Assessment of fetal-maternal haemorrhage in mothers with hereditary persistence of fetal haemoglobin

Kleihauer examination of peripheral blood cannot be used reliably to detect transplacental fetal-maternal haemorrhage in mothers with hereditary persistence of fetal haemoglobin (HPFH). In Rh(D) negative pregnancies diagnostic confusion with a large fetal-maternal haemorrhage could result in the administration of inappropriately excessive amounts of anti-D immunoglobulin, and the inability to diagnose and quantify transplacental haemorrhage in maternal HPFH by current methods could result in insufficient anti-D administration and subsequent Rh(D) sensitisation. Accordingly, a method to detect and quantify fetal-Rh(D) positive maternal haemorrhage using erythrocyte fluorescent immunocytometry was developed. An indirect immunofluorescence method with IgG anti-D immunoglobulin as the primary antibody was used, combined with quantitative analysis on a fluorescence activated cell sorter. The method was accurate, specific, and sensitive and could detect a contaminating population of 0.1% Rh(D) positive cells in Rh(D) negative blood--a level of fetal-maternal haemorrhage well covered by a single dose of 500 IU of anti-D immunoglobulin.

A low-incidence red cell antigen JAL associated with two unusual Rh gene complexes

A multilaboratory investigation during several years has identified a low incidence antigen JAL on the red cells of 7 propositi. JAL appears to be associated with two unusual Rh complexes, one of which produces a depressed C antigen and the other a depressed c antigen. Family studies strongly suggest that the JAL antigen is encoded by the RH locus. Anti-JAL has been implicated in haemolytic disease of the newborn and is thus considered to be a clinically significant antibody.

Another example of haemopoietic (twin) chimaerism in a subject unaware of being a twin

A fourth human blood group chimaera studies in Birmingham is an example of haemopoietic (twin) chimaerism in which the subject was unaware of being a twin. Chimaerism was discovered during routine antenatal serological investigation in which it was shown that the proposita has two red cell populations, one of the rhesus genotype rr, and the other R1r. Further studies showed that she has two populations of lymphocytes, one with the female karyotype, 46XX, and the other with the male karyotype, 46XY. Skin fibroblasts were all 46XX.