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

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Immunohematology

American National Red Cross

Subject: Medical Laboratory Technology

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ISSN: 0894-203X
eISSN: 1930-3955

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VOLUME 37 , ISSUE 1 (March 2021) > List of articles

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

Q. Yin / K. Srivastava / D.G. Brust / W.A. Flegel *

Keywords : RHD*weak D type 4.0 allele, RhIG, pregnancy

Citation Information : Immunohematology. Volume 37, Issue 1, Pages 1-4, DOI: https://doi.org/10.21307/immunohematology-2021-001

License : (Transfer of Copyright)

Published Online: 31-March-2021

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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.

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