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DEL phenotype.

Dong H Kwon1, S G Sandler2, Willy A Flegel3

  • 1Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital.

Immunohematology
|October 19, 2017
PubMed
Summary
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Very weak D antigen (DEL) red blood cells are transfused to D- recipients, potentially causing D alloimmunization. Improved post-transfusion monitoring is crucial to detect anti-D formation in recipients of DEL red blood cells.

Area of Science:

  • Transfusion Medicine
  • Immunology
  • Genetics

Background:

  • DEL red blood cells (RBCs) are misidentified as D-negative by standard serologic testing.
  • These cells express a very weak D antigen, detectable only by specialized methods like adsorption-elution or molecular assays.
  • DEL phenotypes are prevalent in East Asian populations but also found in Caucasians.

Purpose of the Study:

  • To highlight the potential risk of D alloimmunization from transfusing DEL RBCs to D- recipients.
  • To estimate the number of DEL RBC units transfused annually in the United States.
  • To emphasize the need for enhanced post-transfusion monitoring.

Main Methods:

  • Review of existing literature on DEL phenotypes and alloimmunization.
  • Statistical estimation based on population prevalence and immigration data in the United States.

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Main Results:

  • An estimated 68-683 units of DEL RBCs from East Asian donors are transfused as D-negative annually in the U.S.
  • Case reports from East Asia link DEL RBC transfusion to D alloimmunization.
  • DEL phenotypes are common in East Asian populations (up to 30%) but rare in Caucasian (0.1%) and absent in African populations.

Conclusions:

  • Transfusion of DEL RBCs to D- recipients poses a risk of D alloimmunization.
  • The lack of detection of such cases in the U.S. is likely due to insufficient post-transfusion monitoring for anti-D.
  • Proactive monitoring strategies are essential to ensure patient safety in transfusion medicine.