National Blood Centre (NBC), Thai Red Cross Society, Bangkok, Thailand.
University of Brest, Inserm, EFS, UMR1078, GGB, Brest, France; Laboratory of Excellence GR-Ex, Paris, France.
Transfus Apher Sci. 2023 Dec;62(6):103837. doi: 10.1016/j.transci.2023.103837. Epub 2023 Oct 20.
DEL phenotype is a rare Rh variant that cannot be detected by routine serological typing, and DEL individuals are thus typed D-negative (D-). Anti-D alloimmunization has been reported in "true" D- patients receiving DEL red blood cells (RBCs).
A 17-year-old, D- Thai male patient suffering from immunodeficiency syndrome with negative antibody screening received RBC units from 17 serological D- donors over a period of seven months due to acute respiratory failure with anemia. Before the 12th transfusion, anti-D production was detected. He was later transfused with RBCs from six other apparent D- donors. In order to elucidate anti-D production, all 17 blood donors were investigated by replicative serological testing and molecular analysis to identify potential RHD gene variants. All donors were confirmed D- by routine method, but as many as 12/17 were positive by adsorption-elution testing. Molecular analysis showed that five donors, including four whose blood was transfused before anti-D production occurred, carry the Asia type DEL allele, and are thus predicted to express a DEL phenotype. These data clearly suggest that 1/ the alloimmunized D- patient was exposed to D antigen, 2/ our adsorption-elution test is currently defective to identify DEL RBCs, and 3/ molecular analysis is highly valuable for Asia type DEL allele screening.
For the first time in Thailand, we report anti-D alloimmunization in a serological D- patient transfused by Asia type DEL RBC units. This work definitely supports the implementation of a dedicated policy for DEL blood management including molecular testing.
DEL 表型是一种罕见的 Rh 变异体，无法通过常规血清学分型检测到，因此 DEL 个体被定型为 D-阴性（D-）。在接受 DEL 红细胞（RBC）的“真正”D-患者中，已经报道了抗-D 同种免疫。
一名 17 岁的泰国男性 D-免疫缺陷综合征患者，因贫血性急性呼吸衰竭，在七个月的时间里接受了来自 17 名血清学 D-供体的 RBC 单位。在第 12 次输血前，检测到抗-D 产生。随后，他又从另外 6 名疑似 D-供体接受了 RBC 输血。为了阐明抗-D 的产生原因，对所有 17 名献血者进行了复制性血清学检测和分子分析，以鉴定潜在的 RHD 基因突变。所有供体均通过常规方法确认 D-，但多达 12/17 名供体通过吸附洗脱试验呈阳性。分子分析显示，包括在抗-D 产生之前接受输血的 4 名供体在内的 5 名供体携带亚洲型 DEL 等位基因，因此预计表达 DEL 表型。这些数据清楚地表明：1/被同种免疫的 D-患者接触到了 D 抗原；2/我们的吸附洗脱试验目前无法识别 DEL RBC；3/分子分析对于亚洲型 DEL 等位基因筛查非常有价值。
在泰国，我们首次报告了一名血清学 D-患者在接受亚洲型 DEL RBC 单位输血后发生抗-D 同种免疫。这项工作肯定支持实施专门的 DEL 血液管理政策，包括分子检测。
