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Br J Haematol. 2017 Oct;179(1):10-19. doi: 10.1111/bjh.14757. Epub 2017 May 16.

Serological weak D phenotypes: a review and guidance for interpreting the RhD blood type using the RHD genotype.

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Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.
Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA.


Approximately 0·2-1% of routine RhD blood typings result in a "serological weak D phenotype." For more than 50 years, serological weak D phenotypes have been managed by policies to protect RhD-negative women of child-bearing potential from exposure to weak D antigens. Typically, blood donors with a serological weak D phenotype have been managed as RhD-positive, in contrast to transfusion recipients and pregnant women, who have been managed as RhD-negative. Most serological weak D phenotypes in Caucasians express molecularly defined weak D types 1, 2 or 3 and can be managed safely as RhD-positive, eliminating unnecessary injections of Rh immune globulin and conserving limited supplies of RhD-negative RBCs. If laboratories in the UK, Ireland and other European countries validated the use of potent anti-D reagents to result in weak D types 1, 2 and 3 typing initially as RhD-positive, such laboratory results would not require further testing. When serological weak D phenotypes are detected, laboratories should complete RhD testing by determining RHD genotypes (internally or by referral). Individuals with a serological weak D phenotype should be managed as RhD-positive or RhD-negative, according to their RHD genotype.


RHD gene; RhD blood group; blood transfusion; partial D phenotype; serological weak D phenotype

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