RHD genotyping is recommended for all patients with serological weak-D phenotypes in Asian populations – Cases with coexistence of weak-D and Asia type DEL alleles results in complete expression of D-antigen

Weak D types 1, 2, 3 and Asia type DEL (RHD 1227 G > A) can be treated as D-positive for purposes of Rho(D) immune globulin (RhIG) administration or selection of blood components for transfusion. To confirm these D variants, RHD genotyping can be used as a complementary to serologic tests. While ruling out weak D types 1,2,3 is useful in Caucasian populations, these are extremely rare in the Asian population, while Asia type DEL is relatively common. Distinguishing between true D-negative and Asia type DEL (RHD 1227 G > A) by genotyping has the same utility of distinguishing weak D types 1, 2, 3. The main difference between weak D and Asia type DEL is that the latter appears as D negative in conventional serologic methods, while the former will show positive in indirect anti-human immunoglobulin tests. RHD genotyping in apparent D-negative Asian patients has been established, yet the utility of genotyping in Asian patients with weakened D phenotypes require further investigation. We have observed cases of weak D patients with coexistence of a weak D allele and an Asia type DEL (RHD 1227 G > A) allele, we have found that antigen expression of D is as the weak D in indirect antiglobulin testing, yet all epitopes are detected with adsorption and elution assays. This is indicative of completeness of the D antigen epitope, and thus we suggest that all Asian patients with weakened D phenotypes can benefit from RHD genotyping.