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2.2 - Weak D Antigen

This document discusses testing for weak D antigen. It defines weak D as a weakened expression of the D antigen due to variations in antigen quantity or epitopes. Weak D testing is needed when anti-D reaction is negative or weak (2+) to determine if the individual has a weak D phenotype. It describes testing that involves incubating red blood cells with anti-D, washing, then adding antiglobulin (AHG) to look for agglutination, which would indicate a weak D positive result. Goals of weak D testing are to improve Rh typing accuracy, conserve Rh negative units, and prevent unnecessary RhIG administration.

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169 views3 pages

2.2 - Weak D Antigen

This document discusses testing for weak D antigen. It defines weak D as a weakened expression of the D antigen due to variations in antigen quantity or epitopes. Weak D testing is needed when anti-D reaction is negative or weak (2+) to determine if the individual has a weak D phenotype. It describes testing that involves incubating red blood cells with anti-D, washing, then adding antiglobulin (AHG) to look for agglutination, which would indicate a weak D positive result. Goals of weak D testing are to improve Rh typing accuracy, conserve Rh negative units, and prevent unnecessary RhIG administration.

Uploaded by

Ella Ortega
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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2.2 MLS 416 - LABORATORY 2ND SEMESTER | S.Y.

2021-2022
TEST FOR WEAK D ANTIGEN QUANTITATIVE
 Most D positive RBCs react macroscopically with  Inheritance of RHD gene codes for weakened antigen
anti-D at immediate spin expression
o Referred to RH positive which have a 3+ or o D antigen is complete but fewer D antigen
4+ agglutination reaction sites
 It is a need to test for the weak D antigen before o Mutation on the RHD gene
releasing the result for cases that some D positive  May cause changes to the amino
RBCs do not react or agglutinate immediate spin acids present in the
 There is a need for further testing at 37oC or AHG transmembrane or in the
phase to determine the status of a patient. intracellular region of the RHD
 This happens when the individual has a weak D protein
phenotype,  Protein changes happens inside the
 Weak D phenotype is weakened form of D antigen RBC
o Individuals having this phenotype have a  Agglutinate weakly or not at all in immediate spin
weakened expression of D antigen because  Strongly agglutinate in AHG phase
of the variations of the quantity or D  This phenotype rarely produces anti D since RHD
antigen or in the specificity of the antigen antigens are still present but fewer in number
epitopes.  Can safely transfuse D positive blood components
 Mistyping of Rh may cause hemolysis of RBCs and
may cause death to the patient. PARTIAL D ANTIGEN
 Weak D test determined the presence or absence of  D Mosaic
Du factor or weak D antigen on Red Cells  D antigen is not complete
 Detectable in indirect antiglobulin testing phase  RBCs of this type weakly or do not react at all in
o When will you process a test for weak D immediate spin
antigen?  These individuals are type D positive and produce
 We will process for Du if the anti-D anti-D which agglutinates or reacts in all D positive
reaction in the forward grouping id RBCs but do not affect their own selves
negative or have a 2+  The anti-D produces by these individuals may cause
agglutination hemolytic disease of the fetus and newborn and
 2+ or less on anti-D antisera transfusion reactions. Rh negative blood should be
 Rh typing discrepancies (current and previous transfused to these individuals.
results)  One or more D epitopes within the entire D protein
 Neonates are born from Rh negative mothers is either missing or altered
o If the weak D test of the baby is D positive,  Rh negative blood
the mother will be candidate for RHIG. So
that the next baby of the mother will not
have hemolytic disease of the fetus or
newborn.

WEAK D MECHANISMS
 Position effect
 Quantitative
 Partial D antigen

POSITION EFFECT

TEST FOR WEAK D ANTIGEN


 NEGATIVE (no agglutination) at immediate spin
o Incubate at 37oC for 15 minutes
 30 minutes for some laboratories
o Centrifuge (15 seconds)
 Gene interaction effect o Observe for agglutination: positive=Rh
positive
 C in trans to D
 NEGATIVE (no agglutination)
o The allele carrying RHD is in the opposite
haplotype to the allele carrying C o Wash 3x with normal saline
o Add AHG (1 drop)
o Ex:
o Centrifuge (15 seconds)
 Dce/dCe or DcE/Dce
o Observe for agglutination: positive = weak
 DCe/dce (C is in cis position with the D)
D
o Position effect does not happen
 NEGATIVE (no agglutination)
 Can safely transfuse D positive blood components
o Add 1 drop Coomb’s check cells
 Individuals with this mechanism can be safely
o Observe for agglutination: agglutination =
transfused with D positive blood components
test properly performed

BSMLS 3I - Page | 1
o Properly performed = Rh negative
NOTE:
Patients/recipients that require AHG testing to determine
the presence of D antigen, and have D antigen = Weak D
positive

NOTE:
If the reaction is positive for Du test, the person or patient
should be given proper designation. If this individual is
accidentally given a Rh positive (with complete D antigen)
blood component, he may develop an antibody and this
should be avoided

REMEMBER:
Du positive individuals are classified as Rh positive when
the donate blood and Rh negative when they receive
blood.

GOALS FOR WEAK D TESTING


 To improve accuracy in Rh typing
 Conserve Rh negative units
 Prevent unnecessary administration of Rh immune
globulin in weak D stereotypes.

LABAN RMT! - Page | 2


LABAN RMT! - Page | 3

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