Patients with Asian-type DEL can safely be transfused with RhD-positive blood.

Red blood cells (RBCs) of Asian-type DEL phenotype express few RhD proteins and are typed as serologic RhD-negative (D-) phenotype in routine testing. RhD-positive (D+) RBC transfusion for patients with Asian-type DEL has been proposed but has not been generally adopted because of a lack of direct evidence regarding its safety and the underlying mechanism. We performed a single-arm multicenter clinical trial to document the outcome of D+ RBC transfusion in patients with Asian-type DEL; none of the recipients (0/42; 95% confidence interval, 0-8.40) developed alloanti-D after a median follow-up of 226 days. We conducted a large retrospective study to detect alloanti-D immunization in 4045 serologic D- pregnant women throughout China; alloanti-D was found only in individuals with true D- (2.63%, 79/3009), but not in those with Asian-type DEL (0/1032). We further retrospectively examined 127 serologic D- pregnant women who had developed alloanti-D and found none with Asian-type DEL (0/127). Finally, we analyzed RHD transcripts from Asian-type DEL erythroblasts and examined antigen epitopes expressed by various RHD transcripts in vitro, finding a low abundance of full-length RHD transcripts (0.18% of the total) expressing RhD antigens carrying the entire repertoire of epitopes, which could explain the immune tolerance against D+ RBCs. Our results provide multiple lines of evidence that individuals with Asian-type DEL cannot produce alloanti-D when exposed to D+ RBCs after transfusion or pregnancy. Therefore, we recommend considering D+ RBC transfusion and discontinuing anti-D prophylaxis in patients with Asian-type DEL, including pregnant women. This clinical trial is registered at www.clinicaltrials.gov as #NCT03727230. © 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.

Citation

Yanli Ji, Yalin Luo, Jizhi Wen, Yuanfan Sun, Shuangshuang Jia, Chunquan Ou, Wenbing Yang, Jingwang Chen, Hanshen Ye, Xiangfu Liu, Yongneng Liang, Zhigang Lu, Ying Feng, Xinzhong Wu, Muzhou Xiao, Jiankun Mo, Zhenhai Zhou, Zhen Wang, Zhijian Liao, Junhu Chen, Ling Wei, Guangping Luo, Sentot Santoso, Yann Fichou, Willy Albert Flegel, Chaopeng Shao, Chengyao Li, Rui Zhang, Yongshui Fu. Patients with Asian-type DEL can safely be transfused with RhD-positive blood. Blood. 2023 Apr 27;141(17):2141-2150

Mesh Tags

Substances

PMID: 36638337

search → result