title: Prospective Evaluation of a Transfusion Policy of RhD-Positive Red Blood Cells into DEL Patients in China.
abstract: BACKGROUND
  The D antigen is highly immunogenic, requiring only a small quantity of transfused red blood cells (RBCs) to cause alloimmunization in D- immunocompetent recipients. DEL was reported arousing alloimmunization to true Rh- patients. Molecular studies of the RHD gene have revealed that DEL individuals retain a grossly intact RHD gene or have a portion of RHD in their genomes. Avoiding immunization with clinically important antibodies is a primary objective in transfusion medicine.
  
  
  METHODS
  In order to determine whether pregnant DEL women carrying an RhD+ fetus are at risk of anti-D alloimmunization, 808 Rh- pregnant women with a history of gestations or parturitions who regularly visited hospitals for their prenatal anti-D screening and postpartum care from January 2011 to December 2012 were investigated. Samples were analyzed for DEL by PCR with specific primers, PCR-sequence-specific primers (PCR-SSP), reverse transcription-PCR (RT-PCR), PCRrestriction fragment length polymorphism (PCR-RFLP), and by gene sequencing to characterize different alleles.
  
  
  RESULTS
  Among the 808 Rh- pregnant women of our sample, 178 (22.0%) were typed as DEL; 168 DEL samples were confirmed to have the RHD (1,227 G>A) allele, 8 DEL samples were characterized by one base mutation of the RHD (3G >A) allele, and the remaining two DEL samples were determined to carry RHD-CE(4-9)-D or RHD-CE(2-5)-D. The observation of allo-anti-D in two prominent D epitope loss cases confirmed the partial nature of these DEL phenotypes.
  
  
  CONCLUSIONS
  In conclusion, evidence is provided that different DEL genotypes code either for partial or complete D antigen expression. It is suggested that the use of RhD+ RBCs in complete D antigen DEL patients does not induce adverse reaction.
authors.affiliation: Department of Laboratory Medicine, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, China ; Department of Blood Transfusion, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Nuclear Medicine, The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Zhu
authors.affiliation: Department of Laboratory Medicine, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, China.
authors.forename: Bao-Long
authors.initials: BL
authors.lastname: Wang
authors.affiliation: Department of Epidemiology & Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Su
authors.affiliation: Department of Laboratory Medicine, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, China.
authors.forename: Min
authors.initials: M
authors.lastname: Wang
keywords: Alloimmunization; Complete DEL; DEL variant; Partial DEL; Pregnant women