Which RhD alleles are risk factors stimulating allo- anti-D?

The aim of this study was to identify the specific RhD alleles that are risk factors for stimulating allo-anti-D and develop a precise strategy for blood transfusion. To confirm the D phenotype, red blood cells suspended in saline should react to serological anti-D from three manufacturers. An antibody screen test, a saline phase test and a micro-column test were conducted to identify allo-anti-D and other allo-antibodies. RhD alleles were genotyped by PCR using sequence-specific primers. Seven hundred subjects who were either pregnant or had undergone transfusion were enrolled in our study; however, 28 samples were excluded because their RhD alleles were normal, as revealed by tests using genotyping kits. A total of 498 cases (74.1%) were RhD-null (lacking exons 1–10 of RhD), 336 were DEL RhD 1227A (20.2%), and 38 were RHD-CE (2-9) -D (5.6%). There were 136 cases (20.2%) with allo-anti-D among the 672 cases, with an allo-anti-D prevalence of 126 cases (25.3%) in 498 cases that were RhD-null, followed by 10 cases (26.3%) among 38 cases with RHD-CE (2-9) -D, and none in 366 cases with RhD1227A. RhD genetic polymorphism was observed in RhD-negative individuals. We concluded that RhD-null and partial D are risk factors for alloimmunization to the D antigen and should be transfused with Rh-negative blood. RHD1227A recipients can be transfused with RhD-positive blood. Pregnant women with the d/d and D-CE(2-9)-D alleles require appropriate anti-D prophylaxis and RhD1227A may induce a higher tolerance.