Wang M, Wang B L, Xu W, Fan D D, Peng M L, Pan J, Yao P, Jiang G M, Wan X J
The Department of Blood Transfusion, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, China.
The Department of Laboratory Medicine, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, China.
Transfus Med. 2015 Jun;25(3):163-9. doi: 10.1111/tme.12211. Epub 2015 May 29.
To analyse anti-D alloimmunisation in pregnant women with D-elute (DEL) phenotype in China, for developing a predictive model to evaluate whether a person with the DEL phenotype can receive RhD-positive blood.
Alloanti-D acquired by pregnancy or transfusion is one of the major causes of both haemolytic disease among newborns and haemolytic transfusion reactions. To date, there is little data available about the antigenic properties and immunogenicity of extremely weak D variants known as DEL.
RHD genotyping and D epitope mapping were performed using gene sequencing and comprehensive immunohaematological methods, respectively. DEL pregnant women carrying an RhD-positive fetus were tested for the presence of alloanti-D.
A total of 130 of 142 (91·5%) pregnant women with a DEL phenotype were confirmed to carry the RHD (K409K) allele. Among 12 DEL women who appeared to have RHD-CE-D hybrid alleles, there were 1 RHD-CE (4-7)-D, 7 RHD-CE(4-9)-D, and 4 RHD-CE (2-5)-D alleles. Alloanti-D antibodies were detected in 6 of 142 DEL women, and all the six women had the partial DEL phenotype.
The data indicate that partial DEL women appear at risk of alloimmunization to the D antigen. RhD immune globulin prophylaxis is necessary for partial DEL women. Partial DEL patients should receive only RhD-negative RBCs, whereas DEL patients with complete expression of antigen can safely receive RhD-positive RBCs.
分析中国D-洗脱（DEL）表型孕妇的抗-D同种免疫情况，以建立预测模型，评估DEL表型者能否接受RhD阳性血液。
妊娠或输血获得的同种抗-D是新生儿溶血病和溶血性输血反应的主要原因之一。迄今为止，关于被称为DEL的极弱D变异体的抗原特性和免疫原性的数据很少。
分别采用基因测序和综合免疫血液学方法进行RHD基因分型和D抗原表位定位。对携带RhD阳性胎儿的DEL孕妇检测同种抗-D的存在情况。
142例DEL表型孕妇中，共有130例（91.5%）被证实携带RHD（K409K）等位基因。在12例似乎具有RHD-CE-D杂交等位基因的DEL女性中，有1例RHD-CE（4-7）-D、7例RHD-CE（4-9）-D和4例RHD-CE（2-5）-D等位基因。142例DEL女性中有6例检测到同种抗-D抗体，且这6名女性均为部分DEL表型。
数据表明，部分DEL女性似乎有对D抗原产生同种免疫的风险。部分DEL女性有必要进行RhD免疫球蛋白预防。部分DEL患者应仅接受RhD阴性红细胞，而抗原完全表达的DEL患者可安全接受RhD阳性红细胞。
