Tecnologo Medico

Shao et al. / J Zhejiang Univ-Sci B (Biomed & Biotechnol) 2012 13(11):913-918

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Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology) ISSN 1673-1581 (Print); ISSN 1862-1783 (Online) www.zju.edu.cn/jzus; www.springerlink.com E-mail: jzus@zju.edu.cn

DEL RBC transfusion should be avoided in particular blood recipient in East Asia due to allosensitization andineffectiveness*
Chao-peng SHAO1, Bao-yan WANG2, Shi-hui YE3, Wen-li ZHANG3, Hua XU†‡3, Nai-bao ZHUANG1, Xiao-ying WU1, Heng-gui XU4
(1Shenzhen Blood Center, Shenzhen 518035, China) ( Department of Blood Transfusion, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an 710060, China) (3Shaanxi Blood Center, Xi’an 710061, China) ( College of Laboratory Medicine, Dalian MedicalUniversity, Dalian 116044, China)
† 4 2

E-mail: drxuhua@gmail.com

Received Nov. 17, 2011; Revision accepted Apr. 14, 2012; Crosschecked Sept. 27, 2012

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 anyD-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 negativepatients 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. Ourdata 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 delayedhemolytic transfusion reaction (DHTR). Key words: Rh blood group, DEL, Allo-anti-D, Transfusion, Pregnancy, Delayed hemolytic transfusion reaction doi:10.1631/jzus.B1100348 Document code: A CLC number: R457.1

1 Introduction The Rhesus (Rh) blood group is of clinical importance because the D antigen presents a strong immunogenicity in transfusion and mother-fetus alCorresponding author Projectsupported by the National Natural Science Foundation of China (No. 30670893) and the Foundation of Science and Technology Development Scheme of Shaanxi Province (No. 2010K16-01-12), China © Zhejiang University and Springer-Verlag Berlin Heidelberg 2012
* ‡

loimmunization. Commonly D, encoded by either RH genes or RHD, is divided into D-positive and D-negative phenotypes. It has been observedthat D is weakly expressed in many D variants, such as DEL (or Del) (Okubo et al., 1984). The D antigen on a DEL red blood cell (RBC) is so weak that it is serotyped as D-negative by a conventional indirect antiglobulin test (IAT), and needs to be confirmed by an absorption-elution test. Currently neither patients in clinics nor donors in blood banks are screened for

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