Patients with Asian-type DEL can safely be transfused using RhD-positive blood
Yanli Ji
(1, 2)
,
Yalin Luo
(2)
,
Jizhi Wen
(1)
,
Yuanfan Sun
(3)
,
Shuangshuang Jia
(1)
,
Chunquan Ou
(2)
,
Wenbing Yang
(3)
,
Jingwang Chen
(1)
,
Hanshen Ye
(2)
,
Xiangfu Liu
(4)
,
Yongneng Liang
(5)
,
Zhigang Lu
(2)
,
Ying Feng
(6)
,
Xinzhong Wu
(7)
,
Muzhou Xiao
(8)
,
Jiankun Mo
(7)
,
Zhenhai Zhou
(4)
,
Zhen Wang
(1)
,
Zhijian Liao
(1)
,
Junhu Chen
(1)
,
Ling Wei
(1)
,
Guangping Luo
(1)
,
Sentot Santoso
(1)
,
Yann Fichou
(9, 10, 11)
,
Willy Flegel
(12)
,
Chaopeng Shao
(1)
,
Chengyao Li
(2)
,
Rui Zhang
(3)
,
Yongshui Fu
(2, 1)
1
GBC -
Guangzhou Blood Center [Guangzhou, China]
2 Southern Medical University [Guangzhou]
3 SYSU - Sun Yat-sen University [Guangzhou]
4 the Third Affiliated Hospital, Sun Yat-Sen University
5 SYSUCC - Sun Yat-sen University Cancer Center
6 The Second Affiliated Hospital of Guangzhou Medical University
7 MICURAE - Guangdong General Hospital [Guangzhou]
8 GMU - The First Affiliated Hospital of Guangzhou Medical University
9 EFS
10 GGB - Génétique, génomique fonctionnelle et biotechnologies (UMR 1078)
11 Labex Gr-Ex - Laboratoire d'Excellence : Biogenèse et pathologies du globule rouge
12 NIH - National Institutes of Health [Bethesda, MD, USA]
2 Southern Medical University [Guangzhou]
3 SYSU - Sun Yat-sen University [Guangzhou]
4 the Third Affiliated Hospital, Sun Yat-Sen University
5 SYSUCC - Sun Yat-sen University Cancer Center
6 The Second Affiliated Hospital of Guangzhou Medical University
7 MICURAE - Guangdong General Hospital [Guangzhou]
8 GMU - The First Affiliated Hospital of Guangzhou Medical University
9 EFS
10 GGB - Génétique, génomique fonctionnelle et biotechnologies (UMR 1078)
11 Labex Gr-Ex - Laboratoire d'Excellence : Biogenèse et pathologies du globule rouge
12 NIH - National Institutes of Health [Bethesda, MD, USA]
Yanli Ji
- Fonction : Auteur
- PersonId : 1277834
- ORCID : 0000-0001-6792-5612
Jizhi Wen
- Fonction : Auteur
- PersonId : 1277780
- ORCID : 0000-0002-2147-5086
Shuangshuang Jia
- Fonction : Auteur
- PersonId : 1277835
- ORCID : 0000-0002-0092-8576
Chunquan Ou
- Fonction : Auteur
- PersonId : 1277836
- ORCID : 0000-0001-6866-7213
Sentot Santoso
- Fonction : Auteur
- PersonId : 1277837
- ORCID : 0000-0001-6943-3945
Yann Fichou
- Fonction : Auteur
- PersonId : 1108806
- IdHAL : yann-fichou2
- ORCID : 0000-0002-5104-9125
Rui Zhang
- Fonction : Auteur
- PersonId : 1277838
- ORCID : 0000-0001-9000-5021
Yongshui Fu
- Fonction : Auteur
- PersonId : 1277839
- ORCID : 0000-0003-0886-2193
Résumé
Red blood cells (RBCs) of the Asian-type DEL phenotype express few RhD proteins and are typed as serologic RhD-negative (D-) in routine testing. RhD-positive (D+) RBC transfusion for Asian-type DEL patients has been proposed but has not been generally adopted due to a lack of direct evidence regarding its safety and underlying mechanism. We performed a single-arm multicenter clinical trial to document the outcome of D+ RBC transfusion in Asian-type DEL patients; none of the recipients (0/42; 95% confidence interval, 0%-8.40%) developed alloanti-D after a median follow-up of 226 days. We conducted a large retrospective study to detect alloanti-D immunization in 4,045 serologic D- pregnant women throughout China; alloanti-D was found only in true D- individuals (2.63%, 79/3,009), but not in those with Asian-type DEL (0/1,032). We further retrospectively examined 127 serologic D- pregnant women who had developed alloanti-D and found none with Asian-type DEL (0/127). Finally, we analyzed RHD transcripts from Asian-type DEL erythroblasts and examined antigen epitopes expressed by various RHD transcripts in vitro, finding a low abundance of full-length RHD transcripts (0.18% of the total) expressing RhD antigens carrying the entire repertoire of epitopes, which could explain the immune tolerance against D+ RBCs. Our results provide multiple lines of evidence that individuals with Asian-type DEL cannot produce alloanti-D when exposed to D+ RBCs following transfusion or pregnancy. Therefore, we recommend considering D+ RBC transfusion and discontinuing anti-D prophylaxis in Asian-type DEL patients, including pregnant women. This clinical trial is registered at www.clinicaltrials.gov as NCT03727230.