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. 2024 Feb;64(2):281-288.
doi: 10.1111/trf.17691. Epub 2023 Dec 23.

RHD-negative red cells may be avoided for patients with ambiguous serologic typing for the RHD antigen

David Juhl  1 , Kathrin Luckner  1 , Christian Brockmann  1 , Ingrid Musiolik  1 , Tina Bunge-Philipowski  1 , Siegfried Görg  1 , Malte Ziemann  1
Affiliations

RHD-negative red cells may be avoided for patients with ambiguous serologic typing for the RHD antigen

David Juhl et al. Transfusion. 2024 Feb.

Abstract

Background and objectives: Serologic typing with monoclonal anti-D is mandatory for RHD antigen determination before transfusion, but due to aberrant (weak or partial) variants of RHD, results may be ambiguous and molecular RHD-typing is required. Before that, RHD-negative (RHD -) red blood cells concentrates (RBCs) shall be transfused to avoid anti-D formation, which probably leads to wastage of RHD - RBCs. STUDY DESIGN AND METHODS: All patients with ambiguous results in serologic RHD-typing and molecular RHD-typing were assessed retrospectively. The proportions of patients at risk for anti-D formation and the proportion of RHD - RBCs transfused unnecessarily were evaluated for the following transfusion strategies: (1) RHD-positive (RHD + )RBCs for all patients, (2) RHD + RBCs for patients with at least 2+ reaction with anti-D, (3) RHD + RBCs for patients with C and/or E in their RHCE-phenotype, (4) RHD + RBCs for patients with C and/or E and at least 2+ reaction, and (5) RHD - RBCs for all patients.

Results: A total of 112 patients were included. Most had weak D type 1-3 and a minority had other, rare RHD variants. The risk of anti-D formation was 4.5%, 2.9%, 1.8%, 1.0%, and 0% for strategies 1-5, respectively. The proportion of RHD - RBCs transfused unnecessarily was 0%, 49.5%, 0.9%, 50.5%, and 95.5%.

Conclusion: Transfusing patients with a C and/or E in their RHCE-phenotype with RHD + RBCs resulted in a very low risk of immunization while avoiding wastage of RHD - RBCs. Therefore, this strategy should be used for some patients with ambiguous results in serologic RHD-typing and pending results of molecular RHD-typing.

Keywords: RBC transfusion; blood group genomics; immunohematology (RBC serology, blood groups).

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