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Transfusion. 2019 Apr;59(4):1190-1195. doi: 10.1111/trf.15207. Epub 2019 Feb 19.

Production of RBC autoantibody mimicking anti-D specificity following transfusion in a patient with weak D Type 15.

Author information

1
Department of Clinical Laboratory, Tomishiro Central Hospital, Okinawa, Japan.
2
Japanese Red Cross Tohoku Block Center, Sendai, Japan.
3
Division of Medical Technology, Fukushima Prefectural Hygiene Institute, Fukushima, Japan.
4
Japanese Red Cross Central Blood Institute, Tokyo, Japan.
5
Department of Advanced Cancer Immunotherapy, Fukushima Medical University, Fukushima, Japan.

Abstract

BACKGROUND:

Weak D-type RBCs have fewer D epitopes, but it remains unclear whether individuals with certain types of weak D produce alloanti-D directed at D epitopes absent from the RBCs, and whether it is an alloantibody or an autoantibody. We report the first case of a patient with a weak D Type 15 who produced autoantibodies mimicking alloanti-D.

CASE REPORT:

A 52-year-old Japanese male with weak D developed anti-D 3 months after transfusion of D-negative and -positive RBCs, and the antibody persisted for 24 months with a consistently negative direct antiglobulin test. Eluates from the patient's RBCs demonstrated anti-D specificity. The recipient did not exhibit any signs of delayed hemolytic transfusion reaction. As his anti-D was removed by the different adsorbing cells of weak D Type 15 and autologous as well as D positive, D negative, weak D Type 24, and partial DVa, it was thought to be an autoantibody mimicking anti-D rather than an alloantibody. The patient's RBCs reacted weakly with the 13 anti-D reagents used in the study. Polymerase chain reaction and nucleotide sequencing revealed that the patient had an RHD genotype of RHD*01N.01/RHD*15.

CONCLUSION:

Anti-D, produced in a patient with weak D Type 15 after transfusion, was found to be mimicking autoanti-D. Alloanti-D was excluded by an adsorption study with different RBC types.

PMID:
30784074
DOI:
10.1111/trf.15207

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