title: An investigation of secondary anti-D immunisation among phenotypically RhD-negative individuals in the Chinese population.
abstract: BACKGROUND
  Despite the introduction of anti-D prophylaxis into clinical practice, RhD alloimmunisation remains a problem, particularly in the context of transfusions and pregnancy-induced alloimmunisation. The incidence of RhD alloimmunisation among phenotypically RhD-negative individuals is unknown in most countries. We investigated RhD alloimmmunisation in RhD-negative pregnant women and transfusion recipients in south-east China in order to optimise the prevention of this phenomenon.
  
  
  METHODS
  We analysed the RhD alloimmunisation status of RhD-negative pregnant women and transfusion recipients in south-east China. The RhD blood types of the study population were identified by standard serological methods. The D antigen was further tested with the indirect antiglobulin test to exclude or confirm weak D or partial D types. RhC, c, E and e antigens were typed in all subjects. If anti-D antibody screening was positive, the specificity and titre of the antibody were determined. The Del phenotype was investigated by the polymerase chain reaction sequence-specific primer method.
  
  
  RESULTS
  An anti-D antibody was found in 61 of 416 RhD-negative pregnant women (14.66%), and in 11 of 227 RhD-negative transfusion recipients (4.85%). None of the 72 RhD-negative pregnant women or transfusion recipients with anti-D had the Del phenotype. Anti-D antibodies were not detected among Del phenotype individuals and Del phenotypes were not found in anti-D antibody producing individuals.
  
  
  CONCLUSIONS
  Our study suggests that the risk of alloimmunity-induced neonatal haemolysis increases in true RhD-negative multipara. Perinatal protection would be necessary in these patients, while antenatal anti-D testing and Rh immune globulin prophylaxis would be unnecessary for RhDel pregnant women. Pregnant women and transfusion recipients with the Del type seldom produce anti-D antibody. RhD-negative recipients are not at risk of alloimmunisation after transfusion with Del red blood cells.
authors: Department of Clinical Laboratory, the Shaoxing Hospital of China Medical University, Shaoxing, Zhejiang, People's Republic of China.
authors: Qing-Ping
authors: QP
authors: Wang
authors: Department of Emergency Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China.
authors: Guang-Tao
authors: GT
authors: Dong
authors: Department of Clinical Laboratory, the Fifth People's Hospital of Wuxi, the Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, People's Republic of China.
authors: Xue-Dong
authors: XD
authors: Wang
authors: Department of Clinical Laboratory, the Fifth People's Hospital of Wuxi, the Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, People's Republic of China.
authors: Juan
authors: J
authors: Gu
authors: Department of Clinical Laboratory, the Affiliated Hospital of Guilin Medical College, Guilin, Guangxi, People's Republic of China.
authors: Zheng
authors: Z
authors: Li
authors: Department of Clinical Laboratory, the Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.
authors: An-Yuan
authors: AY
authors: Sun
authors: Shenzhen Blood Center and Institute of Blood Transfusion Medicine, Shenzhen, Guangdong, People's Republic of China.
authors: Chao-Peng
authors: CP
authors: Shao
authors: Department of Clinical Laboratory, the Fifth People's Hospital of Wuxi, the Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, People's Republic of China.
authors: Zhao-Lin
authors: ZL
authors: Pan
authors: Department of Clinical Laboratory, the Fifth People's Hospital of Wuxi, the Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, People's Republic of China.
authors: Li-Hua
authors: LH
authors: Huang
authors: Department of Clinical Laboratory, the Fifth People's Hospital of Wuxi, the Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, People's Republic of China.
authors: Wei-Xing
authors: WX
authors: Xie
authors: Zhenjiang Maternal and Children Health Care Hospital, The Fourth Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China.
authors: Guang-Ming
authors: GM
authors: Sun
authors: Department of Clinical Laboratory, the Shaoxing Hospital of China Medical University, Shaoxing, Zhejiang, People's Republic of China.
authors: Jian-Jiang
authors: JJ
authors: Chen
authors: Department of Clinical Laboratory, the Fifth People's Hospital of Wuxi, the Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, People's Republic of China.
authors: Hao
authors: H
authors: Pei
authors: Department of Clinical Laboratory, the Fifth People's Hospital of Wuxi, the Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, People's Republic of China.
authors: Xiao-Juan
authors: XJ
authors: Yang
authors: Department of Blood Transfusion, the Shaoxing Hospital of China Medical University, Shaoxing, Zhejiang, People's Republic of China.
authors: Ping-Nan
authors: PN
authors: Shan
mesh_terms: D000328:Adult; D002681:China; D005260:Female; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D012203:Rh Isoimmunization / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D012204:Rh-Hr Blood-Group System / Q000097:blood*; 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
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