Abstract
Rh-D is an unusual phenotype in Rh blood group system, lacking all Cc or Ee antigens but demonstrates a stronger D antigen expression. We describe here an extremely rare Rh-D phenotyped mother with first baby affected by haemolytic disease of foetus and newborn (HDFN). A 20-year-old pregnant lady, presented in active labour with foetal distress and planned for emergency cesarean section. Her blood group was A RhD positive, with positive antibody screening. Antibody identification demonstrated multiple antibodies against RhCc Ee polypeptide by the reference laboratory. Rh phenotype was -D-/-D- with no C/c and E/e antigen but strong D antigen. Crossmatch was incompatible with all A RhD positive units. Management of such patient is extremely difficult due to the scarcity of Rh-D- donor blood. In this case, reference laboratory had one frozen Rh-D- blood ready for use if indicated. Fortunately, patient underwent caesarean section without any complication. Baby was grouped as A Rh-D positive with probable Rh genotype as CDe/-D-. Baby’s DCT was positive and eluate showed antibodies of identical reactivity as mother. Baby developed mild jaundice at day-2 and managed with phototherapy. Clinically Rh-D- phenotype in pregnant women can cause mild to fatal HDFN. Routine antibody screening in pregnant women can detect such rare case that helps proper management of mother and baby. Prior arrangement of this rare blood is warranted to prevent the maternal and infant mortality and morbidity.
 Bangladesh Journal of Medical Science Vol.20(3) 2021 p.669-672
Highlights
The Rh blood group is one of the highly immunogenic and complex blood group systems, important in both transfusion medicine and pregnancy
Red blood cell alloimmunization against Rh antigen can occurs following sensitization by pregnancy or blood transfusion resulting in haemolytic transfusion reaction (HTR) and haemolytic disease of foetus and newborn (HDFN)[2]
Patient was on antenatal follow up, red cell antibody screening was not performed as this is not a common practice for the RhD positive mothers
Summary
The Rh blood group is one of the highly immunogenic and complex blood group systems, important in both transfusion medicine and pregnancy. Most of the Rh-D- individuals showed presence of anti-Rh17 antibodies in their serum that reacts as a single specificity 4,7 This antibody is best detected with antiglobulin testing, and reacts with both normal and enzyme-treated red blood cells[5]. There is no data on the prevalence of Rh-D- phenotype in Malaysia In this case report, we are presenting an extremely rare Rh-D- phenotype in a primigravida patient having first baby affected with HDFN due to Anti-Rh 17. Patient’s sample was send to reference laboratory, National Blood Centre Malaysia for antibody identification and confirmed the presence of antibody against RhCcEe polypeptide The management of such patient is extremely difficult due to the scarcity of Rh-D- phenotyped donor blood. Patient was asked to bring her immediate family members for screening of the Rh phenotype, they failed to come for screening and lost to follow up to the hospital
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