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Anti-D immunization by DEL red blood cells
Thomas Wagner1, Günther F Körmöczi, Christoph Buchta
1Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria. thomas.wagner@meduni-graz.at
Transfusion
|April 12, 2005
Summary
Extremely weak D (DEL) variants can cause alloanti-D formation in D- recipients. This study identified a novel DEL type in blood units, highlighting the clinical significance of DEL phenotypes in transfusion medicine.
Area of Science:
- Hematology
- Immunology
- Genetics
Background:
- Limited data exists on the immunogenicity of extremely weak D variants (DEL).
- Transfusion of D- blood units can potentially trigger alloanti-D formation in D- recipients.
- The discovery of a novel DEL type arose from evaluating alloanti-D formation in a D- patient after transfusion.
Observation:
- Routine serologic testing classified donor red blood cells (RBCs) as D-.
- The D- recipient developed alloanti-D antibodies post-transfusion.
- Molecular analysis revealed the presence of the RHD gene in the donor, with a specific deletion in RHD intron 5 (RHD IVS5-38del4).
Findings:
- The identified DEL phenotype exhibited a deletion in RHD intron 5 (RHD IVS5-38del4).
- Adsorption-elution techniques showed DEL RBCs possess D epitopes without significant loss.
- The DEL phenotype in the transfused blood unit was clinically significant, inducing anti-D in the recipient.
Implications:
- This study underscores the clinical importance of the DEL phenotype in blood transfusion safety.
- Accurate identification of DEL variants is crucial to prevent alloimmunization.
- Further research into D epitope expression in DEL RBCs is warranted.