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Is current serologic RhD typing of blood donors sufficient for avoiding immunization of recipients? (CME)
Author(s) -
Krog Grethe Risum,
Clausen Frederik Banch,
Berkowicz Adela,
Jørgensen Lone,
Rieneck Klaus,
Nielsen Leif Kofoed,
Dziegiel Morten Hanefeld
Publication year - 2011
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2011.03156.x
Subject(s) - typing , serology , medicine , antibody , immunization , antigen , immunology , virology , polymerase chain reaction , rh blood group system , blood transfusion , gene , biology , genetics
BACKGROUND: Avoiding immunization with clinically important antibodies is a primary objective in transfusion medicine. Therefore, it is central to identify the extent of D antigens that escape routine RhD typing of blood donors and to improve methodology if necessary. STUDY DESIGN AND METHODS: We screened 5058 D− donors for the presence of the RHD gene, targeting Exons 5, 7, and 10 with real‐time polymerase chain reaction. Samples that were positive in the screen test were investigated further by adsorption‐elution, antibody consumption, flow cytometry, and sequencing of all RHD exons with intron‐specific primers. Lookback was performed on all recipients of RBCs from RHD + donors. RESULTS: We found 13 RHD + samples (0.26%). No variants or chimeras were found. Characterization of DNA revealed a novel DEL type (IVS2‐2 A>G). In the lookback of the 136 transfusions with subsequent antibody follow‐up, of which 13 were from DEL donors, one recipient developed anti‐D. However, in this case, a competing and more likely cause of immunization was the concurrent transfusion of D+ platelets. Eleven recipients were immunized with 13 antibodies different from anti‐D, of which five were anti‐K. CONCLUSION: In our laboratory, serologic RhD typing was safe. We detected all D variants and only missed DEL types . In assessing the immunization risk we included a DEL donor, found previous to this study, that did immunize a recipient with anti‐D. We conclude that inadvertent immunization with D antigens in our setting was rare and in the order of 1.4 in 100,000 D− transfusions.