Two cases of the variant RHD*DAU5 allele associated with maternal alloanti-D  

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Immunohematology

American National Red Cross

Subject: Medical Laboratory Technology

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ISSN: 0894-203X
eISSN: 1930-3955

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VOLUME 33 , ISSUE 2 (June 2017) > List of articles

Two cases of the variant RHD*DAU5 allele associated with maternal alloanti-D  

Jennifer A. Duncan / Susan Nahirniak / Rodrigo Onell / Gwen Clarke *

Keywords : Rh blood group system, partial D, DAU5, anti-D, alloimmunization

Citation Information : Immunohematology. Volume 33, Issue 2, Pages 60-63, DOI: https://doi.org/10.21307/immunohematology-2019-009

License : (Transfer of Copyright)

Published Online: 09-October-2019

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ABSTRACT

Rh is a complex blood group system with diverse genotypes that may encode weak and partial D variants. Standard serologic analysis may identify clinically significant D variants as D+; nevertheless, individuals with these D variants should be managed as D– patients to prevent antibody formation to absent D epitopes. Variant identification is necessary during pregnancy to allow for timely and appropriate Rh immune globulin (RhIG) prophylaxis for hemolytic disease of the fetus and newborn (HDFN) as D alloimmunization can occur with some D variants. Here, we describe two cases of the RHD*DAU5 allele associated with maternal alloanti-D in patients of African ancestry. Two obstetric patients were initially serologically classified as D+ with negative antibody detection tests on routine prenatal testing. Repeat testing at delivery identified anti-D in both patients with no history of RhIG administration or transfusion. DNA sequencing revealed that both patients possessed the RHD*DAU5 allele. Cord blood testing on both infants revealed positive direct antiglobulin test (DAT) results with anti-D eluted from the red blood cells (RBCs) of one of the infants. Despite the positive DAT, neither infant experienced anemia or hyperbilirubinemia. We document two cases of pregnant women whose RBCs expressed a partial D variant and were classified as D+ on the basis of standard serologic testing, resulting in subsequent failure to provide RhIG prophylaxis. Both cases were associated with alloanti-D formation but without significant HDFN. To our knowledge, these are the first reported cases of maternal alloanti-D associated with the RHD*DAU5 partial D variant.

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REFERENCES

1. Flegel WA. The genetics of the Rhesus blood group system. Blood Transfus 2007;5:50–7.

2. Gunson HH, Stratton F, Phillips PK. The primary Rho(D) immune response in male volunteers. Br J Haematol 1976;32:317–29.

3. Frohn C, Dümbgen L, Brand JM, Görg S, Luhm J, Kirchner H. Probability of anti-D development in D– patients receiving D+ RBCs. Transfusion 2003;43:893–8.

4. Yazer MH, Triulzi DJ. Detection of anti-D in D– recipients transfused with D+ red blood cells. Transfusion 2007;47: 2197–201.

5. Wagner FF, Flegel WA. The rhesus site. http://www.uni–ulm. de/%7Ewflegel/RH/RIR/rirres. Accessed June 24, 2015.

6. Wagner FF, Gassner C, Müller TH, et al. Molecular basis of weak D phenotypes. Blood 1999;93:385–93.

7. Müller TH, Wagner FF, Trockenbacker A, et al. PCR screening for common weak D types shows different distributions in three Central European populations. Transfusion 2001;41: 45–52.

8. Flegel WA. How I manage donors and patients with a weak D phenotype. Curr Opin Hematol 2006;13:476–83.

9. Stedman CM, White CA. Fatal hydrops fetalis caused by anti-D in a mother with partial D. Obstet Gynecol 2004;104:194–5.

10. Cannon M, Pierce R, Taber EB, Schucker J. Fatal hydrops fetalis caused by anti-D in a mother with partial D. Obstet Gynecol 2003;102:1143–5.

11. Prasad MR, Krugh D, Rossi KQ, et al. Anti-D in Rh positive pregnancies. Am J Obstet Gynecol 2006;195:1158–62.

12. Westhoff CM. Rh complexities: serology and DNA genotyping. Transfusion 2007;47:17S–22S.

13. Wagner FF, Ladewig B, Angert KS, et al. The DAU allele cluster of the RHD gene. Blood 2002;100:306–11.

14. Chen Q, Flegel WA. Random survey for RHD alleles among D+ European persons. Transfusion 2005;45:1183–91.

15. Srivastava K, Polin H, Sheldon SL, et al. The DAU cluster: a comparative analysis of 18 RHD alleles, some forming partial D antigens. Transfusion 2016;56:2520–31.

16. Denomme GA, Wagner FF, Fernandes BJ, et al. Partial D, weak D types, and novel RHD alleles among 33,864 multiethnic patients; implications for anti-D alloimmunization and prevention. Transfusion 2005;45:1554–60.

17. Ansart-Pirenne H, Asso-Bonnet M, Le Pennec P, et al. RhD variants in Caucasians: consequences for checking clinically relevant alleles. Transfusion 2004;44:1282–86.

18. Daniels G. Variants of RhD: current testing and clinical consequences. Brit J Haematol 2013;161:461–70.

19. Sandler SG, Flegel WA, Westhoff CM, et al. It’s time to phase in RHD genotyping for patients with a serologic weak D phenotype. Transfusion 2015;55:680–90.

 

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