It's time to phase in<scp>RHD</scp>genotyping for patients with a serologic weak<scp>D</scp>phenotype

Sandler, S. Gerald; Flegel, Willy A.; Westhoff, Connie M.; Denomme, Gregory A.; Delaney, Meghan; Keller, Margaret; Johnson, Susan T.; Katz, Louis M.; Queenan, John T.; Vassallo, Ralph R.; Simon, Clayton D.

doi:10.1111/trf.12941

Cited by 157 publications

(134 citation statements)

References 132 publications

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“…In our center since 2008, cases with unclear results of serologic RhD typing underwent molecular RHD analysis, and the immunoprophylaxis was implemented for women who were genotyped as partial D carriers. Other studies also point out the importance of RHD genotyping in pregnant women with D variant antigen in order to correctly identify partial D carriers which need to be administered immunoprophylaxis [12,20]. …”

Section: Discussionmentioning

confidence: 99%

“…The low risk of RhD immunization in women with weak D types 1, 2 and 3 is the reason why most authors hold that women with prevalent weak D types do not require RhD immunoprophylaxis [5,10,11,12,13], and weak D patients could safely receive D+ RBC units [4]. Conversely, women with partial D should be classified as D- considering their prenatal management and RhD immunoprophylaxis [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Anti-D Antibodies in Pregnant D Variant Antigen Carriers Initially Typed as RhD+

Krstic

Dajak

Bingulac-Popović

et al. 2016

Transfus Med Hemother

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Background: To evaluate the incidence, the consequences, and the prevention strategy of anti-D alloimmunizations of D variant carriers in the obstetric population of Split-Dalmatia County, Croatia. Methods: RhD immunization events were evaluated retrospectively for the period between 1993 and 2012. Women were tested for RhD antigen and irregular antibodies. Those with anti-D antibody who were not serologically D- were genotyped for RHD. They were evaluated for their obstetric and transfusion history and their titer of anti-D. The neonates were evaluated for RhD status, direct antiglobulin test (DAT), hemoglobin and bilirubin levels, transfusion therapy as well as phototherapy and outcome. Results: Out of 104,884 live births 102,982 women were tested for RhD antigen. Anti-D immunization occurred in 184 women which accounts for 0.9% of individuals at risk of anti-D formation. 181 cases occurred in women serologically typed as D-. Three women were partial D carriers (DVa n = 2, DNB n = 1), initially typed RhD+, and recognized as D variant carriers after the immunization occurred. Anti-D titer varied from 1:1 to 1:16. Six children were RhD+, four had positive DAT, and two underwent phototherapy. Conclusion: Anti-D immunization occurred in pregnant partial D carriers (DVa, DNB). RhD+ children had serologic markers of hemolytic disease of the fetus and newborn (HDFN), with no cases of severe HDFN.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anti-D Antibodies in Pregnant D Variant Antigen Carriers Initially Typed as RhD+

Krstic

Dajak

Bingulac-Popović

et al. 2016

Transfus Med Hemother

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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 RHD 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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“…There are some examples of forward thinking national approaches to testing fetal DNA from a sample of peripheral maternal blood to determine which pregnant women should receive RhIg due to pregnancy with an RhD positive fetus 15 . In 2015, a practice recommendation was made by several professional organizations (AABB, CAP, ACOG, Armed Forces Blood Program, ABC, American Red Cross) to begin to phase in the use of RhD genotyping methods to categorize women with initial RhD typing results that are weak instead of strongly reactive in the serological test system 38 . The recommendation suggests that if the woman carries the RHD genetic variants weak D type 1, 2, or 3, then she can safely be managed as RhD positive and does not need RhIg.…”

Section: Preventionmentioning

confidence: 99%

Hemolytic Disease of the Fetus and Newborn: Modern Practice and Future Investigations

Hendrickson

Delaney

2016

Transfusion Medicine Reviews

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It's time to phase inRHDgenotyping for patients with a serologic weakDphenotype

Cited by 157 publications

References 132 publications

Anti-D Antibodies in Pregnant D Variant Antigen Carriers Initially Typed as RhD+

Anti-D Antibodies in Pregnant D Variant Antigen Carriers Initially Typed as RhD+

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

Hemolytic Disease of the Fetus and Newborn: Modern Practice and Future Investigations

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