Abstract
Background
“Asia type” DEL red blood cells (RBCs) express a very weak D antigen and cannot be
detected by routine RhD typing. Thus, it is routinely typed as D-negative (D–) blood group and transfused to D– recipients. Here we described a case
of secondary alloanti-D immunization that was associated with transfusion of DEL RBCs
to D– recipients and was initially considered as primary alloanti-D immunization.
Case presentation
A 44-year-old D– woman (G2P2) with adenomyosis and anemia underwent transabdominal
hysterectomy. She received four units of D– RBCs before operation. Before transfusion,
the alloantibody screening test was negative. Four days after the first transfusion,
she needed another RBC transfusion. Unexpectedly, the routine pre-transfusion alloantibody
screening test became positive and anti-D (titer, 128-fold) was identified, indicating
an alloanti-D immunization. The anti-D developed four days after the first transfusion
was unexplained, so alloantibody identification was performed on the sample collected
before the first transfusion, and weak anti-D combined with anti-E, which was not
detectable during the previous routine pre-transfusion alloantibody screening test
with non-enzyme-treated screening cells, was identified using bromelain-treated panel
cells. The remaining blood samples of first transfusion in bag tails from two donors
were collected for RHD genotyping analysis. One donor was later identified as “Asia type” DEL having RHD* 1227 A/01 N.01 genotype.
Conclusion
Caution should be applied when we conclude that transfusion of “Asia type” DEL RBCs
to true D– recipients could induce primary alloanti-D immunization, especially if
the short time interval between transfusion and detection of anti-D is observed.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Transfusion and Apheresis ScienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A comprehensive analysis of DEL types: partial DEL individuals are prone to anti-D alloimmunization.Transfusion. 2005; 45: 1561-1567
- DEL RBC transfusion should be avoided in particular blood recipient in East Asia due to allosensitization and ineffectiveness.J Zhejiang Univ Sci B. 2012; 13: 913-918
- Six years' experience performing RHD genotyping to confirm D- red blood cell units in Germany for preventing anti-D immunizations.Transfusion. 2009; 49: 465-471
- DEL in China: the D antigen among serologic RhD-negative individuals.J Transl Med. 2021; 19: 439
- Primary anti-D immunization by DEL red blood cells.Korean J Lab Med. 2009; 29: 361-365
- Primary anti-D alloimmunization induced by "Asian type" RHD (c.1227G>A) DEL red cell transfusion.Ann Lab Med. 2015; 35: 554-556
- Secondary anti-D immunization by Del red blood cells.Transfusion. 2005; 45: 1581-1584
- Incidence of anti-D alloimmunization in D-negative individuals receiving D-positive red blood cell transfusion: A systematic review and meta-analysis.Vox Sang. 2022;
- Retrospective analysis of transfusion Del blood to RhD-negative recipients.Transfusion. 2012; 52: 36A
- Genotyping of RHD c.1227G>A allele by melting curve analysis.Transfus Apher Sci. 2021; 60103078
Article info
Publication history
Published online: May 20, 2022
Accepted:
May 16,
2022
Received in revised form:
May 11,
2022
Received:
March 16,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
