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D: 85% Caucasians, 92% Blacks, 99% Asians
C: 68% Caucasians, 27% Blacks, 93% Asians
E: 29% Caucasians, 22% Blacks, 39% Asians
c: 80% Caucasians, 96% Blacks, 47% Asians
e: 98% Caucasians, 98% Blacks, 96% Asians
http://www.ncbi.nlm.nih.gov/books/NBK2269/
3. Give a list of the more common phenotypes and genotypes of the Rh system, including the antigens
present and their serologic reactions with the 5 antisera.
WEINER
FISHER-RACE
R1r
R1R1
rr
R1R2
R2r
DCe/dce
DCe/DCe
dce/dce
DCe/DcE
DcE/dce
R2R2
DcE/DcE
4. What are the causes of false positive and false negative reactions in Rh typing by the slide method?
a. Improper and inadequate washing of the red cell suspension may cause pseudoagglutination
due to the presence of serum macromolecules in the suspension. This should cause a positive
control as well.
b. The presence of strong autoagglutinins in the patient's or donor's serum may cause
agglutination. Proper washing and the control are designed to prevent or detect this problem.
c. Antibody coating of the red cell (positive DAT) can cause a false positive reaction, particularly
in the weak D test. A DAT will detect this occurrence.
d. A false negative reaction may be seen due to the "blocking phenomenon". This occurs most
commonly in HDFN due to anti-D. Since the red cell's antigen sites are heavily coated with
maternal antibody, they may not react with the antiserum.
e. False positive or negative reactions may occur in the Rh test due to many of the technical
errors..
f. RBCs that react with one manufacturers anti-D reagent but not with another may have a partial
D antigen.
Researcher: CABOBOS, Mary Antonette L.
Reference: cache:-ukZJ95UOwkJ: indianinitiative.org/wp-content/uploads/2011/06/211-RhTyping.doc+&cd=4&hl=en&ct=clnk&gl=ph
5. What is the clinical; significance or importance of Rh typing?
Transfusion Reactions
Rh antigens are highly immunogenic. The D antigen is themost immunogenic antigen outside
the ABO system. When anti-D is detected, a careful medical history will reveal RBC exposure through
pregnancy or transfusion of products containing RBCs. Circulating antibody appears within 120 days of
a primary exposure and within 2 to 7 days after a secondary exposure.
Rh-mediated hemolytic transfusion reactions, whethercaused by primary sensitization or
secondary immunization, usually result in extravascular destruction of immunoglobulin- coated RBCs.
The transfusion recipient may have an unexplained fever, a mild bilirubin elevation, and a decrease in
hemoglobin and haptoglobin. The direct antihuman globulin test is usually positive, and the antibody
screen may or may not demonstrate circulating antibody. When the direct antiglobulin test indicates that
the recipients RBCs are coated with IgG, elution studies may be helpful in defining the offending
antibody specificity. If antibody is detected in either the serum or eluate, subsequent transfusions should
lack the implicated antigen.
Hemolytic Disease of the Newborn (HDN)
HDN is briefly described here because of the historic significanceof the discovery of the Rh
system in elucidating its cause. As stated previously, anti-D was discovered in a woman after delivery
of a stillborn fetus. The mother required transfusion. The fathers blood was transfused, and the mother
subsequently experienced a severe hemolytic transfusion reaction. Levine and Stetson1 postulated that
the antibody causing the transfusion reaction also crossed the placenta and destroyed the RBCs of the
fetus, causing its death. The offending antibody was subsequently identified as anti-D.HDN caused by
Rh antibodies is often severe because the Rh antigens are well developed on fetal cells, and Rh
antibodies are primarily IgG, which readily cross the placenta. After years of research, a method was
developed to preventsusceptible (Rh0 D-negative) mothers from forming anti-D, thus preventing
Rh0(D) HDN. Rh-immune globulin, a purified preparation of IgG anti-D, is given to a D-negative
woman during pregnancy and following delivery of a D positive fetus.
Researcher: CAISO, Zenelei Grace A.
Resources: Harmening, D. M. (2012). Modern Blood Banking And Transfusion Practices (6th Ed.). F.A.
Davis, 2012.