Primary anti-D immunization by weak D type 2 RBCs
Primary anti-D immunization by weak D type 2 RBCs
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DOI：
10.1046/j.1537-2995.2000.40040428.x
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发表时间：
2000-04-01
期刊：
影响因子：
2.9
通讯作者：
Wagner, FF
中科院分区：
文献类型：
--
作者：
Flegel, WA;Khull, SR;Wagner, FF
背景：D是免疫原性最强的血型抗原。在大约0.4%的白人中，D在RBC上以弱形式表达。最近发现，弱D表型是由大量不同的RHD等位基因引起的，这些等位基因通常编码改变的D蛋白。没有特定的分子弱D型尚未显示诱导抗D。抗D免疫所需的D抗原密度的阈值是未知的。病例报告：一个72岁的D-白色男子收到明显的D-红细胞。19天后，他出现了阳性DAT，在他的血清中发现了抗D，并从他的RBC中发现了抗D。发现一个供体是D+，具有弱D型。通过基因组DNA的RHD外显子g特异性核苷酸测序确定弱D型。输血者显示同种抗D。10个月后，检测到抗D抗体，但未检测到其他抗体; DAT呈阴性，抗D抗体无反应性。结论：该病例为弱D2型表型红细胞可引起同种抗D免疫提供了正式证据。在白人中更普遍的弱D型中，弱D 2型具有最低的D抗原密度。因此，来自弱D 2型表型供体的血液单位应标记为D+;弱D 2型表型可能有助于质量保证。
BACKGROUND: D is the most immunogenic blood group antigen. In about 0.4 percent of whites, D is expressed on RBCs in a weak form. Recently, it was found that the weak D phenotypes are caused by a large number of distinct RHD alleles generally encoding altered D proteins. No particular molecular weak D type has yet been shown to induce anti-D. The threshold of D antigen density required for anti-D immunization is not known.CASE REPORT: A 72-year-old D- white man received apparently D- RBCs. Nineteen days later, he developed a positive DAT, and anti-D was found in his serum and an eluate from his RBCs. One donor was found to be D+ with a weak D type. The weak D type was determined by RHD exon g-specific nucleotide sequencing from genomic DNA. The transfusion recipient showed alloanti-D. Ten months later, anti-D but no other antibody was detectable; the DAT was negative and the eluate was nonreactive. The donor of the incriminated unit was D+ (ccDEe) with weak D due to the weak D type 2 allele, expressing about 450 D antigens per RBC.CONCLUSION: This case provides formal proof that RBCs of weak D type 2 phenotype may cause alloanti-D immunization. Among the more prevalent weak D types in whites, weak D type 2 has the lowest D antigen density. Thus, units of blood from donors of the weak D type 2 phenotype should be labeled D+; the weak D type 2 phenotype may be useful for quality assurance.