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Medical Forum / General / General / September 2005

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Anti-C Antibody - Can anyone explain?

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pokee@shaw.ca - 21 Sep 2005 07:32 GMT
Hi,

I just had a baby 5 days ago and my baby developed jaundice due to an
"ABO Incompatibility".  I am told this means I have an Anti-C antibody
with my O POS bloodtype.  My baby also has O POS, but not the Anti-C.

I am confused and my doctor didn't spend enough time with me at the
hosptial to explain.

I've read on the net that this is quite serious.  I probably developed
this antibody from a blood transfusion from my first pregnancy (no
problems with 1st baby) and I've read that this could have (and may
cause) more problems with my baby.

Can anyone explain this condition and what the risks are (to me and my
baby)?  Is my baby's jaundice more serious because of the cause?  Her
billirubin counts were okay when we left the hospital 2 days ago, but I
am worried I should be monitoring this more closely.

Thanks,
Paula
leena - 21 Sep 2005 08:01 GMT
hi,

Pls check this information
i think this would be some help
http://www.medical-health-dictionary.com/encyclopedia/t/TORCH-Syndrome.asp

>Hi,
>
[quoted text clipped - 17 lines]
>Thanks,
>Paula
Robert - 21 Sep 2005 08:30 GMT
> hi,
>
> Pls check this information
> i think this would be some help
> http://www.medical-health-dictionary.com/encyclopedia/t/TORCH-Syndrome.asp

Sorry but TORCH has nothing to do with hemolytic disease of the newborn.
They can cause jaundice as any infection can along with physiological
jaundice and on and on.
Antibody induced jaundice is one of the first tests performed in evaluating
jaundice. It is called a direct coombs.
Cord blood testing is carried out on all mothers who are type O and who are
Rh negative.
Robert - 21 Sep 2005 08:13 GMT
> Hi,
>
> I just had a baby 5 days ago and my baby developed jaundice due to an
> "ABO Incompatibility".

This is not an ABO incompatibility. It is an Rh antigen that you developed
an antibody to.

 I am told this means I have an Anti-C antibody

An antibody screen is performed as a part of all prenatal workups. When it
is positive for irregular antibodies then an antibody identification is done
and a titre is performed. It gives a number as to the strength of the
antibody. The strength is important and the number will dectate how the
pregnancy will be followed up with testing to check the health of the baby.
The titre is followed and if it gets too high then amniocentesis may be
performed to check for bilirubin levels of the fluid.

> with my O POS bloodtype.  My baby also has O POS, but not the Anti-C.

The baby had a test to check for the C antigen? If you have an anti-C then
the babies blood will contain anti-C. The anti-C will react with the babies
C antigen if the baby is positive for that antigen and lead to hemolytic
problems.

> I am confused and my doctor didn't spend enough time with me at the
> hosptial to explain.
>
> I've read on the net that this is quite serious.

Not if followed properly. Anti-D is usually more of a problem as it tends to
yield higher titers.

Anti-C is dosage related. In your case your babies affected will be Cc and
not CC. They are at a lower dose because your babies will have less C in
their blood.

 I probably developed
> this antibody from a blood transfusion from my first pregnancy (no
> problems with 1st baby) and I've read that this could have (and may
> cause) more problems with my baby.

I would ask your doctor to have your husband tested for big C and little c
antigens on his red cells. His blood is CC or Cc. Your blood is cc as you do
not have C.  If your husband is CC then all he can donate is C and all your
babies will be contain some C antigens. If he is Cc then only half of your
babies will be C positive and the other half will be C negative or cc babies
just like you and will not be affected what so ever with anti-C.
It helps with future care.

> Can anyone explain this condition and what the risks are (to me and my
> baby)?

I would respect the presence of your antibody and would hope you keep track
in the future when dealing with operations or need for transufusions in the
future. I would make everyone aware of your antibody status as delays in
crossmatching is common.
Remember where you had the antibody identified for future reference.
Sometimes the antibody goes away in a few years but that does not mean you
should recieve random units. All blood recieved in the future must be C
negative units. The blood bank may not pick up the antibody if it goes away.
You may end up with a delayed transufusion reaction if you are given C
positive units in the future and that is not good for you or your kidneys
etc.

With future pregnancies your baby may end up with jaundice as the red cells
are destroyed and they can harm the baby if the bilirubin gets too high.
They monitor you throughout your pregnancy with titers and as I stated an
increasing titer would indicate your baby probably is C positive and
stimulating your antibody production and if it gets high enough they can
check amniotic fluid and do a bilirubin level on that as a stand in for your
baby and they can go from there.

 Is my baby's jaundice more serious because of the cause?

Obviously cause is important on how to treat but once the baby is out then
this cause is easily treated. The treatment is the same for all hemolytic
disease of the newborn  but if severe enough then an exchange transfusion
can be done to replace the babies blood with C negative blood to reduce the
jaundice when it is a high levels. This is rarely done.

 Her
> billirubin counts were okay when we left the hospital 2 days ago, but I
> am worried I should be monitoring this more closely.
>
> Thanks,
> Paula

If your pregnancy was monitored then I wouldn't worry about it as it often
resembles any other ABO incompatibility.
bae@cs.toronto.no-uce.edu - 21 Sep 2005 15:36 GMT
>I just had a baby 5 days ago and my baby developed jaundice due to an
>"ABO Incompatibility".  I am told this means I have an Anti-C antibody
>with my O POS bloodtype.  My baby also has O POS, but not the Anti-C.
>
>I am confused and my doctor didn't spend enough time with me at the
>hosptial to explain.

Another poster has explained the medical consequences, but I thought
you might be interested in the biology and genetics.

The Rh system actually involves 3 genes.  The most important is D, and
we say someone is Rh+ if they express the D gene.  The other two genes
are c and e, and because the alternate alleles (C and E) are relatively
rare, you don't often hear about problems with them.

Your Rh phenotype is probably cDe, which is the most common worldwide.
Because you are c, you don't produce the C antigen.  Your baby is
probably CDe, having got the C allele from her father.  If your first
child was also C, you may have developed anti-C antibodies from her
blood mixing with yours during your first childbirth.  In this
childbirth, your baby was exposed to your blood, which contained the
anti-C antibodies, which attacked her blood cells and caused jaundice.

>I've read on the net that this is quite serious.  I probably developed
>this antibody from a blood transfusion from my first pregnancy (no
[quoted text clipped - 5 lines]
>billirubin counts were okay when we left the hospital 2 days ago, but I
>am worried I should be monitoring this more closely.

Basically the problem with you and your baby is the same as that of
a Rh- mother with an Rh+ baby, but it's due to "the next gene over"
instead of the more common D gene.  I would think that treatment and
prognosis would be about the same.  If your baby had good bilirubin
values within three days of birth, and didn't need a blood exchange
transfusion or other serious intervention, she probably had only a
fairly mild case -- i.e. you probably had a relatively low level of
anti-C antibody and very little was transferred to the baby.  However,
I have no medical qualifications, so you shouldn't take my word over
that of someone who does!

There is potential for more problems in your future pregnancies, so if
you want to have more children, you should discuss this with your doctor
well in advance.

I hope that when your baby next sees a doctor, that doctor will have more
time to explain the situation to you.  It can be hard to focus on what
you're hearing when you're very worried about your child, as you must have
been in the hospital.  

Best wishes for you and your family!
Robert - 21 Sep 2005 19:39 GMT
> >I just had a baby 5 days ago and my baby developed jaundice due to an
> >"ABO Incompatibility".  I am told this means I have an Anti-C antibody
[quoted text clipped - 7 lines]
>
> The Rh system actually involves 3 genes.

The three loci are allelic genes and inherited as a cluster.
Three from your mother and three from your father.

 The most important is D, and
> we say someone is Rh+ if they express the D gene.  The other two genes
> are c and e, and because the alternate alleles (C and E) are relatively
> rare, you don't often hear about problems with them.

C and E are not rare as she learned from her husband but common. It would
make life easier if they were rare.

> Your Rh phenotype is probably cDe, which is the most common worldwide.

Which corresponds to a genotype of Dce/Dce and those with  Dce/dce.

> Because you are c, you don't produce the C antigen.  Your baby is
> probably CDe, having got the C allele from her father.
 If your first
> child was also C, you may have developed anti-C antibodies from her
> blood mixing with yours during your first childbirth.

It is uncommon to form antibodies to C,c,E,e from childbirth luckily. It is
more likely from the large exposure of transfused blood. Antibody workups
involve asking the number of pregnancies and transfusions in the past.

A married female will often ask her husband to donate blood for her
involving transfusion needs. This is contra-indicated in women of child
bearing age because of what can happen.

 In this
> childbirth, your baby was exposed to your blood, which contained the
> anti-C antibodies, which attacked her blood cells and caused jaundice.

The antibodies cross the placenta for the entire pregnancy and only if the
baby is positive for C antigen will there be HDN so exposure is not just
during childbirth.

> >I've read on the net that this is quite serious.  I probably developed
> >this antibody from a blood transfusion from my first pregnancy (no
[quoted text clipped - 10 lines]
> instead of the more common D gene.  I would think that treatment and
> prognosis would be about the same.

Anti-D is in a class by itself and all the others including non Rh
antibodies are much lower down the road in terms of problems on average.

Anti-G which is often confused as a multiple antibody of Anti-D plus Anit-C
attenuates the condition very much as to not requiring close monitoring.

 If your baby had good bilirubin
> values within three days of birth, and didn't need a blood exchange
> transfusion or other serious intervention, she probably had only a
> fairly mild case -- i.e. you probably had a relatively low level of
> anti-C antibody and very little was transferred to the baby.

C typing of the baby is not clear and most do have a mild case comparable to
ABO HDN rather than Rh erythroblastosis fetalis.
The degree of anemia at birth and the laboratory parameters would be
apparent at that time.

 However,
> I have no medical qualifications, so you shouldn't take my word over
> that of someone who does!
>
> There is potential for more problems in your future pregnancies, so if
> you want to have more children, you should discuss this with your doctor
> well in advance.

She will stop having babies eventually but she will have the antibody for
life so it becomes important for her to know that she will need special
blood bank requirements.
She needs to communicate this at hospital admissions so the blood bank can
call the other locations to confirm the specificity of the antibody if it is
no longer present through the years.
Re-exposure to the antigen can create an amnestic response and jump the
antibody concentration very quickly to not help her maintain blood volumn
and destruction of infused blood.

> I hope that when your baby next sees a doctor, that doctor will have more
> time to explain the situation to you.  It can be hard to focus on what
> you're hearing when you're very worried about your child, as you must have
> been in the hospital.
>
> Best wishes for you and your family!
bae@cs.toronto.no-uce.edu - 21 Sep 2005 21:42 GMT
>> Another poster has explained the medical consequences, but I thought
>> you might be interested in the biology and genetics.
[quoted text clipped - 3 lines]
>The three loci are allelic genes and inherited as a cluster.
>Three from your mother and three from your father.

Not sure what you mean by "allelic genes" here.  The three appear to be
immediately adjacent on chromosome 1. There's controversy whether c and
e are one or two genes.  Crossing over between d and c-e is so rare
that it's worth a scientific paper.  OMIM quotes only one, from the
entire literature.  It's interesting stuff - Rh factor was the first
human gene to be located as to chromosome.

The original case in mammals appears to be only c-e.  D arose later, in
primates, by reduplication of c-e.  The apparently original case in humans
is Dce, and in most of the world, just about everybody has this phenotype.

d (Rh-) probably arose in palaeolithic Europe, and is extremely rare outside
of European-descended populations.  I've seen a wonderful map with isoclines
for frequency of Rh- which show the pattern of neolithic Rh+ farmers from
the middle east displacing palaeolithic hunter/gatherers who moved west
and to higher elevations.  The pattern shows a really high incidence in
the coastal Pyrenees (almost 40%) where the Basque people, who are probably
the closest genetic and linguistic descendants of palaeolithic Europeans,
ended up.  The higher incidence tails off across the east-west mountainous
spine of Europe all the way to the Balkans, decreasing slowly to the east,
and rapidly to north and south.

At any rate, if you're Rh-, and need a transfusion in east Asia or central
Africa, you're going to have a very hard time finding a donor.

>  The most important is D, and
>> we say someone is Rh+ if they express the D gene.  The other two genes
[quoted text clipped - 3 lines]
>C and E are not rare as she learned from her husband but common. It would
>make life easier if they were rare.

Well, depends on what counts as rare.  Rh- is about 15% in North America.
I wasn't able to find the incidence of C or E in the same population.
Do you know it?  By "relatively rare" and "you don't often hear", I'm
referring to "most people".  Of course as a medical lab worker, you'd run
into it far more often than most people.

I'll defer to your greater practical knowledge for the rest of it.
Robert - 22 Sep 2005 08:41 GMT
> >> Another poster has explained the medical consequences, but I thought
> >> you might be interested in the biology and genetics.
[quoted text clipped - 8 lines]
> e are one or two genes.  Crossing over between d and c-e is so rare
> that it's worth a scientific paper.

The order to linkage or association is written as DCE with D more closely
related to C and the more distant E more closely related to C than to D.
Anti-C s often found associated with anti-e and anti-E is often associated
with anti-c.

 OMIM quotes only one, from the
> entire literature.  It's interesting stuff - Rh factor was the first
> human gene to be located as to chromosome.
>
> The original case in mammals appears to be only c-e.  D arose later, in
> primates, by reduplication of c-e.  The apparently original case in humans
> is Dce, and in most of the world, just about everybody has this phenotype.
You don't mention C and E phenotypes.

> d (Rh-) probably arose in palaeolithic Europe, and is extremely rare outside
> of European-descended populations.  I've seen a wonderful map with isoclines
[quoted text clipped - 9 lines]
> At any rate, if you're Rh-, and need a transfusion in east Asia or central
> Africa, you're going to have a very hard time finding a donor.

Correct with the incidence of that as it is in the very high upper 90s.

Plasmodium vivax a species of malaria attaches to the duffy blood group
antigen on the red cells. Those negative for that antigen and most blacks
are, are resistent for that type of malaria.

> >  The most important is D, and
> >> we say someone is Rh+ if they express the D gene.  The other two genes
[quoted text clipped - 5 lines]
>
> Well, depends on what counts as rare.  Rh- is about 15% in North America.

If you ever come across the present term of Weak D or the old name of Du,
they can be interesting.

One variant may be the D mosaic in which the person types as Rh positive but
the D antigen is altered enough to recognize the complete D antigen as
foreign. As a result these people develop an anti-D they should recieve Rh
negative blood.
Of interest also is the newer antisera using monoclonal antibodies are
stronger. Some people previously typed as Rh negative can come across as Rh
positive now. They are pretty upset and some have refused Rh positive blood.

> I wasn't able to find the incidence of C or E in the same population.
> Do you know it?  By "relatively rare" and "you don't often hear", I'm
> referring to "most people".  Of course as a medical lab worker, you'd run
> into it far more often than most people.

The incidence of finding compatible blood with C negative units is 30%. With
E it is 70%, little c 20%, little e 3%.

As you stated it varies with ethnicity and Rh type.
C and E is also less common in Rh negative blood so in emergency situations
we would pick O negative units again relating to the DCE relationship or
conversely the dce relationship.

If they were to order 4 units of O pos blood for surgery how many units
would we have to screen in order to find 4 units.

4/ 0.3 = 13.3  in other words I would have to test 14 units of blood in
order to find 4 units negative for C.

This can be stressful for the patient and us in finding blood in a hurry.

Everybodies favorite for finding blood is anti-K where 90% of units are
negative for K.
 
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