Antibodies against high frequency Gerbich 2 antigen (anti–Ge2): A real challenge in cross matching lab
A 27-year-old Saudi Arabian woman P 2+0 was admitted in gynecology and obstetrics department with the diagnosis of dysfunctional uterine bleeding (DUB) with ovarian cyst, requested 2 units of packed red cells on 26-06-2005. On blood grouping, she was typed as O Rh D+ve and her hemoglobin was 11.2 gm/dl. In cross matching laboratory, her serum was found to be reactive with O Rh D+ve packed cells units tested in indirect Coombs’ testing (IAT) phase with polyspecific (IgG + C3d) Coombs’ gel card (DiaMed AG, Switzerland) with 3+ agglutination, but no incompatibility in immediate spin and 37° C phase in tube technique. More than 90–O Rh D+ve units were cross matched, none of them found compatible to this patient.\nOn laboratory workup, her direct Coombs’ test (DCT) and auto control (AC) were negative and antibody screening (3 cells) and antibody identification by 11 cells panel (DiaMed AG, Switzerland) showed uniform 3+ agglutinations with all 3 screening, as well as 11 panel cells in indirect Coombs’ testing (IAT) phase with polyspecific (IgG + C3d) Coombs’ reagent, but no agglutinations in immediate spin and 37° C phase.\nPanels of Rare Antisera (Diamed AG, Switzerland) were used for the presence of alloantibodies. Her probable Rh genotype was R2R2 (DcE/DcE) with extended phenotype of Le (a–b+), P1+, M+, N+, S+, s–, K– k+, Fy (a+b–), Jk (a+b+), Ge: –2, 3, 4 (Yus Phenotype).\nOn identification panel anti – Ge2 antibodies were identified, which was reactive in indirect antiglobulin phase (IAT). The presence of common alloantibodies were excluded by using papain treated cells, however, unable to exclude the presence of anti–s antibodies. We concluded that this patient should receive Ge–2 and s antigen negative blood.\nBecause of rarity of Ge–2 negative donors, patients siblings were call for screening, six siblings were tested and none of them found compatible to the patient. Patient's hemoglobin was 11.2 gm/dl and after consultation with director of gynecology and obstetrics department, two units of autologous whole blood were collected on day 0 and 14 from surgery date. The patients also prescribed oral iron preparation to boost her hemoglobin. Surgery was done on day 30, calculated from the dated of first unit collection. Two autologous whole blood units were issued and transfused to the patient peri–operatively. The surgery was successful and we did not receive further request for this patient.