>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.
> >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.