Primary anti-D Immunization by DEL Red Blood Cells

Kim, Kyeong-Hee; Kim, Kyung-Eun; Woo, Kwang‐Sook; Han, Jin‐Yeong; Kim, Jeong-Man; Park, Kyoung Un

doi:10.3343/kjlm.2009.29.4.361

Cited by 64 publications

(66 citation statements)

References 15 publications

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“…64 In the current era of frequent migrations, the Del phenotype is of global interest because of an increasing number of reports that it has caused Rh alloimmunization when Del red blood cells were transfused as Rh negative or by pregnancy. [65][66][67][68] Despite the advances in monoclonal antibody technology and RHD genotyping, there are no updated organizational guidelines to advise practitioners whether or not to administer Rh immune globulin to pregnant women with a weak D phenotype. Several investigators have proposed using RHD genotypes to identify the few persons with a serological weak D phenotype who are at risk of forming anti-D if exposed to D-positive red blood cells.…”

Section: Commentmentioning

confidence: 99%

Policies and Procedures Related to Testing for Weak D Phenotypes and Administration of Rh Immune Globulin: Results and Recommendations Related to Supplemental Questions in the Comprehensive Transfusion Medicine Survey of the College of American Pathologists

Sandler

Roseff

Domen

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Advances in RHD genotyping offer an opportunity to update policies and practices for testing weak D phenotypes and administration of Rh immune globulin to postpartum women. Objectives.—To repeat questions from a 1999 College of American Pathologists proficiency test survey, to evaluate current practices for testing for weak D and administration of Rh immune globulin, and to determine whether there is an opportunity to begin integrating RHD genotyping in laboratory practice. Design.—The College of American Pathologists Transfusion Medicine Resource Committee sent questions from the 1999 survey to laboratories that participated in the 2012 proficiency test survey. The results of the 2012 survey were compared with those from 1999. Results from published RHD genotyping studies were analyzed to determine if RHD genotyping could improve current policies and practices for serological Rh typing. Results.—More than 3100 survey participants responded to the 2012 questions. The most significant finding was a decrease in the number of transfusion services performing a serological weak D test on patients as a strategy to manage those with a weak D as Rh negative (from 58.2% to 19.8%, P < .001). Data from RHD genotyping studies indicate that approximately 95% of women with a serological weak D could be managed safely and more logically as Rh positive. Conclusions.—Selective integration of RHD genotyping policies and practices could improve the accuracy of Rh typing results, reduce unnecessary administration of Rh immune globulin in women with a weak D, and decrease transfusion of Rh-negative red blood cells in most recipients with a serological weak D phenotype.

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Section: Commentmentioning

confidence: 99%

Policies and Procedures Related to Testing for Weak D Phenotypes and Administration of Rh Immune Globulin: Results and Recommendations Related to Supplemental Questions in the Comprehensive Transfusion Medicine Survey of the College of American Pathologists

Sandler

Roseff

Domen

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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“…According to this study, we should reconsider our screening policy for DEL in donors and recipients. Although the cases reporting primary and secondary anti-D immunizations by DEL (Yasuda et al, 2005;Kim et al, 2009) were once considered a rare event, our primary data show that 50% of truly D-negative patients with anti-D developed DHTR after DEL RBCs transfusion, and 14.3% of apparent D-negative patients with no detected anti-D developed primary allosensitization. If we excluded two DEL recipients (Shao, 2010;Shao et al, 2010), the latter number would be 20.0%.…”

Section: Discussionmentioning

confidence: 88%

“…In a case report, Yasuda et al (2005) reported a secondary anti-D alloimmunization in a woman who received a RHD1227A DEL blood transfusion in Japan, and more recently, Kim et al (2009) observed a primary allo-anti-D immunization in a 68-year-old Korean man who was transfused with "Asian type" DEL red cells. These studies, along with the high rate of DEL in apparent D-negative individuals, suggest that further clinical investigation is needed to determine whether DEL should be identified in clinics in East Asian countries.…”

Section: Introductionmentioning

confidence: 99%

“…Although DEL is nearly D antigen negative, some truly D-negative patients were still observed being induced allo-anti-D by DEL red cells in transfusions in Europeans and Asians Wagner et al, 2005;Yasuda et al, 2005;Kim et al, 2009). In a case report, Yasuda et al (2005) reported a secondary anti-D alloimmunization in a woman who received a RHD1227A DEL blood transfusion in Japan, and more recently, Kim et al (2009) observed a primary allo-anti-D immunization in a 68-year-old Korean man who was transfused with "Asian type" DEL red cells.…”

Section: Introductionmentioning

confidence: 99%

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DEL RBC transfusion should be avoided in particular blood recipient in East Asia due to allosensitization and ineffectiveness

Shao

Wang

et al. 2012

J. Zhejiang Univ. Sci. B

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Abstract:Previously, both primary and secondary anti-D alloimmunizations induced by "Asian type" DEL (RHD1227A allele) were observed in two incidents. We investigated how often these alloimmunization events occur. The transfusions of any D-negative patients were investigated in the First Affiliated Hospital of Xi'an Jiaotong University Medical College, China, during the entire 2009. The antigens of D, C, c, E, and e were routinely serotyped. The "Asian type" DEL variant was genotyped and the RHD heterozygote was determined through two published methods. The changes in anti-D levels were monitored by the indirect antiglobulin test (IAT) and flow cytometry. Thirty D-negative transfused patients were included in the study. We focused on 11 recipients who were transfused with packed red blood cells (RBCs) from DEL donors at least one time. Of those 11 recipients, seven were anti-D negative before transfusion and four were anti-D positive (one patient with an autoantibody). One of the seven pre-transfusion anti-D negative patients produced a primary-response anti-D after being transfused with 400 ml of DEL blood twice. All four pre-transfusion antibody positive patients were not observed hemoglobin (Hb) levels increased, as expected after transfusions. Two patients had an increase in anti-D from 1:8 to 1:64 by IAT, which was also shown by flow cytometry. None of the patients experienced an acute hemolytic episode. Our data indicated that the primary anti-D induced by DEL transfusion or the secondary anti-D elevated by DEL in a truly D-negative patient might not be unusual. We suggest that a truly D-negative childbearing-aged woman should avoid DEL transfusion to protect her from primary anti-D allosensitization. In addition, anti-D positive recipients should also avoid DEL red cell transfusion due to the delayed hemolytic transfusion reaction (DHTR).

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“…[26]. Four years later, the same allele was shown to cause an anti-D immunization in a 69-year-old Korean male [27]. Still, anti-D immunizations caused by DEL donors seem to be rare events: Only one possible anti-D immunization event was found in a follow-up of 13 units from DEL donors in Denmark [9], and only 3 of 82 D-negative recipients of RHD (93insT) units had developed an anti-D in Canada [15].…”

Section: Evidence For Anti-d Immunization By Del Donorsmentioning

confidence: 99%

<b><i>RHD</i></b> PCR of D-Negative Blood Donors

Wagner¹

2013

Transfus Med Hemother

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RHD PCR of blood donors may be used to reveal weak D, partial D, DEL and chimeric D+/D- donors among presumed D-negative blood donors. Units donated by such donors pose a definite yet low risk for anti-D immunization of transfusion recipients. The frequency of DEL donors among D-negative donors is 1:350 to 1:2,000 in Europe and up to 1:5 in Asian countries. Different strategies for RHD PCR of blood donors have been used. Probably, the most cost-efficient implementation is replacement of sensitive D antigen testing with the indirect antiglobulin test by RHD PCR in pools which might even reduce total testing cost.

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Primary anti-D Immunization by DEL Red Blood Cells

Cited by 64 publications

References 15 publications

Policies and Procedures Related to Testing for Weak D Phenotypes and Administration of Rh Immune Globulin: Results and Recommendations Related to Supplemental Questions in the Comprehensive Transfusion Medicine Survey of the College of American Pathologists

Policies and Procedures Related to Testing for Weak D Phenotypes and Administration of Rh Immune Globulin: Results and Recommendations Related to Supplemental Questions in the Comprehensive Transfusion Medicine Survey of the College of American Pathologists

DEL RBC transfusion should be avoided in particular blood recipient in East Asia due to allosensitization and ineffectiveness

<b><i>RHD</i></b> PCR of D-Negative Blood Donors

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