The Jr(a—) phenotype and anti‐Jra in two Beduin Arab women in Israel

To the Editor: Tippett and Sanger' defined D variant category l l l b red cells as D-positive, G-negative, V-positive or negative, and usually VS-positive. They also noted that the sera of some l l l b individuals reacted with cells of subgroups lIla and I l k . They hypothesized that, since llIa and I l k cells are G-positive, this could be due to the additional presence of anti-G. We recently identified a D" variant, G-negative patient who supports this hypothesis. A 57-year-old woman of Greek descent was admitted to Beth Israel Hospital in August 1984 for open heart surgery. Her history included two pregnancies and transfusions of 2 units of packed red cells during surgery in 1979. On this admission, her red cells typed as group AB Rh-positive, D'-positive (2+). The direct antiglobulin test (DAT) and antibody screening tests were both negative. She received 4 units each of Rh-positive red cells and fresh-frozen plasma during her hospitalization. On readmission in December 1984, testing confirmed her red cell type as group AB Rh-positive, D" positive. The cells were C-, E+, c+, e+. She now had a positive DAT( I+) with IgG on the red cells; antibody screening tests showed I to 2+ agglutination at 37OC with albumin and 3 to 4+ agglutination with anti-human globulin (AHG). Similar reactivity occurred with all panel cells positive for C and/ or D and was enhanced by ficin treatment of the cells. No additional alloantibodies were detected. To determine if a n t i 4 was present in addition to anti-C and -D, sequential adsorptions and elutions were performed? After the serum was adsorbed onto r'r cells, anti-D was still demonstrable in the serum. An eluate from the r'r cells was prepared and then adsorbed onto R,r cells; this left anti-C demonstrable in the eluate. A second eluate, prepared from the R,r cells, reacted with both C+ and D+ red cells, thus showing the presence of anti-G. In addition, the patient's serum reacted strongly with three examples of rGr cells, including those of Crosby, the first rG proposita. The patient's cells typed as G negative using the original anti&. The cells were also V-positive; VS antigen typing was not performed. An eluate prepared from the patient's DAT-positive red cells reacted with all cells tested. Warm autoabsorption of the serum did not change its reactivity with Cand D-positive cells, or the antibody titers, thus demonstrating that the serum antibodies were alloimmune in nature? Rh-positive, G-negative cells have been described! However, our patient is unusual in being a Dy variant with alloanti-G. She appears t o be a member of Tippett and Sanger's category IIIL; thus, our findings support the hypothesis that the reactions of some IIIb serums with group l l l a and IIIc cells are due t o anti-G. DEAN S. MESSIER, MT(ASCP) DONNA G. PACINI, MT(ASCP)SBB