Process to distinguish rare RhCE phenotypes associated with a risk of immunization.
Three steps are proposed: (1) routine phenotype, (2) serological studies with anti-e MoAbs or human sera, and (3) ASP-PCR to detect mutations correlated to the serological profile as shown in this study. Wild-type ASP-PCR is also performed to determine zygosity. The ceAR phenotype can be detected in the category of Dccee phenotypes with normal Rhe or with depressed Rhe, depending of the routine reagents used. For DCcee phenotypes with decreased expression of C and e antigens, expression of RH32 and specific mutation of theceMO allele indicates the composite heterozygousceMO/RN genotype. When there is a decreased expression of both C and e antigens within a DCCee phenotype, serological testing is sufficient to detect RH:32,-46. For the ddCcee phenotype, few serological alterations are exhibited in the RH:−34 individuals. Therefore, an ASP-PCR to detect the altered(C)ces haplotype would be straightforward. In all cases, rare blood has to be provided if transfusion is needed. The case of DccEe with depressed Rhe has not been considered because rather common DccEE units can be transfused to avoid anti-e immunization or immunohemolytic reaction when anti-e is already produced.
