A Case of D--/D-- Phenotype Associated with Moderate Hemolytic Disease of the Newborn / 대한수혈학회지

The very rare D--/D-- phenotype lacks C, c, E, e antigens with strong expression of the D antigen. A 31-year-old woman delivered her second baby, 3.6 kg girl at 38+4 weeks' gestation through repeat-Cesarean section. Her parents were not consanguineous. She had one artificial abortion, one Cesarean section with red blood cell transfusion and two spontaneous abortions. Her red cells were typed as O, D+C-c-E-e- and did not react with anti-Hr(o) (Rh 17). Her serum reacted with all of the screening cells and identification panel cells with strength of (++)~(+++). The baby was mildly jaundiced 12 hours after delivery. At 1 day after delivery, total bilirubin was 17.7 mg/dL, and direct and indirect antiglobulin tests were both positive. Phototherapy was immediately given for the baby but jaundice and anemia were worsened. Twenty six milliliter of the mother's whole blood was given twice to the baby after plasma depletion and leukocyte reduction. The baby showed improvement of jaundice and anemia, and discharged at hospital day 14. As far as we know, this is the third reported case of hemolytic disease of the newborn occurred in the D--/D-- mother with anti-Hr(o) in Korea, and the first case that was neither fatal nor treated with intensive medical care.

Analysis of antibodies causing hemolytic disease of the newborn / 대한수혈학회지

BACKGROUND: Since the introduction of anti-Rh immunoglobulin prophylaxis, the incidence of hemolytic disease of the newborn (HDN) due to anti-D has remarkably decreased while the number of HDN due to ABO antibodies or minor blood group antibodies remains same. In Caucasians, anti-c, anti-E and anti-K are antibodies most frequently implicated in HDN. But in Koreans, antigenic frequency of Rh or Kell blood group is very different from Caucasians, so it is expected that the frequency of antibodies causing HDN would also be very different. Because there has been no representative data on minor blood group antibodies causing HDN in Korea, we analyzed 79 antibodies associated with HDN. METHODS: From January 1989 to July 1998, we determined the antibody specificity causing HDN in 79 cases. The nature and in vitro characteristics of the antibodies were analyzed. RESULTS: Among 79 cases, ABO antibodies were responsible in 20 cases, and anti-D was responsible in 7 cases. In minor blood group incompatibility, anti-E+c (21 cases) and anti-E (18 cases) antibodies were the antibodies most commonly involved. In ABO incompatibility, Direct Coombs' test (DAT) on baby RBC was positive only in 65% (13/20 cases). In 13 cases, ABO antibodies were detected only in the eluate of baby RBC. In non-ABO incompatibility, 96.6% (57/59 cases) showed positive DAT. In cases associated with anti-E+c and anti-E, Rh subtypes of 20 mothers were all CCDee except one, and Rh subtypes of 12 babies were all CcDEe except one. CONCLUSION: In ABO-HDN, negative DAT was frequently found and the test on baby RBC eluate was an essential part for diagnosis. Among non-ABO incompatibility, Rh incompatibilities, including RhD, were responsible in 94.9% (56/59 cases). Among HDN due to minor blood group antibodies, in contrast to previous reports, we found that anti-E+c was the most common antibody involved in HDN.

A study on immuno-state and RHD gene of a rare D~(VI) type Ⅲ pregnant woman / 中国输血杂志

Objective Study on fetomaternal immuno state and RHD type of a pregnant woman of weak D phenotype.MethodsThrough polymerase chain reaction (PCR)、direct genomic DNA sequencing and flow cytometry.ResultsIn both sequence specific promer (SSP) PCR and the sequencing PCR tests, the sample was detected negative in exons 3 6 of the RHD gene, whereas all other exons (exons 1 2,7 10) were tested positive. And the sequence of detected exons (exons 1 2,7 10) are the same with normal RHD in GenBank (accession no. AJ299020 1 and AJ299026 9). Serologically and genetically, the sample can be designated as D category VI type Ⅲ. Through a duce tube PCR method, the RhD zygosity of this individual was typed CD VI e/cde。In flow cytometry, a few fetal erythrocytes were detected in peripheral blood of the mother. However there were no anti D detected in sera and hemolytic disease of the newborn(HDN) observed at all.ConclusionSevere cases of HDN have occurred in D positive babies born to partial D mother with anti D, although HDN don't take place in this case. We may still consider D VI phenotype individuals as D positive donors and D negative receiptions in our transfusion practice and in clinical anti D allo immune prophylaxis and monitoring.