A Rare Case of Pregnancy-induced Anti-D, Anti-C, and Anti-G Antibodies

Abstract

ABSTRACT A 39-year-old female with breast carcinoma presented with complaints of menorrhagia and weakness. At current admission, her hemoglobin was 6.2 g/dL, and a requisition for packed red blood cells (PRBCs) was sent to the blood center. There was no previous history of transfusions, and the last pregnancy was 11 years ago. During the immunohematological (IH) workup, she was typed as O, ccdee, with an extra reaction in reverse grouping. Her antibody screening was positive, followed by the antibody identification, which was suggestive of anti-D and anti-C antibodies. The “Rhesus G” is an immunogenic antigen that is present on red cells that are D- and/or C-positive. Therefore, it is essential to determine the possibility of the presence of an anti-G antibody in the patient since anti-G appears as anti-D + anti-C serologically. In our case, a series of IH tests were performed, which ultimately led to the detection of all three antibodies: anti-D, anti-C, and anti-G. The patient’s husband and both children were typed as A, CcDee. Hence, her alloantibodies were most probably pregnancy induced, and since antibodies to the Rhesus system have a poor evanescence phenomenon, they are persisting to date. She was safely transfused with two units of O, ccdee PRBCs, and a special blood group card was provided to ensure that she always receives transfusions with phenotype-matched red cells in the future to avoid further alloimmunization.