Relevance and costs of RHD genotyping in women with a weak D phenotype

Laget, Laurine; Izard, C; Durieux-Roussel, Elisabeth; Gouvitsos, Julia; Dettori, Isabelle; Chiaroni, Jacques; Ferrera-Tourenc, Virginie

doi:10.1016/j.tracli.2018.05.001

Cited by 6 publications

(14 citation statements)

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“…Moreover, genotyping of pregnant women with weak D phenotype is beneficial to the patient without increasing the cost, and can even reduce financial cost for the hospital and blood bank on the subsequent pregnancy. 22,23 Based on these recommendations, Quebec's national advisory committee on transfusion medicine proposed the systematic genotyping of all women ≤45 years old showing a serological weak D. Quebec's healthcare has the advantage that all serological and genotyping results are centralized in a national database, allowing for the patient's profile to be easily accessible from different hospitals. We report the results of a retrospective study of the weak D genotyping program at Hema-Quebec for the years 2016 to 2020.…”

Section: Discussionmentioning

confidence: 99%

High prevalence of weakDtype 42 in a large‐scaleRHDgenotyping program in the province ofQuebec (Canada)

et al. 2021

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Background: The determination of the RhD phenotype is crucial to avoid alloimmunization, especially in childbearing women. Following the 2015 recommendation from the Work Group on RHD Genotyping, a large-scale RHD genotyping program was implemented in the province of Quebec (Canada) and offered to women ≤45 years old with a serological weak D or discordant results. Since weak D type 42 was previously shown to be prevalent among French Canadians, genotyping for that variant was also performed. Our aim was to report the prevalence of the weak D alleles in the province of Quebec.Study Design and Methods: A retrospective study of 2105 women with serological weak D referred to Hema-Quebec's immunohematology reference laboratory (IRL) between June 2016 and May 2020 was conducted. Results from the serological tests performed by the referring hospital were compiled and RHD were genotyped.Results: Most patients presented at least one serological result ≤2+ before being referred to Hema-Quebec. Weak D type 42 was the most prevalent variant, representing 17.5% (368/2105) of all individuals tested. Only 15.3% (323/2105) of patients were weak D type 1, 3.3% (69/2105) were type 2, and 8.6% (180/2105) were type 3. Weak D type 42 is highly expressed in regions with low immigration rate and known for their founder effect. Conclusion: Our RHD genotyping program allowed for a better management of weak D. The province of Quebec presents a unique RHD genotype distribution. We confirmed that weak D type 42 is associated with a founder effect found in Caucasian French Canadians. K E Y W O R D Sfounder effect, genetics, RHD genotyping, serological testing, weak D | INTRODUCTIONRh is one of the most clinically important blood groups in transfusion medicine. It is encoded by the highly homologous RHD and RHCE genes. The determination of the RhD expression is crucial to transfusion medicine and genetic variations need to be accounted for to avoid Rh incompatibility, and prevent alloimmunization and

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Section: Discussionmentioning

confidence: 99%

High prevalence of weakDtype 42 in a large‐scaleRHDgenotyping program in the province ofQuebec (Canada)

et al. 2021

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“…Studies on cost and financial implications explored the economic aspect of RHD genotyping for pregnant women with a weak D phenotype. 16,17 If the personal health information is properly maintained and shared, particularly in highly developed countries like the United States, RHD genotyping would add only a one-time testing cost for each pregnant woman with a weak D phenotype, while providing a rationale for the transfusion strategy during the rest of a woman's life. 18 This strategy could prevent unnecessary costs and risks associated with RhIG administration and follow-up scheduling during the current and every subsequent pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Transfusion support during childbirth for a woman with anti-U and the RHDweak D type 4.0* allele

et al. 2021

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D-red blood cells (RBCs), always in short supply, and Rh immune globulin (RhIG) are not needed for patient care if D+ RBCs can safely be transfused. According to a recent work group recommendation, patients with the RHD*weak D type 4.0 allele can be considered D+. We report an African American woman who presented for delivery at the end of the third trimester, at which time anti-U and a serologic weak D phenotype were recognized, requiring U-, D-RBC units. We obtained 3 U-RBC units, including 1 D-unit. Later, the RHD*weak D type 4.0 allele was determined by RHD genotyping, only 6 days before delivery. The patient had an uneventful vaginal delivery of a D+ baby. No transfusion was needed for mother or baby. In this case, a pregnant woman with the RHD*weak D type 4.0 allele can safely be managed as D+, relaxing the unnecessary D-restriction for the limited U-RBC supply. The procured U-, D-RBC unit was frozen with 14 days of shelf-life remaining. To conserve D-RBC units, not limited to U-, for patients with a definite need, we recommend molecular analysis of a serologic weak D phenotype before a transfusion becomes imminent. The best time to resolve a serologic weak D phenotype with RHD genotyping is early in a pregnancy. Immunohematology 2021;37:1-4.

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“…Recognizing the financial and logistical complexity of this transition, we emphasize the concept of “phasing in” as a step‐by‐step, responsible integration of RHD genotyping. As cost‐effective and quicker methods for managing serologic weak D phenotypes become available, the focus should turn to developing protocols for managing patients with RHD alleles, who do not have a serologic weak D phenotype, but who are at risk for developing anti‐D, such as RHD*DIIIa and RHD*DIVa .…”

Section: Phase‐in Of Rhd Genotyping and Phase‐out Of Reports For Seromentioning

confidence: 99%

“…2 We also reaffirm that our primary goal is "to increase awareness of the available molecular science and promise of RHD genotyping and, thereby, to shorten the time for achieving the full benefits of … implementation of RHD genotyping." 2 Recognizing the financial and logistical complexity of this transition, 25,51 we emphasize the concept of "phasing in" as a step-by-step, responsible integration of RHD genotyping. As cost-effective and quicker methods for managing serologic weak D phenotypes become available, the focus should turn to developing protocols for managing patients with RHD alleles, who do not have a serologic weak D phenotype, but who are at risk for developing anti-D, such as RHD*DIIIa and RHD*DIVa.…”

Section: Phase-in Of Rhd Genotyping and Phase-out Of Reports For Seromentioning

confidence: 99%

“…We have observed that when the molecular report does not provide an interpretation and recommendation, clinical practictioners not experienced in blood group genetics hesitate to interpret RHD genotyping results as D+ or D−. For the purposes of RhIG adminstration and transfusion, interpretation of an RHD genotype requires not only pertinent experience but also knowledge of the history 2,5 as well as the current evolving data [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] and literature reports 15,16,[23][24][25][26] of the risks for alloimmunization associated with specific RHD genotypes. 27 Hospital computer systems may require updating to accomodate new requirements, such as the ability to change a prior serologic D typing result, when it is overridden by a different D type based on RHD genotyping results.…”

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It's time to phase out “serologic weak D phenotype” and resolve D types with RHD genotyping including weak D type 4

et al. 2020

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Relevance and costs of RHD genotyping in women with a weak D phenotype

Cited by 6 publications

References 10 publications

High prevalence of weakDtype 42 in a large‐scaleRHDgenotyping program in the province ofQuebec (Canada)

High prevalence of weakDtype 42 in a large‐scaleRHDgenotyping program in the province ofQuebec (Canada)

Transfusion support during childbirth for a woman with anti-U and the RHDweak D type 4.0* allele

It's time to phase out “serologic weak D phenotype” and resolve D types with RHD genotyping including weak D type 4

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Relevance and costs of RHD genotyping in women with a weak D phenotype

Cited by 6 publications

References 10 publications

High prevalence of weakDtype 42 in a large‐scaleRHDgenotyping program in the province ofQuebec (Canada)

High prevalence of weakDtype 42 in a large‐scaleRHDgenotyping program in the province ofQuebec (Canada)

Transfusion support during childbirth for a woman with anti-U and the RHD*weak D type 4.0 allele

It's time to phase out “serologic weak D phenotype” and resolve D types with RHD genotyping including weak D type 4

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Transfusion support during childbirth for a woman with anti-U and the RHDweak D type 4.0* allele