Journal List > Korean J Lab Med > v.29(4) > 1011566

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Kim, Kim, Woo, Han, Kim, and Park: Primary anti-D Immunization by DEL Red Blood Cells
Case Report

Korean J Leg Med 2009;29(4):361-365.

Published online: 14 January 2009

DOI: https://doi.org/10.3343/kjlm.2009.29.4.361

Primary anti-D Immunization by DEL Red Blood Cells

Kyeong-Hee Kim, M.D.1, Kyung-Eun Kim, M.D.1, Kwang-Sook Woo, M.D.1, Jin-Yeong Han, M.D.1, Jeong-Man Kim, M.D.1, Kyoung Un Park, M.D.2

1Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea

2Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea

Corresponding author: Kyeong-Hee Kim, M.D. Department of Laboratory Medicine, Dong-A University College of Medicine, 1 Dongdaesindong 3-ga, Seo-gu, Busan 602-103, Korea Tel: +82-51-240-2850, Fax: +82-51-255-9366 E-mail: progreen@dau.ac.kr

      Revised 17 March 200927 May 2009       Accepted 12 June 2009

Copyright © 2009 Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Extremely weak D variants called DEL are serologically detectable only by adsorption-elution techniques. A nucleotide change of exon 9 in RHD gene, RHD (K409K, 1227G>A) allelic variant is present in almost all the DEL individuals of East Asians. No DEL phenotype has yet been shown to induce a primary alloanti-D immunization in East Asia. A 68-yr-old D-negative Korean man was negative for anti-D at admission, and he developed alloanti-D after transfusion of red blood cells (RBC) from 4 apparently D-negative donors. Four donors who typed D-negative by routine serologic test were analyzed by real-time PCR for RHD gene and RHD (K409K). One donor was found to have RHD (K409K). This is the first case in which DEL RBCs with RHD (K409K) induced a primary alloanti-D immunization in Asian population. Because the DEL phenotype can induce an anti-D immunization in D-negative recipients, further discussion is needed whether RhD negative donors should be screened by molecular method and what an efficient genotyping method is for detecting the RHD gene carriers in Korea.

Keywords: RHD, DEL RBC, Anti-D antibody, Alloimmunization

REFERENCES

1.Daniels G. Human blood groups. 1st ed.Oxford: Blackwell Science;1995.
2.Lin-Chu M., Broadberry RE., Chang FJ. The distribution of blood group antigens and alloantibodies among Chinese in Taiwan. Transfusion. 1988. 28:350–2.
crossref
3.Mak KH., Yan KF., Cheng SS., Yuen MY. Rh phenotypes of Chinese blood donors in Hong Kong, with special reference to weak D antigens. Transfusion. 1993. 33:348–51.
crossref
4.Okuda H., Kawano M., Iwamoto S., Tanaka M., Seno T., Okubo Y, et al. The RHD gene is highly detectable in RhD-negative Japanese donors. J Clin Invest. 1997. 100:373–9.
crossref
5.Hwang YS. Haplotype frequencies of Rh gene loci in Koreans. Korean J Blood Transfus. 1996. 7:233–40. (황유성. 한국인 Rh 혈액형의 유전자일배체형분석. 대한수혈학회지 1996;7:233-40.).
6.Kim JY., Kim SY., Kim CA., Yon GS., Park SS. Molecular characterization of D- Korean persons: development of a diagnostic strategy. Transfusion. 2005. 45:345–52.
crossref
7.Luettringhaus TA., Cho D., Ryang DW., Flegel WA. An easy RHD genotyping strategy for D- East Asian persons applied to Korean blood donors. Transfusion. 2006. 46:2128–37.
crossref
8.Wagner T., Körmöczi GF., Buchta C., Vadon M., Lanzer G., Mayr WR, et al. Anti-D immunization by DEL red blood cells. Transfusion. 2005. 45:520–6.
crossref
9.Yasuda H., Ohto H., Sakuma S., Ishikawa Y. Secondary anti-D immunization by Del red blood cells. Transfusion. 2005. 45:158–14.
crossref
10.Avent ND., Martin PG., Armstrong-Fisher SS., Liu W., Finning KM., Maddocks D, et al. Evidence of genetic diversity underlying Rh D-, weak D (Du), and partial D phenotypes as determined by multiplex polymerase chain reaction analysis of the RHD gene. Blood. 1997. 89:2568–77.
crossref
11.Aubin JT., Le Van Kim C., Mouro I., Colin Y., Bignozzi C., Brossard Y, et al. Specificity and sensitivity of RHD genotyping methods by PCR-based DNA amplification. Br J Haematol. 1997. 98:356–64.
crossref
12.Wagner FF., Frohmajer A., Flegel WA. RHD positive haplotypes in D negative Europeans. BMC Genet. 2001. 2:10.
13.Avent ND., Reid ME. The Rh blood group system: a review. Blood. 2000. 95:375–87.
crossref
14.Gassner C., Doescher A., Drnovsek TD., Rozman P., Eicher NI., Legler TJ, et al. Presence of RHD in serologically D-, C/E+ individuals: a European multicenter study. Transfusion. 2005. 45:527–38.
15.Richard M., Perreault J., Constanzo-Yanez J., Khalifé S., St-Louis M. A new DEL variant caused by exon 8 deletion. Transfusion. 2007. 47:852–7.
16.Sun CF., Liu JP., Chen DP., Wang WT., Yang TT. Use of real time PCR for rapid detection of Del phenotype in Taiwan. Ann Clin Lab Sci. 2008. 38:258–63.
17.Flegel WA., von Zabern I., Wagner FF. Six years' experience performing RHD genotyping to confirm D- red blood cell units in Germany for preventing anti-D immunizations. Transfusion. 2009. 49:465–71.
18.Polin H., Danzer M., Gaszner W., Broda D., St-Louis M., Pröll J, et al. Identification of RHD alleles with the potential of anti-D immunization among seemingly D-blood donors in Upper Austria. Transfusion. 2009. 49:676–81.

Table 1.
Primers used for RHD gene real-time PCR
Name Genomic region Sequence (5′-3′) Reference
e4F Intron 4 CCTATTTTGGGCTGTACTGTGG [10]
Di4R Intron 4 GAACCTGCTCTGTGAAGTGCT [10]
De7F Exon 7 TGTTGTAACCGAGTGC [11]
De7R Exon 7 ACCATGCCATTGCCG [11]
PRM-F Promoter TCCACTTTCCACCTCCCTGC [12]
  region    
PRM-R Promoter region GCAGCCAACTTCCCCTGTG [12]
De10-3F Exon 10 TAAGCAAAAGCATCCAA [11]
De10-3R Exon 10 ATGGTGAGATTCTCCT [11]
Table 2.
Primers and probes for real-time PCR to detect the RHD (K409K)
Name Reaction Sequence (5′-3′)
RHK409-F Primer AAAATATGGAAAGCACCTCATGA
RHK409-R Primer ATGGATTTGTTTCTCCTCTAGTT
RHK409-D Probe LC Red 640-ATCTTACCTTCCAGAAAA-CTTGGTCATCAA-Phosphate
RHK409-A Probe CATGCACTCAAAATCTATCACGTTAATA-GGTGAA-fluorescein
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