J Clin Lab Anal. 2018;32:e22285. wileyonlinelibrary.com/journal/jcla
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Anti- D reagents should be chosen accordingly to the
prevalence of D variants in the obstetric population
Jelena Lukacevic Krstic
| Slavica Dajak
| Jasna Bingulac-Popovic
| Jela Mratinovic-Mikulandra
Department of Transfusion Medicine, Split
University Hospital Center, Split, Croatia
Department of Molecular
Diagnostics, Croatian Institute of Transfusion
Medicine, Zagreb, Croatia
Jelena Lukacevic Krstic, Department of
Transfusion Medicine, Split University Hospital
Center, Split, Croatia.
Background: Resolving ambiguous results of D antigen typing is crucial for appropriate
and rational administration of anti- D immunoprophylaxis and transfusion practice in
obstetric population. The aim of the study was to establish selection criteria of anti- D
reagents for our population.
Methods: A total of 12689 samples from primiparous women in Split-Dalmatia
results were submitted to additional serologic investigation and genotyping. RHD gen-
otyping was performed by commercial genotyping kits (Ready Gene weak D
Ready gene CDE, Inno- Train, Kronberg, Germany). Relative frequencies and accompa-
0.03;0.13).AllweakDvariantswereweakDtypes1,2and3(RHD*weak D type 1,
RHD*weak D type 2, RHD*weak D type 3). Weak D samples were distinguishable from
partial D in routine typing due to the difference in reactivity of partial D samples with
clones D7B8 and RUM- 1. Cell line RUM- 1 gives weak or negative reactions with par-
tial DVa category.
Conclusion: The most common partial D variant in our population is DVa. It is recom-
mended to use cell lines which do not strongly agglutinate DVa variant in routine RhD
typing. The appropriate choice of reagents will enable the serology methods to recog-
nize the cases in which RHD genotyping is required.
anti-D reagents, D variants, obstetric, population
1 | INTRODUCTION
The RhD antigen is clinically the most significant blood group antigen
for obstetric medicine due to its immunogenicity and the high inci-
dence of RhD- individuals.
with15%-20% prevalencebeingmost com-
Anti-Disstillthe leading cause ofthe hemolytic
disease of fetus and newborn (HDFN) in the obstetric population of
Split- Dalmatian County, Croatia.
ward, due to over 200 D variant phenotypes having been reported to
Generally, “weak D” variants are result of mutations in which
all D epitopes are present but with reduced expression, while “partial
D” represents variants in which the mutations result in the absence
of certain polypeptides on the outer RBC surface.
found weak D types to also possess slightly to considerably altered D
antigens, with the extent of qualitative changes overlapping with that
in partial D.
The prevalence of weak D types among Caucasians is