Hydrops Fetalis / Q000209:etiology*; D007518:Isoantibodies / Q000097:blood / Q000276:immunology; D010949:Plasma; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy
chemical_list: D001789:Blood Group Antigens; D006021:Glycophorins; D007518:Isoantibodies
keywords: Anti-Gerbich; Grossesse; Pregnancy; Transfusion