Sensitization to Multiple Rh Antigens by Transfusion of Random Donor Platelet Concentrates in a -D- Phenotype Patient

Abstract

The -D- phenotype is a rare Rh phenotype that strongly expresses D antigen without C, c, E, or e antigens. In -D- phenotype individuals, anti-Rh17 (Hro) is commonly found if there is a history of pregnancy or transfusion with red blood cells (RBCs) that express C, c, E, or e antigens. We report the first case of a -D- phenotype patient with multiple Rh antibodies including anti-Rh17 who had a history of two occasions of transfusion with eight random donor platelet concentrates two and six years ago. We found that a trivial amount of RBCs in the platelet components was able to trigger sensitization to RBC antigens, especially the highly immunogenic and clinically significant Rh antigens, including C, c, E, e or CcEe polypeptides. To avoid unnecessary sensitization and to minimize the risk of hemolytic transfusion reactions in patients with this rare Rh phenotype, a modified strategy for pretransfusion screenings needs to be discussed in the field of transfusion medicine.

Evaluating the TaqMan Jra-Genotyping Method for Rapidly Predicting the Presence of Anti-Jra Antibodies

“…Accordingly, an alternative approach that can aid in anticipating the presence of anti-Jr a , anti-Di b , and anti-Rh17 antibodies is required in clinical laboratories. The presence of anti-Rh17 can be predicted based on positivity for the D antigen and negativity for the C, c, E, and e antigens by performing serological Rh phenotyping [ 29 ]. However, for anti-Jr a and anti-Di b , antisera are not available, and using a molecular-genetics method to determine the antigen genotype is another promising option that can help predict the existence of these antibodies.…”

Development of Anti-e after Platelet Concentrate Transfusion

“…Platelets express ABO and HLA class 1 antigens on their membrane surface but do not express Rh antigens, however, PC also contain a small amount of donor RBCs that carry Rh antigens. Previous studies have shown a low rate of development of anti-D after D-positive platelets transfusion to D-negative recipients [2,4], and case reports have documented sporadic cases of development of other Rh antibodies after transfusion with apheresis platelets [5] or platelets concentrates [6].…”

Anti-Rh17 Alloimmunization: A Rare Case of Severe Hemolytic Disease of the Newborn and Review of the Literature

“…The individuals with D--phenotype produce multiple Rh antibodies against C, c, E, or e antigens (AntiRh17 antibody also known as Anti-Hr0) if they are sensitized to Rh antigens because of previous blood or even platelet transfusion of incompatible product, or fetomaternal bleeding in the previous pregnancy (13). While this will significantly raise the risk for severe hemolytic transfusion reactions in healthy subjects, prior sensitization in a pregnant woman put her fetus at risk for severe alloimmune hemolytic disease of newborn, severe anemia, and hyperbilirubinemia (5,14).…”