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. Th...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).展开更多
Background Rh blood group system is the most complex and immunogenetic blood group system. Prevalent RHD alleles varied in different populations. The purpose of this study is to determine the molecular basis of weak D...Background Rh blood group system is the most complex and immunogenetic blood group system. Prevalent RHD alleles varied in different populations. The purpose of this study is to determine the molecular basis of weak D and DEL phenotype in Anhui Chinese Han population. Methods The D antigen was determined with IgM monoclonal anti-D conformed to the guidelines for donor testing in China. Weak D samples were identified by an indirect antiglobulin test. DEL phenotype was determined by adsorption and elution test. All the RHD 10 exons were screened by PCR with sequence-specific priming or sequenced for the first-time donors who typed weak D, DEL or D negative by serologic test. Results Of all the 30 799 blood donors, 155 blood samples were found D negative with IgM anti-D; 34 blood samples were found D positive by indirect antiglobulin test or absorption elution test. RHD alleles were identified by nucleotide sequencing. Total 4 RHD alleles were found including two new. One hundred and twenty of 155 （77.4%） of the serologically D negative samples lacked the RHD gene. One D negative was RHD（615de12）. Thirty-two of 155 （20.6%） carried RHD（K409K） among them one carrying 1227G〉A and 845G〉A. Two of 155 （1.3%） was weak D type 15. Conclusions In this study at the molecular level, all DEL phenotype is RHD（K409K）; weak D type 15 is the prevalent weak D allele in Anhui Chinese Han population. Additionally, an improved more efficient method was adopted to amplify all the RHD exons in one PCR program. Our study added to the understanding of molecular mechanisms underlying D antigen expression in Anhui Han population and provided useful information for adopting suitable genotyping strategies in routine use.展开更多
基金supported by the National Natural Science Foundation of China(No. 30670893)the Foundation of Science and Technology Development Scheme of Shaanxi Province (No. 2010K16-01-12), China
文摘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).
文摘Background Rh blood group system is the most complex and immunogenetic blood group system. Prevalent RHD alleles varied in different populations. The purpose of this study is to determine the molecular basis of weak D and DEL phenotype in Anhui Chinese Han population. Methods The D antigen was determined with IgM monoclonal anti-D conformed to the guidelines for donor testing in China. Weak D samples were identified by an indirect antiglobulin test. DEL phenotype was determined by adsorption and elution test. All the RHD 10 exons were screened by PCR with sequence-specific priming or sequenced for the first-time donors who typed weak D, DEL or D negative by serologic test. Results Of all the 30 799 blood donors, 155 blood samples were found D negative with IgM anti-D; 34 blood samples were found D positive by indirect antiglobulin test or absorption elution test. RHD alleles were identified by nucleotide sequencing. Total 4 RHD alleles were found including two new. One hundred and twenty of 155 （77.4%） of the serologically D negative samples lacked the RHD gene. One D negative was RHD（615de12）. Thirty-two of 155 （20.6%） carried RHD（K409K） among them one carrying 1227G〉A and 845G〉A. Two of 155 （1.3%） was weak D type 15. Conclusions In this study at the molecular level, all DEL phenotype is RHD（K409K）; weak D type 15 is the prevalent weak D allele in Anhui Chinese Han population. Additionally, an improved more efficient method was adopted to amplify all the RHD exons in one PCR program. Our study added to the understanding of molecular mechanisms underlying D antigen expression in Anhui Han population and provided useful information for adopting suitable genotyping strategies in routine use.
