A 56-year-old Chinese lady with valvular heart disease and atrial fibrillation was referred to us from a private hospital for further management of autoimmune haemolytic anaemia. Physical examination and laboratory investigations did not support the diagnosis of haemolytic anaemia. However, direct antiglobulin test (DAT) was strongly positive with anti-IgG and negative with anti-C3d. There was also mild anaemia and reticulocytosis, which was attributable to persistent haematuria. The DAT became positive after commencing Unasyn and cessation was associated with decreasing reactivity of the positive DAT. We believe that the positive DAT in this patient was most likely due to the Unasyn therapy.
Red cell alloimmunisation is defined as the development of antibodies in response to foreign red cell antigens through transfusion or pregnancy. In pregnant women even without the history of previous blood transfusion, this is possible through previous or current pregnancy with the presence of paternal red cell antigen inherited by the fetus. This study was aimed to determine the prevalence of red cell alloimmunisation among pregnant women without previous history of blood transfusion and the association with number of pregnancy and history of obstetric complications. This was a cross-sectional study in which 150 pregnant women were randomly selected from the antenatal clinic. Ten mls of peripheral blood was obtained for antibody screening using indirect antiglobulin test besides the routine antenatal screening. In this study, the majority (37.3%) of the women were primigravidae. Red cell alloantibodies were detected in two out of 150 (1.3%) patients which were subsequently identified as anti-C and anti-D. However none of the primigravida was alloimmunised. One woman of gravida 2 (2.9%) and gravida 3 (3.6%) each were positive for alloimmunisation. One of them also had a bad obstetric history. This study showed that the prevalence of red cell alloimmunisation among pregnant women was low in this centre. Nevertheless, red cell alloantibody screening test should be made available to reduce possible complications of alloimmunisation in mothers and fetuses.
Study site: Antenatal clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
We reported a case of a woman with no past medical illness who presented with a few days' history of fever, myalgia, arthralgia, hypochromic microcytic anaemia and thrombocytopaenia and who was nonstructural protein 1 antigen (NS1Ag)-positive. Haemolytic anaemia including full blood picture work-up revealed high reticulocyte count and haemolysis with positive direct Coombs test. She was started on prednisolone and was discharged well.
OBJECTIVE: We here report the first study on the distribution of red cell antigens and phenotype frequencies of various blood group systems in Maldives.
METHOD: Randomly selected 123 regular blood donors of O group were phenotyped for seven blood group systems by direct tube agglutination and or indirect antiglobulin tests. Blood group systems studied were Rh, Kidd, Duffy, Lewis, Kell, P and MNS system.
RESULTS: Rh blood grouping showed, 7.3% donors were Rh(D) negative, 92.7% were Rh(D) positive with the predominance of genotype complex of DCe/DCe (39.0%). The incidence of Jk(a+b+) phenotype was the most common in Kidd system. In Duffy system, the incidence of Fy(a+b+) phenotype was 50.4%. Lewis system was predominated by Le(a-b+) phenotype accounting to 80.5% of the donors. In the Kell system only two phenotypes were present, K+k- (5.7%) and k+k+ (94.3%), in the Maldivian blood donors. P system was represented by P1, P2 and P2k phenotypes with an incidence of 28.5%, 70.7% and 0.8% respectively. In the MNS system, MNss and MNSs phenotypes summed up to 48.8% of blood donors.
CONCLUSION: The detail knowledge of red cell antigen composition and their frequencies in the Maldivian population will be helpful in terms of population genetic perspectives, in establishing a donor data-bank for in-house production of indigenous screening and identification cell panels, and facilitate availability of antigen negative compatible blood for patients with previously identified multiple alloantibodies.
A study was conducted to determine the seroprevalence and risk factors associated with brucellosis in farmers, veterinary technical staff and other volunteers in Peninsular Malaysia using the One Health concept. A cross sectional study design was employed to sample a population of farmers and Veterinary technical staff on a volunteer basis. The Brucella Coombs test was used to elucidate the seroprevalence of brucellosis in the sampled population and the associated factors and predictors for brucellosis. The seroprevalence of brucellosis among farmers and non-farmers (veterinary technical staff and others) of 446 people studied was 1.35% (95% CI=0.28-2.42). Occupation, age and drinking unpasteurized milk were significant risk factors for brucellosis using multivariate logistic regression at 90% confidence level. The odds of having brucellosis increased by 7.19 times in farmers compared to non-farmers (90% CI=1.16, 44.71), it increased 7.16 times in individuals 40 years and below compared with those above 40 years old (90% CI=1.16, 44.41) and 4.45 times among those who drink unpasteurized milk compared to those who do not (90% CI= 1.03, 19.15). This study highlights the current state of human brucellosis in Malaysia among those groups that are occupationally at risk. A nationwide health education of the occupationally exposed population especially farmers may decrease the incidence of the infection and support the on-going eradication efforts of brucellosis in Malaysia.
This study investigated a person with an AB0 discrepancy. Her blood group initially typed at the birth as AB Rh+ (positive); however, it was B Rh+ (positive) or Rh- (negative) when she was in her teens. At room temperature, her erythrocytes were agglutinated by anti-B, and the agglutination was significantly weaker at 37 ºC. As a result, her erythrocytes did not absorb anti-B but anti-A. Furthermore, her erythrocytes were agglutinated by anti-A at 37 ºC with signs of hemolysis in the presence of complement. The unwashed erythrocytes were also agglutinated in an antiglobulin test by polyclonal anti-A at 37 ºC and by heated polyclonal anti-A and anti-A MAB 2-8 at room temperature. Moreover, her serum agglutinated A erythrocytes at room temperature with less activity at 37 ºC; however, it agglutinated B erythrocytes at 37 ºC. The ability of the erythrocytes of this person to absorb anti-A came along with the agglutination of her erythrocytes at 37 ºC by polyclonal serum and decreased activity of the serum to agglutinate A erythrocytes at 37 ºC, compared to room temperature. The absence of anti-B absorbance by the person’s erythrocytes was accompanied by the presence of anti-B in the serum, which was active at 37 ºC. The incubation of the person’s serum with 0 erythrocytes induced the ability of erythrocytes to absorb anti-A and to be hemolyzed by anti-A in the presence of complement in accordance with the person’s characteristics of erythrocytes. The reaction of absorption and agglutination at room temperature and 37 ºC by heated serum with the use of complement may help to reveal both weak A and B antigens and anti-A and anti-B antibodies while AB0 blood typing.
Thalassaemia is one of the major public health problems in Malaysia. Regular monthly blood transfusion remains the main treatment for severe thalassaemia patients. One of the complications of blood transfusion is the formation by the recipients of alloantibodies and autoantibodies against red blood cell (RBC) antigen. The purpose of this study was to determine the prevalence of RBC autoantibodies among multiple-transfused thalassaemic patients in our institution and factors that contribute to its development.