Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
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Sensitization to Multiple Rh Antigens by Transfusion of Random Donor Platelet Concentrates in a -D- Phenotype Patient

  • Yun, Jae Won (Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kang, Eun-Suk (Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ki, Chang-Seok (Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Koh, Kwang Cheol (Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Dae Won (Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Published : 2012.11.01
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Abstract

The -D- phenotype is a rare Rh phenotype that strongly expresses D antigen without C, c, E, or e antigens. In -D- phenotype individuals, anti-Rh17 ($Hr_{\circ}$) is commonly found if there is a history of pregnancy or transfusion with red blood cells (RBCs) that express C, c, E, or e antigens. We report the first case of a -D- phenotype patient with multiple Rh antibodies including anti-Rh17 who had a history of two occasions of transfusion with eight random donor platelet concentrates two and six years ago. We found that a trivial amount of RBCs in the platelet components was able to trigger sensitization to RBC antigens, especially the highly immunogenic and clinically significant Rh antigens, including C, c, E, e or CcEe polypeptides. To avoid unnecessary sensitization and to minimize the risk of hemolytic transfusion reactions in patients with this rare Rh phenotype, a modified strategy for pretransfusion screenings needs to be discussed in the field of transfusion medicine.

Keywords

References

  1. Okubo Y, ed. Pretransfusion testing with special reference to blood groups (in Japanese). Tokyo: Ishiyaku Publishers, Inc., 1991:40-1.
  2. Han KS, Kim HC, Shim WS. A case of fatal hemolytic disease of the newborn associated with-D-/-D-phenotype. Am J Perinatol 1997;14:495-7. https://doi.org/10.1055/s-2007-994188
  3. Whang DH, Kim HC, Hur M, Choi JH, Park JS, Han KS. A successful delivery of a baby from a D--/D-- mother with strong anti- Hr0. Immunohematology 2000;16:112-4.
  4. Hwang JY, Suh IB, Shim JY, Cho JS, Lee DH. A case of fetal hydrops associated with maternal -D-/-D- phenotype. Korean J Obstet Gynecol 2006;49:1378-82.
  5. Um TH, Cho CR, Whang JH, Whang DH, Yoon MS, Han KS. A case of D--/D-- phenotype associated with moderate hemolytic disease of the newborn. Korean J Blood Transfus 2007;18:61-5.
  6. Kim HC, Joo KW, Hahn KS, Shim WS, Yoon MS, Han BY, et al. A family with -D- phenotype associated with fatal hemolytic disease of the newborn. Korean J Blood Transfus 1995;6:201-6.
  7. Mertens G, Muylle L, Ursi JP, Docx M, Renard JM. Transfusion with thawed Rh -- D blood of a newborn suffering from haemolytic disease due to anti-Rh 17. J Obstet Gynaecol 1997;17:590-1. https://doi.org/10.1080/01443619768731
  8. Huang CH. Alteration of RH gene structure and expression in human dCCee and DCW-red blood cells: phenotypic homozygosity versus genotypic heterozygosity. Blood 1996;88:2326-33.
  9. Denomme GA, Rios M, et al. eds. Molecular protocols in transfusion medicine. San Diego: Academic press, 2000:85-93.
  10. Choi KH, Rhu JH, Park HR, Kim HO. The preparation of frozen red blood cells and a procedure for deglycerolizing frozen RBCs using COBE 2991 blood cell processor. Korean J Blood Transfus 2001;12:189-96.
  11. Avent ND and Reid ME. The Rh blood group system: a review. Blood 2000;95:375-87.
  12. Kim CA, Seo DH, Hwang BG, Kim SI. Current status of the quality control of blood components at the Korean Red Cross blood centers. J Clin Pathol Qual Control 2001;23:319-23.
  13. De Vooght KM, Demir AY, Folman CC, Schutgens RE, van Solinge WW, Kemperman H. Successful transfusion care for a patient with the Rhesus -D- phenotype and antibodies against Rh17 and two additional alloantibodies. Ann Hematol 2012;91:963-4. https://doi.org/10.1007/s00277-011-1344-7
  14. Aref K, Boctor FN, Pande S, Uehlinger J, Manning F, Eglowstein M, et al. Successful perinatal management of hydrops fetalis due to hemolytic disease associated with D-- maternal phenotype. J Perinatol 2002;22:667-8. https://doi.org/10.1038/sj.jp.7210775
  15. Brumit MC, Carnahan GE, Stubbs JR, Storry JR, Reid ME. Moderate hemolytic disease of the newborn (HDN) due to anti-Rh17 produced by a black female with an e variant phenotype. Immunohematology 2002;18:40-2.
  16. Deitenbeck R, Tutschek B, Crombach G, Stannigel H. Successful management of pregnancy and hemolytic disease of the newborn due to anti-HrO in a woman of the D--phenotype. Transfusion 1999;39:1151-2. https://doi.org/10.1046/j.1537-2995.1999.t01-1-39101150.x
  17. Hirose M, Nakanishi K, Kaku S, Moro H, Hodohara K, Aotani H, et al. Fetal hemolytic disease due to anti-Rh17 alloimmunization. Fetal Diagn Ther 2004;19:182-6. https://doi.org/10.1159/000075147
  18. Urbaniak SJ and Robertson AE. A successful program of immunizing Rh-negative male volunteers for anti-D production using frozen/thawed blood. Transfusion 1981;21:64-9. https://doi.org/10.1046/j.1537-2995.1981.21181127486.x
  19. Jakobowicz R, Williams L, Silberman F. Immunization of Rh-negative volunteers by repeated injections of very small amounts of Rh-positive blood. Vox Sang 1972;23:376-81. https://doi.org/10.1111/j.1423-0410.1972.tb03475.x

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