ANTI-E ANTI-c CASE STUDY

ANTI-E ANTI-c ISOIMMUNIZATION: CASE REPORT

By: A1C Malack and AMN Green

07 SEP 16

HISTORY OF PATIENT

Why did levels drop?

Human Chorionic Gonadotropin

Fetomaternal Hemorrhage:

Entry of fetal blood into the maternal circulation.

How does this happen?

• IgM class breakdown

7/30/15 - HCG+

8/17/15 - Prenatal

9/15/15 - HCG 2117.1 mIU/mL*

9/21/15 - HCG 96.8 mIU/mL

10/05/15 - HCG 26.9 mIU/mL

11/09/15 - HCG=

Causes:

• neurological injury
• stillbirth
• neonatal death*

~Pt. came to Eglin positive for Anti-E

Titer: 09/01/16

Antibody Titration: anti-c

Patients Antibody Titer:

Isoimmunization

• Titers are performed monthly for first 28 weeks of pregnancy and every 2 weeks thereafter
• This is done to keep eye on growing antibody

Rhesus Blood Group

• red cell antigens in this grouping: c (little c), C (big C), D, e (little e) and E (big E).
• the c, C, e, E antibodies are not as immunogenic as the D-antigen, however capable of causing HDN.

8/4/16: Anti-c 1:4

Anti-E 1:1

9/1/16: Anti-c 1:16

Anti-E <1

Anti-c in pregnancy:

• Occurs in 0.07% of pregnancies
• 2nd in immunogenicity after RhD
• Rare yet severe cause of HDN
• Monitored closely w/ Antibody Titrations

Chances of

Re-occurrence?

Hemolytic Disease of the Newborn

Pt. is at 1:16 titer

<7.5 IU/mL continue to monitor

7.5-20.0 IU/mL moderate risk of HDN

>20.0 IU/mL risk of severe HDN

Erythroblastosis fetalis:

• fetal RBCs cross the placenta into the maternal circulation
• stimulate antibody production
• antibodies return to the fetal circulation and result in RBC destruction.

• Patient is at moderate risk of HDN

Prevention/Management

• Anti-D is the most form of severe HDN. The disease varies from mild to severe.
• Anti-E is a mild disease
• Anti-c can range from a mild to severe disease and is the third most common form of severe HDN
• Anti-e - rare
• Anti-C - rare
• Antibody combinations (ie anti-c and anti-E antibodies occurring together) - can be severe

• presently not enough is established to prevent this
• minimize Rhc positive transfusions to women of child bearing age
• red cell antibodies detected in pregnancies should be monitored closely

Citations:

Thank You

For Listening

• http://europepmc.org/articles/PMC3710558

• http://www.sharinginhealth.ca/conditions_and_diseases/isoimmunization.html

• Human Chorionic Gonadotropin (hCG) - hCG Levels. (n.d.). Retrieved from http://americanpregnancy.org/while-pregnant/hcg-levels/

• https://www.ucsfbenioffchildrens.org/pdf/manuals/42_Hemol.pdf

• http://www.bcshguidelines.com/documents/antibody_testing_pregnancy_bcsh_07062006.pdf

• http://www.womenshealthsection.com/content/obsmd/obsm010.php3

• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3251192/