Serological Identification of Partial D Variants in a Sub-Saharan African Population: A Cross-Sectional Study From Yaoundé, Cameroon

Jeanne Manga Messina-Mbeti*; Jobert Richie Nansseu; Francoise Ngo Sack; Leopold Mbous Nguimbous; Annie Rachel Epote; Suzanne Belinga

**Jeanne Manga Messina-Mbeti*, Jobert Richie Nansseu, Francoise Ngo Sack, Leopold Mbous Nguimbous, Annie Rachel Epote and Suzanne Belinga**

Volume6-Issue6
Dates: Received: 2025-06-02 | Accepted: 2025-06-15 | Published: 2025-06-16
Pages: 652-660

Abstract

Objective: This study aimed to identify partial D variants in african black populations living in Africa.

Methods: A cross-sectional study was carried out at the CPC Hematology Laboratory from April 2016 to June 2017. A 5 ml volume of blood was collected in an EDTA tube, from all patients coming for the ABO/D blood grouping. Three Biorad antisera reagents characterized by monoclonal anti-D antibody were used for D antigen testing: IgG (MS-26)/IgM (TH-28) , anti-DVI- [LHM59/20 (LDM3) +175-2] and anti-DVI+ [ESD-1M+175-2] . An extended partial Rh D typing panel of 12 anti-D (LHM76/58; LHM76/59; LHM174/102; LHM50/2B; LHM169/81; ESD1; LHM76/55; LHM77/64; LHM70/45; LHM59/19; LHM169/80; LHM57/17) was used to identify partial D on discrepant results.

Results: Of the 3 439 patients sampled, 1.6% with a median age of 24 years showed discordant results. Men were 2.7 times (1.3-5.5) more likely to have concordant results (p = 0.005) than women. Variant characterization revealed 7.3% of weak D and 87.3% of partial D including 36.4% DFR, 32.7% DV, 14.6% DIII, 1.8% DAR-E, and 1.8% DHK/DAU-4.

Conclusion: The use of anti-D reagents from different cell lines is essential for the detection of D variants. The identification of these variants by larger panels of antisera is highly required and their confirmation with molecular approaches is becoming paramount.

FullText HTML FullText PDF DOI: 10.37871/jbres2119

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How to cite this article

Messina-Mbeti JM, Nansseu JR, Sack FN, Nguimbous LM, Epote AR, Belinga S. Serological Identifi cation of Partial D Variants in a Sub-Saharan African Population: A Cross-Sectional Study From Yaoundé, Cameroon. J Biomed Res Environ Sci. 2025 Jun 16; 6(6): 652-660. doi: 10.37871/jbres2119, Article ID: JBRES2119, Available at: https://www.jelsciences.com/articles/ jbres2119.pdf

Subject area(s)

Biomedical Science

References

S S, Shastry S, B PB. Variable reactivity of Rh D antigen and its serological characterization. Acta Clin Belg. 2021 Oct;76(5):346-350. doi: 10.1080/17843286.2020.1735115. Epub 2020 Feb 28. PMID: 32108563.
Ouchari M, Jemni Yacoub S, Houissa B, Abdelkefi S, Chakroun T, Bouslama M, Jerray I, Belhedi S, Hmida S. Système RH : dépistage de D partiels avec RHD/RHCE gène hybride [System RH: screening of partials D with RHD/RHCE hybrid gene]. Transfus Clin Biol. 2013 Mar;20(1):35-9. French. doi: 10.1016/j.tracli.2012.11.002. Epub 2013 Mar 21. PMID: 23523094.
Daniels G. Variants of RhD--current testing and clinical consequences. Br J Haematol. 2013 May;161(4):461-70. doi: 10.1111/bjh.12275. Epub 2013 Feb 25. PMID: 23432139.
Menegati SFP, Santos TD, Macedo MD, Castilho L. Discrepancies between red cell phenotyping and genotyping in daily immunohematology laboratory practice. Transfus Apher Sci. 2020 Feb;59(1):102585. doi: 10.1016/j.transci.2019.06.020. Epub 2019 Jul 9. PMID: 31303508.
Campos FC, Mota MA, Aravechia MG, Torres KB, Bub CB, Kutner JM, Castilho L. Variant RHD Types in Brazilians With Discrepancies in RhD Typing. J Clin Lab Anal. 2016 Nov;30(6):845-848. doi: 10.1002/jcla.21946. Epub 2016 Apr 13. PMID: 27076392; PMCID: PMC6806703.
Credidio DC, Pellegrino J, Castilho L. Serologic and molecular characterization of D variants in Brazilians: impact for typing and transfusion strategy. Immunohematology. 2011;27(1):6-11. PMID: 22356480.
Geoff D. Rh and RHAG blood group systems. In: Human blood groups. Wiley-Blackwell; 2013:182-258. doi:10.1002/9781118493595.ch5.
Kacem N. Determination of RHD gene zygosity in the Tunisian population: Impact of "Rh Box" polymorphisms on the relevance of molecular analyses. Aix-Marseille University and Monastir University; 2013.
Belinga S, Ngo Sack F, Bilong C, Manga J, Mengue MA, Tchendjou P. High prevalence of anti-D antibodies among women of childbearing age at Centre Pasteur of Cameroon. Afr J Reprod Health. 2009 Sep;13(3):47-52. PMID: 20690261.
Ajhoun I. Prevalence of ABO and RH-Kell blood group phenotypes among blood donors at the hmimv blood transfusion center in Rabat. Mohammed V University. Rabat. 2022.
El Ghali B, Mohammed O, Hicham Y, Mustapha AA. Les fréquences phénotypiques et génotypiques des systèmes ABO et Rh dans la population marocaine : Expérience du Service de Transfusion de l´Hôpital Militaire Avicenne. Marrakech. PAMJ-CM. 2020;2. doi: 10.11604/pamj-cm.2020.2.140.20679.
El Housse H, El Wafi M, Ouabdelmoumene Z, Zarati F, Alid R, Nourichafi N, Bouisk K, Benajiba M, Férec C, Fichou Y, Habti N. Comprehensive phenotypic and molecular investigation of RhD and RhCE variants in Moroccan blood donors. Blood Transfus. 2019 Mar;17(2):151-156. doi: 10.2450/2018.0153-18. Epub 2018 Oct 24. PMID: 30418133; PMCID: PMC6476734.
Kabiri Z, Benajiba M, Hajjout K, Dakka N, Bellaoui H. Testing for Partial RhD with a D-Screen Diagast Kit in Moroccan Blood Donors with Weak D Expression. J Blood Transfus. 2014;2014:204301. doi: 10.1155/2014/204301. Epub 2014 Oct 28. PMID: 25530908; PMCID: PMC4228700.
Xhetani M, Seferi I, Férec C, Zoraqi G, Fichou Y. Distribution of Rhesus blood group antigens and weak D alleles in the population of Albania. Blood Transfus. 2014 Oct;12(4):565-9. doi: 10.2450/2014.0240-13. Epub 2014 Jun 12. PMID: 24960662; PMCID: PMC4212038.
Subramaniyan R. Prevalence of D variants in the Indian donor population. Hematol Transfus Cell Ther. 2019 Apr-Jun;41(2):190-193. doi: 10.1016/j.htct.2018.09.004. Epub 2018 Dec 31. PMID: 31084770; PMCID: PMC6517790.
Pahuja S, Pujani M, Sethi N, Kushwaha S, Jain M, Kumari R. Frequency of variant D in Delhi, India. Asian J Transfus Sci. 2014 Jul;8(2):142-3. doi: 10.4103/0973-6247.137459. PMID: 25161360; PMCID: PMC4140062.
Usman M, Rizwan M, Iqbal N, Shaikh NU, Mehmood HO. Frequency of RH-D negative and weak D in Pakistani population. 2020;23(1):5.
Canizalez-Román A, Campos-Romero A, Castro-Sánchez JA, López-Martínez MA, Andrade-Muñoz FJ, Cruz-Zamudio CK, Ortíz-Espinoza TG, León-Sicairos N, Gaudrón Llanos AM, Velázquez-Román J, Flores-Villaseñor H, Muro-Amador S, Martínez-García JJ, Alcántar-Fernández J. Blood Groups Distribution and Gene Diversity of the ABO and Rh (D) Loci in the Mexican Population. Biomed Res Int. 2018 Apr 23;2018:1925619. doi: 10.1155/2018/1925619. PMID: 29850485; PMCID: PMC5937518.
Blood type frequencies by country including the Rh factor - Rhesus negative. 2022.
Kabemba BH, Kabobo KI, Mukena TS, Ngiele MD, Kabingie NG, Kasolva TC, Pungwe KJ, Kasendue EP. Frequency of erythrocyte phenotypes in blood group systems ABO and rhesus at moba, province of Tanganyika, democratic Republic of Congo. OALib. 2017;04(03):1-12. doi: 10.4236/oalib.1103421.
Schmidt LC, Castilho L, Vieira OV, Sippert E, Gaspardi AC, Martins ML, da Silva Malta MC. Impact of a confirmatory RhD test on the correct serologic typing of blood donors. Rev Bras Hematol Hemoter. 2015 Sep-Oct;37(5):302-5. doi: 10.1016/j.bjhh.2015.06.001. Epub 2015 Jul 9. PMID: 26408363; PMCID: PMC4685092.
Jeong D, Oh S, Song EY, Hong YJ, Park KU. Molecular Characteristics of the Serological Weak D Phenotype in Koreans. Diagnostics (Basel). 2021 May 21;11(6):920. doi: 10.3390/diagnostics11060920. PMID: 34063775; PMCID: PMC8223775.
Sandler SG, Queenan JT. A Guide to Terminology for Rh Immunoprophylaxis. Obstet Gynecol. 2017 Sep;130(3):633-635. doi: 10.1097/AOG.0000000000002190. PMID: 28796682.
Ojok P, Oyet C, Webbo F, Mwambi B, Taremwa IM. Prevalence of RhD variants among blood donors at Gulu Regional Blood Bank, Gulu, Northern Uganda. J Blood Med. 2017 Sep 15;8:151-154. doi: 10.2147/JBM.S145550. PMID: 28979173; PMCID: PMC5608233.
Hussein E, Teruya J. Weak D types in the Egyptian population. Am J Clin Pathol. 2013 Jun;139(6):806-11. doi: 10.1309/AJCP1T9FGZBHIQET. PMID: 23690125.
Christiansen M, Samuelsen B, Christiansen L, Morbjerg T, Bredahl C, Grunnet N. Correlation between serology and genetics of weak D types in Denmark. Transfusion. 2008 Jan;48(1):187-93. doi: 10.1111/j.1537-2995.2007.01504.x. Epub 2007 Sep 27. PMID: 17900277.
Van Sandt VS, Gassner C, Emonds MP, Legler TJ, Mahieu S, Körmöczi GF. RHD variants in Flanders, Belgium. Transfusion. 2015 Jun;55(6 Pt 2):1411-7. doi: 10.1111/trf.12947. Epub 2014 Nov 21. PMID: 25413499.
Person RDM, Arnoni CP, Muniz JG, Vendrame TAP, Latini FRM, Cortez AJP, Pellegrino J Jr, Castilho LM. Serologic strategy in detecting RHD altered alleles in Brazilian blood donors. Hematol Transfus Cell Ther. 2020 Oct-Dec;42(4):365-372. doi: 10.1016/j.htct.2019.08.004. Epub 2019 Oct 13. PMID: 31780389; PMCID: PMC7599269.
Kulkarni S, Kasiviswanathan V, Ghosh K. A simple diagnostic strategy for RhD typing in discrepant cases in the Indian population. Blood Transfus. 2013 Jan;11(1):37-42. doi: 10.2450/2012.0006-12. Epub 2012 Jul 12. PMID: 22871818; PMCID: PMC3557475.
Sandler SG, Flegel WA, Westhoff CM, Denomme GA, Delaney M, Keller MA, Johnson ST, Katz L, Queenan JT, Vassallo RR, Simon CD; College of American Pathologists Transfusion Medicine Resource Committee Work Group. It's time to phase in RHD genotyping for patients with a serologic weak D phenotype. College of American Pathologists Transfusion Medicine Resource Committee Work Group. Transfusion. 2015 Mar;55(3):680-9. doi: 10.1111/trf.12941. Epub 2014 Dec 1. PMID: 25438646; PMCID: PMC4357540.
Wagner FF, Moulds JM, Tounkara A, Kouriba B, Flegel WA. RHD allele distribution in Africans of Mali. BMC Genet. 2003 Sep 24;4:14. doi: 10.1186/1471-2156-4-14. PMID: 14505497; PMCID: PMC222912.
Hussein E, Teruya J. Serologic findings of RhD alleles in Egyptians and their clinical implications. Transfus Apher Sci. 2014 Oct;51(2):184-7. doi: 10.1016/j.transci.2014.08.014. Epub 2014 Aug 27. PMID: 25219636.
Abdelrazik AM, Elshafie SM, Ezzat Ahmed GM, Abdelaziz HM. Combining serology and molecular typing of weak D role in improving D typing strategy in Egypt. Transfusion. 2013 Nov;53(11 Suppl 2):2940-4. doi: 10.1111/trf.12100. Epub 2013 Jan 30. PMID: 23362929.
Miranda MR, Dos Santos TD, Castilho L. Systematic RHD genotyping in Brazilians reveals a high frequency of partial D in transfused patients serologically typed as weak D. Transfus Apher Sci. 2021 Dec;60(6):103235. doi: 10.1016/j.transci.2021.103235. Epub 2021 Aug 8. PMID: 34389204.
Bub CB, Aravechia MG, Costa TH, Kutner JM, Castilho L. RHD alleles among pregnant women with serologic discrepant weak D phenotypes from a multiethnic population and risk of alloimmunization. J Clin Lab Anal. 2018 Jan;32(1):e22221. doi: 10.1002/jcla.22221. Epub 2017 Apr 4. PMID: 28374955; PMCID: PMC6816983.
Yan L, Wu J, Zhu F, Hong X, Xu X. Molecular basis of D variants in Chinese persons. Transfusion. 2007 Mar;47(3):471-7. doi: 10.1111/j.1537-2995.2006.01138.x. PMID: 17319828.
British Committee for Standards in Haematology; Milkins C, Berryman J, Cantwell C, Elliott C, Haggas R, Jones J, Rowley M, Williams M, Win N. Guidelines for pre-transfusion compatibility procedures in blood transfusion laboratories. British Committee for Standards in Haematology. Transfus Med. 2013 Feb;23(1):3-35. doi: 10.1111/j.1365-3148.2012.01199.x. Epub 2012 Dec 6. Erratum in: Transfus Med. 2022 Feb;32(1):91. doi: 10.1111/tme.12842. PMID: 23216974.