After 70 years, serological RhD determination remains a challenge: DNA to the rescue

After ABO system antigens, RhD is the most clinically significant blood group antigen. This is reflected in its high immunogenicity and potential to cause haemolytic transfusion reactions (HTR) and severe haemolytic disease of the newborn (HDN). Thus, correct determination of the RhD antigen is essential for a safe transfusion strategy and adequate indications of anti ‐D immunoglobulin prophylactic administration. The RhD determination challenge started in 1939 with a case history of fatal HDN and HTR in a mother who was transfused with her husband′s blood. Subsequent findings of an antibody reacting with 80% ABO compatible red blood cells (RBCs) in the serum of the afflicted woman lead to the hypothesis that the mother was lacking an antigen present on the father's and fetal RBCs and that her production of a corresponding antibody was responsible for both HDN and HTR. This hypothesis was proven to be correct. The following year, the effort to determine the origin of a causal antigen coincided with an animal immunization experiment where a similarly reacting antibody developed by injecting Rhesus monkey RBCs into rabbits and guinea‐pigs, as well as with another publication of HTRs after ABO compatible blood transfusions in patients with antibodi es of apparently identical specificity. This first challenge in the ‘pre‐DNA’ era was slightly erroneously named in humans as the anti‐Rhesus antibody, and 20 years later, the animal antibody was designated anti‐LW. Me...
Source: ISBT Science Series - Category: Hematology Authors: Tags: Congress Review Source Type: research