RH BLOOD TYPING Unusual Rh Phenotypes

Presence and absence of D an.gen Rh mod: weaken expression of all Rh Ags

ISBT NO.004 Rh null: Rh genes are inherited but not expressed
Rh deleted: rare rh phenotype exist
Integral part of red cell membrane
Non glycosylated transmembrane
1939 levine Stetson Parameter Rh Deleetd Rh null
1940 karl lansdteiner Morphology normal Stomatocytes,
MW 174 000 spherocytes
DcECe Rh Ags Maraming D No
Vivo survival normal reduced
Immune in nature
37 degrees react HDFN
igG in nature can cross the placenta Erythroblastosis fetalis
do not fix complement important HDN and HTR Rhogam : IV ,IM
Mother: rose]e test /flow cytometry
Enzyme: enhance
Op.mal reac.vity : AHG ANTI HUMAN GLOBULIN TEST
Pregnancy Immunized non-human to human globulins such igG
Premature destruc.on of RBC : Erythroblastosis or complement either free in seum or a]ached to
Fetalis an.gens.
An. Rh an.bodies
Monospecific AHG- single component
Wiener agglu.nogen that we inherit in our parents Polyspecific AHG -mul.ple component
contain 3 blood factors
Genes : italicized Indirect method
Agglu.nogen / blood factors : standard form Vitro sensi.zed
Enhance medium : 22 % bovine albumin
D 85 % Specimen : donor red cell
d 15%
C 70 % Indicates presence of circula.ng an.bodies in pa.ent
E 30% serum n
c 80% For nega.ve add check cell or coombs cell
e 98 % mas madami
Indirect method uses
1. Crossmatching
Mechanism of anAgen producAon 2. Detec.on and iden.fica.on of unexpected
Chromosome 1 : RhD / RhCE Rh gene an.bodies
Chromosome 6 : RHAG Rh associated glycoprotein 3. Red cell phenotyping
similar to structure of Rh proteins (co expressor) 4. Inves.ga.on of transfusion reac.ons
5. Dectec.ng weak d
Weak D Dirrect method
C trans Genes are present on Vivo sensi.za.on
different chromosome Specimen :rbc
or trans to one another Centri : 15 sec
Posi.on effect , steric
suppression Uses of Direct Method
Par.al D 1 Fragment is missing 1. HDN
Gene.c Weak D Appear in complete but 2. AIHA
few in number 3. Transfusion reac.on
4. Red cell sensi.zed caused by
penicillin,methyldopa ,cephalothin
DAT IAT

Detects IgG Detects IgG and

and complement coated
complement red cells
coated red
cells

IgG IgG a]achment to

a]achment to red cells has
red cells has occurred during the
occurred incuba.on step
within the
pa.ent’s
body

One stage Two stage

procedure procedure

Pa.ent’s red Test requires

cells are incuba.on step
tested with before the addi.on
AHG without of AHG
an incuba.on

Tests for Used as reac.on

certain phase of several
clinical tests in
condi.ons: Immunohematology
HDFN, HTR,
AIHA