First report of the rare RhCE‐depleted D‐‐phenotype in sixteen people of Iranian origin

Abstract

Background and Objectives In transfusion medicine, it may be a challenge to acquire compatible blood for patients who have clinically important alloantibodies to high-prevalence antigens. The aim of this study was to study prevalence of rare D--phenotype in samples from patients and their relatives referred to the Immunohematology reference laboratory of the Iranian Blood Transfusion Organization and the detection and identification of the phenotype and associated antibodies, particularly in an antenatal setting. This is the first report of the cases evaluated by the IBTO and family studies of the D--proposita in Iran and possibly the first attempted comprehensive study in the current transfusion-related literatures. Materials and MethodsThis retrospective cross-sectional study was carried out on 6720 pregnant women and individuals with difficult positive pretransfusion testing referred for ABO/Rh(D) typing and antibody screening during a period of 8 years from 2008 to December 2016 in the Immunohematology Reference Laboratory of the Iranian Blood Transfusion Organization, Tehran, Iran.Results During 2008 to December 2016, 16 persons from ten families were detected to have rare D--phenotype. Anti-Rh17 and anti-c were identified in plasma of the 11 persons, including 10 females with a history of multiple unsuccessful pregnancy and the total number of 24 abortions and one male with history of blood transfusion vs. 5 individuals, including an unmarried single woman, 1 person with a history of first-time pregnancy and 3 persons with a history of multiple pregnancy, who showed no alloimmunization. Based on these collective findings, we interpreted these results as being confirmed as D--phenotype (0.23%).Conclusion Irrespective of Rh (D) group a serological antibody screening test is recommended to be required in a National prenatal testing guideline.Key words: Anti-Rh17 (anti-Hro), D--phenotype, haemolytic disease of the fetus and newborn.

Ethical Issues and Management of Fetal Hemolytic Anemia Caused by Anti-Rh17 in a Multipara with Rare –D– Phenotype

“…We have described the course of the fourth and the fifth pregnancy of a woman with allo-anti-Rh17. As described by Shahverdi et al [9] our patient also has a history of 2 unsuccessful pregnancies. In the fourth pregnancy, the already known anti-Rh17 did not induce HDFN.…”

“…An alternative therapy was suggested by Mimura et al [12], who reported on a case of HDFN due to anti-Rh17 where the pregnant woman received multiple therapeutic plasma exchanges as well as highdose intravenous immunoglobulins. As a source of donor blood for intrauterine transfusions or transfusions of the newborn, maternal blood is suggested in the literature [2,9,13,14]. However, for our transfusion, we did not collect maternal blood because of the mother's low body weight [5].…”

Challenges in blood transfusion caused by anti-Hr0: A rare case of D-- Phenotype in Asia Abstract

“…The rare Rh-deficience phenotypes are characterized by the absence of one or more Rh antigens (known as Rhnull, D--, Dc-, etc. ), of which D--phenotypic individuals can produce a rare alloantibody called anti-Rh17 (Hr0) due to blood transfusion or pregnancy, which may lead to severe hemolytic transfusion reaction (HTR) and haemolytic disease of the fetus and newborn (HDFN) [8].…”

Integrated analyses reveal unexpected complex inversion and recombination in RH genes

“…Case reports of the D-- phenotype have been published for various ethnic groups. 5 , 6 , 7 , 8 The common mechanism of the D-- phenotype is genomic rearrangements between the closely linked homologous genes RHD and RHCE , resulting in RHCE∗CE-D-CE hybrid alleles. 9 , 10 , 11 , 12 , 13 Other identified molecular mechanisms responsible for the D-- phenotype include single-nucleotide deletions 10 , 14 and altered RNA splicing sites.…”