title: Secondary anti-D immunization by Del red blood cells.
abstract: BACKGROUND
  Recent molecular studies of the RHD gene have revealed that D(el) individuals retain a grossly intact RHD gene or have a portion of RHD in their genomes. No D(el) phenotype has yet been shown to induce a primary or secondary alloanti-D immunization, however.
  
  
  METHODS
  A 67-year-old D- Japanese woman with a history of allosensitization from transfusion of D+ red blood cells (RBCs) was negative for anti-D at admission. After she received RBCs from 19 apparently D- donors, she developed anti-D with an 8-fold titer. The titer of anti-D increased further to 128-fold after transfusions of cross-match-compatible D- negative RBCs from 40 donors over the next 2 years. Two of 59 donors were found to be RHD gene-positive and antigen D- with a D(el) phenotype, that is, RHD(K409K).
  
  
  CONCLUSIONS
  This is the first case in which RBCs having the D(el) phenotype induced a secondary alloanti-D immunization. A D- donor with the RHD(K409K) allele was associated with the development of anti-D. Adverse episodes or evidence of hemolysis was not observed after the transfusion of RHD(K409K) RBCs. Further clinical evidence is needed to reveal whether the D(el) phenotype has a clinically relevant potential for anti-D immunization.
authors.affiliation: Division of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima, Japan. hyasuda@fmu.ac.jp
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Yasuda
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ohto
authors.forename: Shizue
authors.initials: S
authors.lastname: Sakuma
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Ishikawa
mesh_terms: D000368:Aged; D000483:Alleles; D001782:Blood Donors; D001788:Blood Grouping and Crossmatching; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D004912:Erythrocytes / Q000276:immunology*; D005188:False Negative Reactions; D005260:Female; D005838:Genotype; D006239:Haplotypes / Q000235:genetics; D006386:Hemagglutination Tests; D006801:Humans; D007163:Immunosorbent Techniques; D007518:Isoantibodies / Q000032:analysis / Q000096:biosynthesis* / Q000276:immunology; D007564:Japan; D010641:Phenotype; D016133:Polymerase Chain Reaction; D018807:Polymorphism, Single-Stranded Conformational; D012203:Rh Isoimmunization / Q000209:etiology* / Q000235:genetics / Q000276:immunology; D012204:Rh-Hr Blood-Group System / Q000235:genetics / Q000276:immunology*; D018029:Rho(D) Immune Globulin; D065227:Transfusion Reaction
chemical_list: D007518:Isoantibodies; C061961:RHO(D) antibody; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin; C026410:Rho(D) antigen