Contents lists available at ScienceDirect Transfusion and Apheresis Science journal homepage: www.elsevier.com/locate/transci A case report on anti-Mia antibody in a multi-transfused patient from India Soma Agrawal ⁎ , Mohit Chowdhry Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, 110076, India ARTICLE INFO Keywords: Anti-Mia Mia antigen Miltenberger series ABSTRACT GP.Mur antigen belongs to the MNSs system and the corresponding antibody is called as anti-Mia antibody. Anti- Mia antibody is a clinically significant antibody capable of causing haemolytic disease of the new born (HDFN) and intravascular haemolytic transfusion reactions. Literature on anti-Mia antibody from India is very limited. We report here a case of anti-Mia antibody in a multi-transfused patient from India. 1. Introduction The MNSs blood group system has 46 antigens identified and owes its complexity to the recombination between closely linked homologous genes. GP.Mur (previously Mi.III, Miltenberger series) is one such phenotype formed due to a hybrid gene of GYPB. The corresponding antibody is called as anti-Mia antibody [1]. The clinical significance of anti-Mia antibody was a matter of debate since long time. However, owing to the reported cases of haemolytic disease of the new born [HDFN] and intravascular haemolytic trans- fusion reactions, Mia antibody is considered to be of clinical sig- nificance by most of the medical faculties [2]. In fact, the anti‑Mia antibody was first described in 1951 in the serum of Mrs. Miltenberger, who had developed this antibody in response to immunization from her foetus who was positive for the antigen [1]. We report here a case of anti-Mia antibody, to our knowledge the first one from Indian population wherein the absence of antigen in the patient was confirmed with molecular antigen typing assay and was transfused with a packed red cell (PRC) unit which was typed negative for Mia antigen using anti Mia antisera. 2. Case report A 28 year old male patient was diagnosed with Thalassemia major at 2 months of age and since then has been on regular packed red cell (PRC) transfusions with our department of Transfusion Medicine with an average of 2 (PRC) / month. His blood group is B Rh D positive He was screened for presence of any allo/auto-antibody before every transfusion event and was transfused with PRC units compatible at AHG phase till January 2013, when molecular genotyping of the patient was done on Bioarray (Immucor Inc, Norcross, USA) for Rh, Kell, Kidd, Duffy, MNS, Lutheran, Diego, Colton, Dombrock, Landsteiner-Weiner and Scianna antigens. His Rh and Kell genotype was CCee, Kk and was thereafter transfused with PRC units which were compatible for his Rh and Kell genotype as well as compatible at AHG phase of cross matching by solid phase red cell adherence assay (SPRCA). Until the last episode, all his antibody screens were negative and the patient was transfused successfully every month. However, in April 2019 his antibody screening was positive with the 3 cell antigen panel (ID-DiaCell I-II-III, Biorad]), where the third cell (Mia+) showed a reactivity (Fig. 1a and b) An extended panel of 16 cells (Capture R Ready ID, Immucor Inc, Norcross, USA) was tested and the last cell (Mia +) showed a reactivity whereas all other cells were negative. The two cells which were reactive were positive for Mia antigen as per the manufacturer’s note. An antibody against Mia antigen was suspected and for the con- firmation the patients’ sample was sent to the reference centre, Indian Institute of Immunohematology (IIH) in Mumbai, India. On typing the patient by molecular assay using the sequence specific primer method, the patient was found to be Mia antigen negative. Patients’ sample was also tested with known Mia positive and negative cells which confirmed the presence of anti-Mia antibody. We had also sent two donor samples for typing of Mia antigen, which were compatible at AHG phase with the patients’ plasma. Both the units were negative by serology for Mia antigen. The units were transfused to the patient without any untoward sequel. 3. Discussion Anti-Mia antibody is a clinically significant antibody causing HDFN and red cell haemolysis. It has been found to be prevalent in South-east Asia and China and is rare to find in the Western population as per the reports from the literature [3,4]. There has been a recent report of four https://doi.org/10.1016/j.transci.2019.08.027 Received 4 June 2019; Accepted 16 August 2019 ⁎ Corresponding author. E-mail addresses: doctorsoma86@gmail.com (S. Agrawal), mohit_c@apollohospitalsdelhi.com (M. Chowdhry). Transfusion and Apheresis Science xxx (xxxx) xxx–xxx 1473-0502/ © 2019 Elsevier Ltd. All rights reserved. Please cite this article as: Soma Agrawal and Mohit Chowdhry, Transfusion and Apheresis Science, https://doi.org/10.1016/j.transci.2019.08.027