Abstract
The Rh blood group system (C, c, E, e, D, and approximately 50 other antigens) is second only to ABO in clinical importance, because the Rh antigens, especially D, are highly immunogenic and the antibodies can result in delayed hemolytic transfusion reactions (HTR) and hemolytic disease of the fetus and newborn (HDFN). The RH locus consists of two genes, RHD and RHCE . D-negative individuals have deleted or inactive RHD . The system is more complex in some ethnic groups, specifically blacks and Hispanics, and point mutations and genetic exchange between the two genes generate new epitopes on the Rh proteins responsible for the large number of antigens. Serologic reagents are not available to identify many of the antigens, but RH genotyping by DNA methods can detect them. The presence of antibodies with multiple and complex Rh specificities can make it difficult to find compatible red blood cell products. However, RH genotyping aids in component selection and transfusion management. This particularly occurs in patients with sickle cell disease.
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