<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>D– red blood cells (RBCs), always in short supply, and Rh immune globulin (RhIG) are not needed for patient care if D+ RBCs can safely be transfused. According to a recent work group recommendation, patients with the <italic>RHD*weak D type 4.0</italic> allele can be considered D+. We report an African American woman who presented for delivery at the end of the third trimester, at which time anti-U and a serologic weak D phenotype were recognized, requiring U–, D– RBC units. We obtained 3 U– RBC units, including 1 D– unit. Later, the <italic>RHD*weak D type 4.0</italic> allele was determined by <italic>RHD</italic> genotyping, only 6 days before delivery. The patient had an uneventful vaginal delivery of a D+ baby. No transfusion was needed for mother or baby. In this case, a pregnant woman with the <italic>RHD*weak D type 4.0</italic> allele can safely be managed as D+, relaxing the unnecessary D– restriction for the limited U– RBC supply. The procured U–, D– RBC unit was frozen with 14 days of shelf-life remaining. To conserve D– RBC units, not limited to U–, for patients with a definite need, we recommend molecular analysis of a serologic weak D phenotype before a transfusion becomes imminent. The best time to resolve a serologic weak D phenotype with <italic>RHD</italic> genotyping is early in a pregnancy. <bold>
<italic>Immunohematology 2021;37:1–4</italic>
</bold>.</p>
</abstract>

D– red blood cells (RBCs), always in short supply, and Rh immune globulin (RhIG) are not needed for patient care if D+ RBCs can safely be transfused. According to a recent work group recommendation, patients with the RHD*weak D type 4.0 allele can be considered D+. We report an African American woman who presented for delivery at the end of the third trimester, at which time anti-U and a serologic weak D phenotype were recognized, requiring U–, D– RBC units. We obtained 3 U– RBC units, including 1 D– unit. Later, the RHD*weak D type 4.0 allele was determined by RHD genotyping, only 6 days before delivery. The patient had an uneventful vaginal delivery of a D+ baby. No transfusion was needed for mother or baby. In this case, a pregnant woman with the RHD*weak D type 4.0 allele can safely be managed as D+, relaxing the unnecessary D– restriction for the limited U– RBC supply. The procured U–, D– RBC unit was frozen with 14 days of shelf-life remaining. To conserve D– RBC units, not limited to U–, for patients with a definite need, we recommend molecular analysis of a serologic weak D phenotype before a transfusion becomes imminent. The best time to resolve a serologic weak D phenotype with RHD genotyping is early in a pregnancy. 
Immunohematology 2021;37:1–4
.

Transfusion support during childbirth for a woman with anti-U and the <italic>RHD*weak D type 4.0</italic> allele

Immunohematology

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Transfusion support during childbirth for a woman with anti-U and the  allele

D– red blood cells (RBCs), always in short supply, and Rh immune globulin (RhIG) are not needed for patient care if D+ RBCs can safely be transfused. According...

Test	Results (normal range)
Maternal
Transfusion medicine ^†
ABO group	B
RhD phenotype	Serologic weak D phenotype: 2 + reaction strength^‡
RhCE phenotype	C–E–c+e+
Antibody screen	Anti-U
DAT	Negative
Red cell genotyping^†
RHD allele	RHD*weak D type 4.0
RHD zygosity	Hemizygous
Hematology †
Hemoglobin, g/dL
Antepartum	9.8 (10.0–15.0)
Postpartum	8.9 (10.0–15.0)
Neonatal
Transfusion medicine ^§
ABO group	B
RhD phenotype	D+
RhCE phenotype	C–E–c+e+
DAT	Negative
Red cell genotyping^§
RHD allele	RHD*weak D type 4.0 and normal RHD
RHD zygosity	Compound heterozygous
Hematology
Hemoglobin, g/dL	17.6 (14.0–24.0)
Unconjugated bilirubin, mg/dL
At birth	4.9 (<6)
4 hours after birth	5.5 (<6)
Reticulocyte count, %	4.46 (3.0–7.0)

				RHD genotype
Location	Nucleotide change*	dbSNP reference number	Protein residue change^†	Mother^‡	Neonate
Promoter	−368a>g	rs28710826	NA	g/g	a/g
Intron 2	336−76_−75−>insTGAA	rs112473736	NA	insTGAA/insTGAA	insTGAA/−
Intron 3	487−414a>g	rs28586271	NA	g/g	a/g
	487−316t>g	rs28572396	NA	g/g	t/g
Exon 4	602C>G	rs1053355	Thr201Arg	G/G	C/G
Exon 5	667T>G	rs1053356	Phe223Val	G/G	T/G
Intron 5	801+219 t> g	rs28510210	NA	g/g	g/g
	801+395g>a	rs145236797	NA	a/a	g/a
	802−16c>t	rs201120463	NA	t/t	c/t
Exon 6	819G>A	rs150606530	Ala273Ala	A/A	G/A
Intron 6	939+295c>a	rs112222730	NA	c/c	c/a
Intron 7	1073+94g>a	rs533903485	NA	a/a	g/a
	1073 + 311g> c	rs3118453	NA	c/c	c/c

Transfusion support during childbirth for a woman with anti-U and the RHD*weak D type 4.0 allele

Article Category: article

Published Online: Mar 31, 2021

Page range: 1 - 4

DOI: https://doi.org/10.21307/immunohematology-2021-001

© 2021 Q. Yin et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Clinical laboratory results for mother and neonate

Single nucleotide variants detected in the RHD gene