Sekundäre Anti-D-Immunisierung bei RhD-negativem Empfänger, verursacht durch ein D_el-Erythrozytenkonzentrat

Zusammenfassung

Wir berichten über eine Patientin, die nach Übertragung zahlreicher Erythrozytenkonzentrate der Blutgruppe 0 RhD-negativ ein Anti-D entwickelt hat. Die nachfolgenden Untersuchungen lassen eine sekundäre Immunisierung durch ein D_el-Erythrozytenkonzentrat (EK) annehmen, wobei Anti-D-Immunisierungen bislang nur selten nach Gabe von D_el-EK beschrieben wurden. Dies ist der erste Fall einer Anti-D-Immunisierung nach Übertragung eines Erythrozytenkonzentrats eines Spenders, bei dem der Genotyp RHD(1–9)-CE(10)/RHD(DelEx10) nachgewiesen wurde. Anlässlich dieser Kasuistik wird diskutiert, ob Veränderungen der RhD-Untersuchungen von Spendern entsprechend der Hämotherapie-Richtlinien sinnvoll sein könnten.

Abstract

Within one week a total of 14 units of blood group 0 RhD negativ were transfused. With one exception (Ccddee) all donors were known as ccddee. Prior to the transfusion, the patient was tested 0 RhD negative (ccddee). 10 days after the first transfusion the antibody screen became positive (detection of an anti-D). The antibody screen as well as its identification on the patient was performed by using the card technique. Serological tests were carried out on the D-characteristic of the donor by using partial D panel. The genotype was specified by means of SSP-PCR. 12 out of 14 donors could be re-examined so far. In 1 of these 12 patients the hybrid RHD(1–9)-CE(10)/RHD(delEx10) could be suspected. This allel is ascribed a very low density of 50 antigens per red cell. These findings support an anti-D immunization by a DEL serotyped as Ccddee. Therefore some blood donation services carry out the genotyping of serologically D-negative donors to avoid an immunization.

Schlüsselwörter

Rhesus–Blutgruppe - DEL - Anti-D–Immunisierung - Blutspender - RHD–PCR

Key words

Rh blood group - DEL - anti-D immunization - blood donor - RHD PCR

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