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Anti\u2010D can occur in D+ patients with <jats:italic>RHD<\/jats:italic> variants that encode partial D antigens. Anti\u2010D has also been reported in patients with conventional <jats:italic>RHD<\/jats:italic> transfused primarily with units from Black donors who frequently have variant <jats:italic>RHD<\/jats:italic>. We report 48 anti\u2010D in 690 D+ transfused individuals with sickle cell disease, categorized here as expressing conventional D, partial D or D antigen encoded by <jats:italic>RHD*DAU0<\/jats:italic>. Anti\u2010D formed in a greater proportion of individuals with partial D, occurred after fewer D+ unit exposures, and remained detectable for longer than for those in the other categories. Among all anti\u2010D, 13 had clinical or laboratory evidence of poor transfused red cell survival. Most individuals with anti\u2010D were chronically transfused, including 32 with conventional <jats:italic>RHD<\/jats:italic> who required an average of 62 D\u2212 units\/year following anti\u2010D. Our findings suggest that patients with partial D may benefit from prophylactic D\u2212 or <jats:italic>RH<\/jats:italic> genotype\u2010matched transfusions to prevent anti\u2010D. Future studies should investigate whether <jats:italic>RH<\/jats:italic> genotype\u2010matched transfusions can improve use of valuable donations from Black donors, reduce D immunization and minimize transfusion of D\u2212 units to D+ individuals with conventional <jats:italic>RHD<\/jats:italic> or <jats:italic>DAU0<\/jats:italic> alleles.<\/jats:p>","DOI":"10.1111\/bjh.18774","type":"journal-article","created":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T09:25:00Z","timestamp":1680341100000},"page":"1220-1228","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Variant <scp><i>RHD<\/i><\/scp> alleles and Rh immunization in patients with sickle cell disease"],"prefix":"10.1111","volume":"201","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2081-9692","authenticated-orcid":false,"given":"Kaoru","family":"Takasaki","sequence":"first","affiliation":[{"name":"Division of Hematology, Department of Pediatrics The Children's Hospital of Philadelphia  Philadelphia Pennsylvania 19104 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7422-6676","authenticated-orcid":false,"given":"David F.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Pediatrics The Children's Hospital of Philadelphia  Philadelphia Pennsylvania 19104 USA"},{"name":"Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania 19104 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Uter","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Pediatrics The Children's Hospital of Philadelphia  Philadelphia Pennsylvania 19104 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0243-266X","authenticated-orcid":false,"given":"Sunitha","family":"Vege","sequence":"additional","affiliation":[{"name":"Immunohematology and Genomics New York Blood Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1929-4593","authenticated-orcid":false,"given":"Connie M.","family":"Westhoff","sequence":"additional","affiliation":[{"name":"Immunohematology and Genomics New York Blood Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4333-6965","authenticated-orcid":false,"given":"Stella T.","family":"Chou","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Pediatrics The Children's Hospital of Philadelphia  Philadelphia Pennsylvania 19104 USA"},{"name":"Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania 19104 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199006073222301"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537\u20102995.2001.41091086.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2020.270546"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13123"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/voxs.12296"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V76.7.1431.1431"},{"key":"e_1_2_9_8_1","unstructured":"National Institutes of Health National Heart Lung and Blood Institute.Evidence\u2010Based Management of Sickle Cell Disease: Expert Panel Report 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