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- Title
Weak D phenotypes and transfusion safety: where do we stand in daily practice?
- Authors
Noizat-Pirenne, France; Verdier, Martine; Lejealle, Annette; Mercadier, Anne; Bonin, Philippe; Peltier-Pujol, Françoise; Fialaire-Legendre, Anne; Tournamille, Christophe; Bierling, Philippe; Ansart-Pirenne, Hélène
- Abstract
BACKGROUND: Weak D Types 1, 2, and 3 recipients cannot be immunized when exposed to D antigen. Molecular biology is very efficient to type weak D variants but rarely implemented in daily practice. The serologic typing practice of weak D in a Caucasian patient population was analyzed and a transfusion strategy is proposed. STUDY DESIGN AND METHODS: Samples typed either ddCcee or ddccEe in routine laboratories were tested with the indirect antiglobulin test (Du test). Du-positive samples were screened for weak D alleles Types 1, 2, and 3 and further tested with immunoglobulin M (IgM) anti-D reagents, used in a fully automated device. RESULTS: A total of 468 of 55,162 samples were found to be ddCcee or ddccEe. Ninety-three expressed weak D after the Du test leading to D+ assignment for transfusion. Seventy-three percent of Du-positive samples were weak D alleles Type 1, 2, or 3. Almost all weak D Types 1, 2, and 3 were positive with IgM reagents in gel matrix with an automated device. Other variants that could be potentially associated with anti-D alloimmunization, however, were also positive. CONCLUSION: Serology is very sensitive to detect weak D Types 1, 2, and 3, but there is no cutoff to distinguish variants of clinical significance. When molecular analysis is not available, it is proposed that a D+ status for blood recipients found to be weak D with a sensitive method be assigned, except for women of childbearing age or younger, because of the remaining possibility to be partial D or other rare weak D who can be immunized.
- Subjects
ANTIGENS; IMMUNOGLOBULIN M; MOLECULAR biology; SEROLOGY; BLOOD donors; BLOOD banks
- Publication
Transfusion, 2007, Vol 47, Issue 9, p1616
- ISSN
0041-1132
- Publication type
Article
- DOI
10.1111/j.1537-2995.2007.01332.x