Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark.
Transfusion. 2011 Nov;51(11):2278-85. doi: 10.1111/j.1537-2995.2011.03156.x. Epub 2011 May 13.
Avoiding immunization with clinically important antibodies is a primary objective in transfusion medicine. Therefore, it is central to identify the extent of D antigens that escape routine RhD typing of blood donors and to improve methodology if necessary.
We screened 5058 D- donors for the presence of the RHD gene, targeting Exons 5, 7, and 10 with real-time polymerase chain reaction. Samples that were positive in the screen test were investigated further by adsorption-elution, antibody consumption, flow cytometry, and sequencing of all RHD exons with intron-specific primers. Lookback was performed on all recipients of RBCs from RHD+ donors.
We found 13 RHD+ samples (0.26%). No variants or chimeras were found. Characterization of DNA revealed a novel DEL type (IVS2-2 A>G). In the lookback of the 136 transfusions with subsequent antibody follow-up, of which 13 were from DEL donors, one recipient developed anti-D. However, in this case, a competing and more likely cause of immunization was the concurrent transfusion of D+ platelets. Eleven recipients were immunized with 13 antibodies different from anti-D, of which five were anti-K.
In our laboratory, serologic RhD typing was safe. We detected all D variants and only missed DEL types. In assessing the immunization risk we included a DEL donor, found previous to this study, that did immunize a recipient with anti-D. We conclude that inadvertent immunization with D antigens in our setting was rare and in the order of 1.4 in 100,000 D- transfusions.
避免临床重要抗体的免疫是输血医学的主要目标。因此，确定常规 RhD 定型检测中逃避检测的 D 抗原的程度，并在必要时改进方法，这一点至关重要。
我们使用实时聚合酶链反应，针对外显子 5、7 和 10 对 5058 名 D-供体进行 RHD 基因筛查。在筛查试验中呈阳性的样本进一步通过吸附洗脱、抗体消耗、流式细胞术和使用内含子特异性引物对所有 RHD 外显子进行测序进行调查。对所有接受 RHD+供体 RBC 的受血者进行了回溯调查。
我们发现了 13 例 RHD+样本（0.26%）。未发现变体或嵌合体。DNA 特征分析揭示了一种新的 DEL 类型（IVS2-2 A>G）。在 136 次随后进行抗体随访的输血中进行了回溯，其中 13 次来自 DEL 供体，1 名受血者产生了抗-D。然而，在这种情况下，更有可能导致免疫的是同时输注了 D+血小板。有 11 名受血者因 13 种不同的抗体（包括 1 种抗-D）而发生免疫，其中 5 种为抗-K。
在我们的实验室中，血清学 RhD 定型是安全的。我们检测到了所有的 D 变体，仅错过了 DEL 类型。在评估免疫风险时，我们包括了在此项研究之前发现的一名 DEL 供体，该供体导致了一名受血者产生抗-D。我们的结论是，在我们的环境中，D 抗原的意外免疫是罕见的，每 10 万次 D-输血中约有 1.4 次发生。
