ANTI-RH29 WITHOUT CLINICAL RELEVANCE IN A PATIENT WITH RHNULL PHENOTYPE TRANSFUSED WITH INCOMPATIBLE RBC UNITS
- 1Centro de Hematologia e Hemoterapia do Paraná (HEMEPAR), Curitiba, Brazil
- 2Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, Brazil
- 3Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
Abstract
The monocyte monolayer assay (MMA) was performed 1 to evaluate the clinical relevance of an anti-Rh29 antibody, detected in association with anti-e, in a male patient with end-stage liver disease and an Rhnull phenotype. Urgent liver transplantation was indicated. Although RBC transfusion was not required during surgery, the patient subsequently developed acute graft rejection with progressive clinical deterioration and a marked decrease in hemoglobin levels after transplantation. Given the absence of compatible RBC units and the urgent need for transfusion (hemoglobin 2 g/dL), MMA was performed using rr and R2R2 RBCs. Both assays yielded negative results (monocyte index [MI] < 5%). IgG subclass analysis of both anti-Rh29 and anti-e antibodies was negative for IgG1 and IgG3. Patient received R2R2 RBC over a five-day period, with premedication consisting of intravenous immunoglobulin (1 g/kg) and metilprednisone (40 mg) administered prior to the first incompatible transfusion. No laboratory or clinical evidence of post-transfusion hemolysis was observed. After completion of the transfusions, MMA was repeated. The assay with R2R2 RBCs remained negative, while a slight increase in MI was observed with rr RBCs (MI = 6%). The Rhnull phenotype is exceedingly rare, and anti-Rh29 antibodies are typically associated with severe post-transfusion hemolytic reactions and hemolytic disease of the fetus and newborn. The absence of clinical relevance of anti-Rh29 in this case, as demonstrated by MMA, is unique and highlights the critical role of cell-based assays in predicting hemolysis in emergency settings where compatible blood from very rare donors is unavailable.
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BibTeX
@article{prochaska2026antirh29,
title = {{ANTI-RH29 WITHOUT CLINICAL RELEVANCE IN A PATIENT WITH RHNULL PHENOTYPE TRANSFUSED WITH INCOMPATIBLE RBC UNITS}},
author = {Caroline Luise PROCHASKA and Maria Fernanda Schabert Ferreira LINKE and Raíssa Muniz SANTOS and Marina Cavalcanti Albuquerque Veiga CONRADO and Regina Aprecida CARDOSO and Taynara Fernada VIEIRA and Vanderson ROCHA and Alfredo MENDRONE-JUNIOR and Carla Luana DINARDO},
journal = {Hematology, Transfusion and Cell Therapy},
year = {2026},
month = oct,
doi = {10.1016/j.htct.2026.106971},
url = {https://doi.org/10.1016/j.htct.2026.106971},
note = {CC BY},
}
RIS
TY - JOUR
TI - ANTI-RH29 WITHOUT CLINICAL RELEVANCE IN A PATIENT WITH RHNULL PHENOTYPE TRANSFUSED WITH INCOMPATIBLE RBC UNITS
AU - Caroline Luise PROCHASKA
AU - Maria Fernanda Schabert Ferreira LINKE
AU - Raíssa Muniz SANTOS
AU - Marina Cavalcanti Albuquerque Veiga CONRADO
AU - Regina Aprecida CARDOSO
AU - Taynara Fernada VIEIRA
AU - Vanderson ROCHA
AU - Alfredo MENDRONE-JUNIOR
AU - Carla Luana DINARDO
PY - 2026
DA - 2026/10/23
JO - Hematology, Transfusion and Cell Therapy
DO - 10.1016/j.htct.2026.106971
UR - https://doi.org/10.1016/j.htct.2026.106971
AB - The monocyte monolayer assay (MMA) was performed 1 to evaluate the clinical relevance of an anti-Rh29 antibody, detected in association with anti-e, in a male patient with end-stage liver disease and an Rhnull phenotype. Urgent liver transplantation was indicated. Although RBC transfusion was not required during surgery, the patient subsequently developed acute graft rejection with progressive clinical deterioration and a marked decrease in hemoglobin levels after transplantation. Given the absence of compatible RBC units and the urgent need for transfusion (hemoglobin 2 g/dL), MMA was performed using rr and R2R2 RBCs. Both assays yielded negative results (monocyte index [MI] < 5%). IgG subclass analysis of both anti-Rh29 and anti-e antibodies was negative for IgG1 and IgG3. Patient received R2R2 RBC over a five-day period, with premedication consisting of intravenous immunoglobulin (1 g/kg) and metilprednisone (40 mg) administered prior to the first incompatible transfusion. No laboratory or clinical evidence of post-transfusion hemolysis was observed. After completion of the transfusions, MMA was repeated. The assay with R2R2 RBCs remained negative, while a slight increase in MI was observed with rr RBCs (MI = 6%). The Rhnull phenotype is exceedingly rare, and anti-Rh29 antibodies are typically associated with severe post-transfusion hemolytic reactions and hemolytic disease of the fetus and newborn. The absence of clinical relevance of anti-Rh29 in this case, as demonstrated by MMA, is unique and highlights the critical role of cell-based assays in predicting hemolysis in emergency settings where compatible blood from very rare donors is unavailable.
SN - 2531-1379
SN - 2531-1387
ER -