St-Louis Maryse, Lebrun André, Goldman Mindy, Lavoie Marianne
PhD (corresponding author), Scientist, Research and Development, Héma-Québec, 1070, avenue des Sciences-de-la-Vie, Québec (Québec), G1V 5C3 Canada.
MD, Vice-President Medical Affairs Hematology, Héma-Québec, Montréal (Québec), Canada.
Immunohematology. 2013;29(4):136-40.
The alloimmunization potential of many RHD variants is unknown, and it can be explored by lookback and traceback studies. Hema-Quebec (HQ) investigated the RHD status of 3980 D- repeat blood donors. Thirteen were found to be RHD positive: 4 RHD1p, and 1 RHD487delACAG, which show a Dphenotype;and 1 RHD885T and 7 RHD(93-94insT) causing a DEL phenotype when C antigen is present. Look back studies were done to verify the alloimmunization potential of these eight DEL donors. Coincidentally, Canadian Blood Services (CBS)performed a trace back study by investigating the RHD status of donors after aD- recipient developed anti-Dafter transfusion of two D- red blood cell (RBC) units. Donor genotyping was done either manually (HQ) or using the Progenika Bloodchip platform(CBS). Donations were traced through computer records. Letters were sent to hospital blood bank physicians to verify the presence of anti-Din recipients and to donors to request repeat samples.A total of 118 RBC units were transfused, 82 to D- recipients.Anti-D was found in three patients transfused with RHD*(93-94insT) DEL red blood cells. One donor presenting the same DEL variant was involved in the trace back study. Even without strong evidence clearly demonstrating the alloimmunization potential of DEL variants, whenever HQ or CBS identifies a donor harboring a DEL phenotype, his or her D status will be changed from DtoD+ to protect against the potential alloimmunization risk.
许多RHD变异体的同种免疫潜力尚不清楚，可以通过回顾性和追溯性研究来进行探索。魁北克血液中心（HQ）调查了3980名D重复型献血者的RHD状态。发现其中13人为RHD阳性：4例为RHD1p，1例为RHD487delACAG，这些显示为D表型；1例为RHD885T和7例为RHD(93 - 94insT)，当存在C抗原时会导致DEL表型。进行回顾性研究以验证这8名DEL献血者的同种免疫潜力。巧合的是，加拿大血液服务中心（CBS）通过调查一名D阴性受者在输注两个D阴性红细胞（RBC）单位后产生抗-D后的献血者RHD状态进行了追溯性研究。献血者基因分型通过手动操作（HQ）或使用Progenika Bloodchip平台（CBS）完成。通过计算机记录追踪献血情况。向医院血库医生发送信件以核实受者中抗-D的存在情况，并向献血者索要重复样本。总共输注了118个RBC单位，其中82个输给了D阴性受者。在3例输注RHD*(93 - 94insT) DEL红细胞的患者中发现了抗-D。一名呈现相同DEL变异体的献血者参与了追溯性研究。即使没有有力证据明确证明DEL变异体的同种免疫潜力，每当HQ或CBS识别出一名具有DEL表型的献血者时，其D状态将从D阴性改为D阳性，以防范潜在的同种免疫风险。
