Based on the following serology, which antibody is suspected? Anti-A 4+, Anti-B 0, Anti-D 0, RhC 0, A1 Cells 2+, B cells 3+, SCI 3+, SCII 3+, SCIII 3+, Adult O cells 4+, Cord O cells 1+.

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Multiple Choice

Based on the following serology, which antibody is suspected? Anti-A 4+, Anti-B 0, Anti-D 0, RhC 0, A1 Cells 2+, B cells 3+, SCI 3+, SCII 3+, SCIII 3+, Adult O cells 4+, Cord O cells 1+.

The pattern points to an antibody that targets an antigen whose expression changes with cell maturation—specifically the IH antigen. I and H antigens vary as RBCs mature: cord blood cells have little I antigen, while adult red cells express more I. An antibody against the IH structure tends to react more strongly with adult cells (which have higher I antigen) and more weakly with cord cells (which have little I). In the results, the adult O cells show a strong reaction (4+), whereas cord O cells react only weakly (1+). There are also appreciable reactions with A1 and B cells, which can reflect IH-related binding on those cells as well, independent of ABO antigens. This age-related reactivity pattern—robust reaction with adult cells and diminished reaction with cord cells—is characteristic of Anti-IH, distinguishing it from anti-H (which would typically yield broad, less selective reactivity) and anti-M (which would show a different, M-allele–specific pattern). Anti-I alone would not typically account for the observed cord-versus-adult gradient in this panel, making Anti-IH the best fit for the given serology.

The pattern points to an antibody that targets an antigen whose expression changes with cell maturation—specifically the IH antigen. I and H antigens vary as RBCs mature: cord blood cells have little I antigen, while adult red cells express more I. An antibody against the IH structure tends to react more strongly with adult cells (which have higher I antigen) and more weakly with cord cells (which have little I). In the results, the adult O cells show a strong reaction (4+), whereas cord O cells react only weakly (1+). There are also appreciable reactions with A1 and B cells, which can reflect IH-related binding on those cells as well, independent of ABO antigens. This age-related reactivity pattern—robust reaction with adult cells and diminished reaction with cord cells—is characteristic of Anti-IH, distinguishing it from anti-H (which would typically yield broad, less selective reactivity) and anti-M (which would show a different, M-allele–specific pattern). Anti-I alone would not typically account for the observed cord-versus-adult gradient in this panel, making Anti-IH the best fit for the given serology.

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