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Variant RHD alleles and Rh immunization in patients with sickle cell disease.

Kaoru TakasakiDavid F FriedmanStacey UterSunitha VegeConnie M WesthoffStella T Chou
Published in: British journal of haematology (2023)
RH diversity among patients and donors contributes to Rh immunization despite serologic Rh-matched red cell transfusions. Anti-D can occur in D+ patients with RHD variants that encode partial D antigens. Anti-D has also been reported in patients with conventional RHD transfused primarily with units from Black donors who frequently have variant RHD. We report 48 anti-D in 690 D+ transfused individuals with sickle cell disease, categorized here as expressing conventional D, partial D or D antigen encoded by RHD*DAU0. Anti-D formed in a greater proportion of individuals with partial D, occurred after fewer D+ unit exposures, and remained detectable for longer than for those in the other categories. Among all anti-D, 13 had clinical or laboratory evidence of poor transfused red cell survival. Most individuals with anti-D were chronically transfused, including 32 with conventional RHD who required an average of 62 D- units/year following anti-D. Our findings suggest that patients with partial D may benefit from prophylactic D- or RH genotype-matched transfusions to prevent anti-D. Future studies should investigate whether RH genotype-matched transfusions can improve use of valuable donations from Black donors, reduce D immunization and minimize transfusion of D- units to D+ individuals with conventional RHD or DAU0 alleles.
Keyphrases
  • end stage renal disease
  • chronic kidney disease
  • stem cells
  • kidney transplantation
  • red blood cell
  • immune response
  • coronavirus disease
  • current status
  • sars cov
  • peritoneal dialysis
  • case control
  • patient reported