RESUMEN
BACKGROUND: Rh immune globulin (RhIG) has been used successfully for many years for the antenatal suppression of anti-D in D- mothers carrying D+ babies to prevent hemolytic disease of the fetus and newborn. Although the mechanism of RhIG-induced immunosuppression remains unknown, a recent report (TRANSFUSION 2006;46:1316-22) has shown that women receiving RhIG produce elevated levels of transforming growth factor (TGF)ß-1, a powerful immunosuppressant cytokine. It was suggested that induction of TGFß-1 and immunosuppression may be independent of cognate antigen recognition by RhIG. Herein, we present a description of a mother and baby that supports this hypothesis. STUDY DESIGN AND METHODS: Red blood cells and serum were analyzed using saline-tube indirect antiglobulin test methods. RhIG (RhoGAM) was administered after each amniocentesis performed at 28, 31, and 36 weeks' gestation. RESULTS: A group A, D-(cde), K+, Fy(a-b+), MNs, Jk(a+b+) mother with no detectable anti-D had an anti-Fy(a) titer of 4096 before RhIG but only 256 after RhIG. Mother gave birth to a group O, D-(cde), Fy(a+b+) healthy baby boy having a weak-positive direct antiglobulin test with anti-Fy(a) eluted from his cells and the titer in the cord serum was 4. CONCLUSION: This case demonstrates the potential immunosuppressive properties of RhIG for down regulation of a possible clinically significant alloantibody, not anti-D, where no D+ antigen is in the circulation of the mother. The case illustrates the potential utility for using RhIG to modulate antibody levels in situations other than for classical suppression of anti-D production. Although the mechanism in this case is unknown, TGFß-1-mediated or antibody-mediated immunosuppression to soluble nonparticulate antigens are possible mechanisms.
Asunto(s)
Eritroblastosis Fetal/prevención & control , Isoanticuerpos/inmunología , Globulina Inmune rho(D)/uso terapéutico , Adulto , Eritroblastosis Fetal/inmunología , Femenino , Feto , Humanos , Recién Nacido , Embarazo , Adulto JovenRESUMEN
BACKGROUND: RBCs of the Hy- phenotype have, in the past, been typed as Gy(a+w), Hy-, Jo(a-), and RBCs with the Jo(a-) phenotype type Gy(a+), Hy+w, and Jo(a-). Anti-Hy and anti-Joa are difficult to identify mainly because appropriate reagent RBCs are poorly characterized. Historically, anti-Joa has not reacted with RBCs with either phenotype. This report describes a case of an anti-Joa that shows Hy- RBCs express some Joa antigen, albeit weakly. CASE REPORT: Anti-Joa was identified in a serum sample of a 71-year-old woman. The antibody reacted 1+ to 2+ by the IAT with all untreated and ficin-treated panel RBCs and did not react with Gy(a-) RBCs and Jo(a-) RBCs. Unexpectedly, the serum sample reacted weakly with six of eight RBC samples with the Hy- phenotype. The anti-Joa was adsorbed onto and eluted from Hy- RBCs, indicating the presence of weak Joa antigen. The patient's RBCs typed Gy(a+), Hy+, Jo(a-). DNA studies using PCR-RFLP analysis showed the patient to be homozygous for the JO allele, which is consistent with the serologically determined Jo(a-) status. CONCLUSION: The DNA and serologic evidence of this case show that Hy- RBCs may express low levels of Joa antigen, which contradicts previously published data concerning the Joa type of Hy- RBCs.