Transfusion support for a woman with RHD*09.01.02 and the novel RHD*01W.161 allele in trans

Test	Result
ABO group	AB (mixed-field agglutination for A)*
RhD phenotype	Serologic weak D phenotype^†
RhCE phenotype	C+E–c+e+
Antibody detection test	Negative
Direct antiglobulin test	Negative

[i] *Anti-A₁ negative. Molecular characterization consistent with A₂B phenotype.

_† D typing in tube agglutination using a routine oligoclonal anti-D blend (BS232, BS221, and H41 11B7; Bio-Rad, Hercules, CA) was negative in immediate spin but 2+ positive with antihuman globulin (AHG). D typing in gel matrix method (clone MS-201) with AHG was 3+ positive.

Table 2

Red cell genotyping of the RHD gene

Test	Allele 1	Allele 2
RBC-FluoGene D weak/variant	RHD01W.14*	Possible RHD01W.14* or RHD01* or RHD01N.01*
wRHD BeadChip	RHDDAR*	Possible RHD01*
Nucleotide sequencing
Allele recognized	Known	Novel
Nucleotide sequence (GenBank)	KF712273	MT980847
Amino acid change(s)	T201R, F223V, I342T	I204K
Serologic weak D phenotype¹⁵	DAR1.2 (weak D 4.2.2)¹⁸	Weak D type 161
ISBT terminology¹⁶	RHD09.01.02*¹⁸	RHD01W.161*^†

[i] ^†ClinVar SCV001977615.

Table 3

Serologic testing with panels of anti-D

Clone	Isotype	epD	Patient CDe/cDe	19^‡ CDe/cde	1 CDe/cde	4.0^§ cDe/cde	4.1 cDe/cde	4.2.2^¶ cDe/cde	45 CDe/cde	64 cDe/cde	88 cDE/cde	D+ cDe/cde
LHM76/58	IgG_1λ	8.1	4+	+	4+	4+	4+	3+ to 4+	4+	4+	4+	4+
LHM76/59	IgG₁	15.1	4+	+	4+	4+	4+	3+ to 4+	4+	4+	4+	4+
LHM174/102	IgG_3κ	1.2	2+	+	0	0	0	0	4+	2+	1+	4+
LHM50/2B	IgG_1λ	6.3	4+	NT	4+	4+	4+	3+ to 4+	4+	4+	4+	4+
LHM169/81	IgG_3κ	1.1	4+	+	4+	4+	4+	2+ to 3+	4+	4+	4+	4+
ESD1	IgG_1κ	4.1	4+	NT	4+	4+	4+	3+ to 4+	4+	4+	4+	4+
LHM76/55	IgG_1κ	3.1	4+	+	4+	4+	4+	3+ to 4+	4+	4+	4+	4+
LHM77/64	IgG_1κ	9.1	4+	NT	4+	4+	4+	3+ to 4+	4+	4+	4+	4+
LHM70/45	IgG_1λ	1.2	3+	+	3+	3+	3+	0 to 2+	3+	3+	3+	4+
LHM59/19	IgG_3κ	8.1	4+	NT	3+	3+	3+	0 to 2+	4+	3+	3+	4+
LHM169/80	IgG_3λ	6.3	4+	NT	4+	4+	4+	3+ to 4+	4+	4+	4+	4+
LHM57/17	IgG_1λ	6.3	0	NT	0	0	0	0 to 2+	NT	0	0	1+
LDM1	IgM	6.5	3+	NT	0	4+	3+	0 to 2+	4+	0	2+	4+

[i] *Gel matrix test with antihuman globulin.

^†ALBAclone Advanced Partial RhD typing kit (recently renamed as ALBAclone RhD Variant Investigation kit) (Alba Bioscience/Quotient, Eysins, Switzerland).

^‡Results from Yu et al.²³

^§Two samples tested.

^¶Four samples tested.

NT = not tested.

Table 4

Immediate spin testing

		Samples
Test method*	Patient CDe/cDe	4.0^† cDe/cde	4.1 cDe/cde	4.2.2^‡ cDe/cde	45 CDe/cde	64 cDe/cde	88 cDE/cde	D+ cDe/cde	D– cde/cde
Tube	0	2+	1+	0	2+	0	0	3+	0
Gel matrix	3+	3+	3+	1+ to 3+	4+	3+	3+	4+	0

[i] * For the tube testing, clones BS232 (IgM, epD 6.4), BS221 (IgG, epD 6.3), and H41 11B7 (IgG, epD 3.1) were used, and for gel matrix testing, clone MS-201 (IgM, epD 6.1) was used. Per test principle, all immediate spin tests are performed without antihuman globulin.

^†Two samples tested.

^‡Four samples tested.

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DOI: https://doi.org/10.21307/immunohematology-2022-036 | Journal eISSN: 1930-3955 | Journal ISSN: 0894-203X

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Language: English

Page range: 17 - 24

Published on: Apr 29, 2022

Published by: American National Red Cross

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

D antigen,

RHD allele,

transfusion medicine,

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© 2022 K. Srivastava, M.U. Bueno, W.A. Flegel, published by American National Red Cross
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 38 (2022): Issue 1 (March 2022)