Anti‐D alloimmunization by weak D type 1 red blood cells with a very low antigen density

Mota, Márcia Maria Peruzzi Elia da; Fonseca, N. L.; Rodrigues, Ana Maria; Kutner, José Mauro; Castilho, Lilian

doi:10.1111/j.1423-0410.2005.00604.x

Cited by 41 publications

(45 citation statements)

References 25 publications

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“…However, in spite of “weak D” testing some weaker variants of D antigen may not be detectable and thus could result in anti-D production when transfused to D negative individuals. Earlier studies have demonstrated that red blood cells from subjects with the weak D type 1 phenotype and weak D type 2 phenotype may cause primary alloimmunization of anti-D.[1213]…”

Section: Discussionmentioning

confidence: 99%

Direct antiglobulin test positivity in multi-transfused thalassemics

Jain¹,

Agnihotri²,

Marwaha³

et al. 2016

Asian J Transfus Sci

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Introduction:Red cell allo- and auto-immunization is a well recognized problem in multi-transfused thalassemic patients. We conducted this study on 301 multi-transfused thalassemic patients under the Thalassemia Transfusion Programme of Advanced Pediatric Centre of PGIMER.Aims and Objectives:The study was designed to determine the frequency of alloimmunization and autoimmunization in multi-transfused thalassemic patients and to establish the specificity of alloantibody to red cell antigens, if alloimmunization is detected.Materials and Methods:The antibody screening was performed by the conventional tube technique using commercially available three cell screening panel (Diamed Switzerland) by saline, low ionic strength solution (LISS) and albumin indirect antiglobulin test (IAT). Samples with alloantibodies were then tested with red cell identification panel to determine the alloantibody specificity. Autoantibody screening was performed by direct antiglobulin test (DAT) during pre-transfusion testing.Results:Of the 301 patients, 52 (17.28%) were found to have antibodies (-allo and –autoantibodies). A total of 11 red cell alloantibodies were detected in 10 patients and the specificities were anti-Kell in 6(54.5%), anti-D in 2(18.2%), anti-c in 1(9.1%) and a combination of anti-E (9.1%) and anti-Jkb in 1 (9.1%) patients. DAT was positive in 48 (15.9%) patients. The frequency of autoantibody was significantly higher in alloimmunized group as compared to non-alloimmunized group (60% V/s 14.4%). Also, the pre-transfusion hemoglobin was significantly lower in the immunized group (8.5 gm/dl V/s 9.0 gm/dl; p=0.03) than the non-immunized group.Conclusion:Based on these observations, we suggest antigen typing of all thalassemia major patients for ABO, Rh and Kell antigens before initiating transfusion therapy. Also, screening for allo- and auto-antibodies at regular intervals should be done prior to each transfusion.

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Section: Discussionmentioning

confidence: 99%

Direct antiglobulin test positivity in multi-transfused thalassemics

Jain¹,

Agnihotri²,

Marwaha³

et al. 2016

Asian J Transfus Sci

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“…An antiglobulin test for the detection of some weaker forms of D variant phenotypes is not recommended for patient testing in the UK [29], France, Germany [30, 31], the Netherlands [32], or the USA [27], but it is mandatory in some countries in central Europe, for example Austria [19, 20]. Both institutes which participated in this study adopted the abovementioned algorithm, as well as an indirect antiglobulin test by gel method for weak D variants.…”

Section: Discussionmentioning

confidence: 99%

Implementation of Molecular <b><i>RHD</i></b> Typing at Two Blood Transfusion Institutes from Southeastern Europe

Guzijan¹,

Srzentic²,

Jankovic³

et al. 2019

Transfus Med Hemother

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Introduction: Determination of RhD variants in blood donors, pregnant women, and newborns is important for transfusion strategies, in order to prevent RhD alloimmunisation and hemolytic disease of fetuses and newborns. Implementation of molecular RHD typing in two transfusion institutes is presented in this article, from Banja Luka (Bosnia and Herzegovina) and Belgrade (Serbia). Study Design and Methods: Blood donors’ RhD was checked by direct agglutination assays (tube) and indirect antiglobulin test (gel). Molecular RHD typing was performed by PCR-SSP with fluorometric signal detection in both centres. Donors were selected by weak RhD serological reactivity (Banja Luka, 85 samples; Belgrade, 62 samples) or serologically RhD-negative C/E-positive results (Banja Luka, 92 samples; Belgrade, 61 samples). Results: Among serologically determined weak D donors from the institute from Banja Luka, weak D type 3 was the most frequent (58.8%), followed by type 1 (35.3%) and DNB (1.2%), whereas results obtained at the Belgrade institute were distributed between weak D type 1 (41.9%), type 3 (30.7%), type 14 (6.5%), type 15 (1.6%), and DNB with anti-D (1.6%). In 17.7% of serologically typed weak D samples from the Belgrade institute, the molecular typing result was standard D. Additionally, RHD presence was detected in 9.8% of serologically RhD-negative, C/E-positive samples from both institutes. Conclusion: Rh molecular testing was successfully implemented in both blood transfusion institutes in Banja Luka and Belgrade. This study proved the efficiency of serological algorithms for weak D, as well as the presence of the RHD gene among serologically tested RhD-negative, C/E-positive samples.

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“…Therefore, a D-negative recipient of D-positive cells will recognize an entirely foreign antigen, with several distinct epitopes, whereas in case of most other blood group disparities a single or a few amino acid differences are seen as foreign. Even the weak D type red blood cells with very low antigen density have been reported to be capable of anti-D immunization [80][81][82] . The exact immunogenicity of other antigens is unknown, as few studies exist deliberately exposing antigen-negative persons to antigen-positive RBC 83 .…”

Section: Immunogenicitymentioning

confidence: 99%

Red Blood Cell Alloimmunization after Blood Transfusion

Schonewille¹

2007

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Anti‐D alloimmunization by weak D type 1 red blood cells with a very low antigen density

Cited by 41 publications

References 25 publications

Direct antiglobulin test positivity in multi-transfused thalassemics

Direct antiglobulin test positivity in multi-transfused thalassemics

Implementation of Molecular <b><i>RHD</i></b> Typing at Two Blood Transfusion Institutes from Southeastern Europe

Red Blood Cell Alloimmunization after Blood Transfusion

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