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Updated: Aug 15, 2026
Personalized Peptide Arrays for Detection of HLA Alloantibodies in Organ Transplantation
Published on: September 6, 2017
Partial D, weak D types, and novel RHD alleles among 33,864 multiethnic patients: implications for anti-D
Gregory A Denomme1, Franz F Wagner, Bernard J Fernandes
1Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada. greg.denomme@bloodservices.ca
Background:
The D antigen includes category D, partial D, and weak D types, which are important because anti-D alloimmunization can occur in some but not all persons that express a variant RHD allele. At present, there is little prospective information on the prevalence of D variants among obstetric patients and potential transfusion recipients.
Study Design And Methods:
The RHD alleles were prospectively examined in a large patient population identified on the basis of a difference in anti-D reactivity between two reagents.
Results:
Fifty-five discrepancies (0.96% of D-) were noted among 33,864 ethnically diverse patients over 18 months, of which 54 represented mutated RHD alleles. Seven obstetric patients were assigned D- status based on serology; only 1 patient had a partial RHD allele. Ten of 25 (36%) obstetric patients and 4 of 6 (67%) female potential transfusion recipients of childbearing age or younger were assigned D+ status, and they expressed a D variant known to permit anti-D alloimmunization. In total 20 RHD alleles were identified including category, DVa or DVa-like alleles (n = 7), DAR (n = 8), and four novel RHD alleles including two new DAU alleles.
Conclusion:
Given the complexity of D antigen expression, it is concluded that some clinically important D variants identified by standard serologic analysis phenotype as D+ and are potentially at risk for the development of anti-D.
