Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, China; The Key Medical Laboratory of Guangzhou, Guangzhou, China.
Department of Blood Transfusion, Affiliated Tungwah Hospital of Sun Yat-Sen University, Dongguan, China.
Transfus Apher Sci. 2022 Dec;61(6):103458. doi: 10.1016/j.transci.2022.103458. Epub 2022 May 20.
"Asia type" DEL red blood cells (RBCs) express a very weak D antigen and cannot be detected by routine RhD typing. Thus, it is routinely typed as D-negative (D-) blood group and transfused to D- recipients. Here we described a case of secondary alloanti-D immunization that was associated with transfusion of DEL RBCs to D- recipients and was initially considered as primary alloanti-D immunization.
A 44-year-old D- woman (G2P2) with adenomyosis and anemia underwent transabdominal hysterectomy. She received four units of D- RBCs before operation. Before transfusion, the alloantibody screening test was negative. Four days after the first transfusion, she needed another RBC transfusion. Unexpectedly, the routine pre-transfusion alloantibody screening test became positive and anti-D (titer, 128-fold) was identified, indicating an alloanti-D immunization. The anti-D developed four days after the first transfusion was unexplained, so alloantibody identification was performed on the sample collected before the first transfusion, and weak anti-D combined with anti-E, which was not detectable during the previous routine pre-transfusion alloantibody screening test with non-enzyme-treated screening cells, was identified using bromelain-treated panel cells. The remaining blood samples of first transfusion in bag tails from two donors were collected for RHD genotyping analysis. One donor was later identified as "Asia type" DEL having RHD* 1227 A/01 N.01 genotype.
Caution should be applied when we conclude that transfusion of "Asia type" DEL RBCs to true D- recipients could induce primary alloanti-D immunization, especially if the short time interval between transfusion and detection of anti-D is observed.
“亚洲型”DEL 红细胞（RBC）表达非常弱的 D 抗原，无法通过常规 RhD 定型检测到。因此，其通常被定型为 D-阴性（D-）血型，并输给 D-受血者。在这里，我们描述了一例继发于 DEL RBC 输注给 D-受血者的 alloanti-D 免疫，该病例最初被认为是原发性 alloanti-D 免疫。
一名 44 岁的 D-女性（G2P2），患有子宫腺肌病和贫血，接受了经腹子宫切除术。手术前她接受了四单位的 D- RBC。输血前，同种抗体筛查试验为阴性。第一次输血后四天，她需要再次输血。出乎意料的是，常规输血前同种抗体筛查试验呈阳性，并鉴定出抗-D（效价，128 倍），表明 alloanti-D 免疫。第一次输血后四天出现的抗-D 无法解释，因此对第一次输血前采集的样本进行了同种抗体鉴定，使用菠萝蛋白酶处理的谱细胞鉴定出弱抗-D 与抗-E 结合，在之前的常规输血前同种抗体筛查试验中用未酶处理的筛查细胞检测不到。第一个输血袋的尾端剩余血样被采集，用于 RHD 基因分型分析。其中一位供者后来被鉴定为“亚洲型”DEL，具有 RHD*1227A/01N.01 基因型。
当我们得出结论，输注“亚洲型”DEL RBC 给真正的 D-受血者可能会导致原发性 alloanti-D 免疫时，应谨慎，特别是如果观察到输血和抗-D 检测之间的时间间隔较短。
