{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T16:50:24Z","timestamp":1784998224966,"version":"3.55.0"},"reference-count":63,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T00:00:00Z","timestamp":1689724800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001700","name":"Ministry of Education, Culture, Sports, Science and Technology","doi-asserted-by":"publisher","award":["T22\u201002\u2010015"],"award-info":[{"award-number":["T22\u201002\u2010015"]}],"id":[{"id":"10.13039\/501100001700","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000098","name":"NIH Clinical Center","doi-asserted-by":"publisher","award":["ZIC CL002128"],"award-info":[{"award-number":["ZIC CL002128"]}],"id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The DEL phenotype is the D variant expressing the least amounts of D antigen per red cell. Asian\u2010type DEL (<jats:italic>RHD<\/jats:italic>:<jats:italic>c:1227G\u2009&gt;\u2009A<\/jats:italic>) is the most prevalent DEL in East Asia without any anti\u2010D alloimmunization reported before. We investigated the first observation of an anti\u2010D in any DEL phenotype, reported in the Japanese language at a 1987 conference, only 3\u2009years after the discovery of DEL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We contacted the proband 35\u2009years after the initial report. Standard hemagglutination, adsorption\/elution, and flow cytometry tests were performed, as was nucleotide sequencing for the <jats:italic>RHD<\/jats:italic>, <jats:italic>RHCE<\/jats:italic>, and <jats:italic>HLA class I<\/jats:italic> and <jats:italic>class II<\/jats:italic> genes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The healthy multiparous Japanese woman, a regular blood donor, still had the anti\u2010D of titer 8 representing an alloantibody by standard serologic methods. Unexpectedly, she carried an Asian\u2010type DEL without any additional <jats:italic>RHD<\/jats:italic> gene variation. All 12 <jats:italic>HLA<\/jats:italic> alleles identified were known in the Japanese population. Interestingly, one of her <jats:italic>HLA\u2010DRB1<\/jats:italic> and a variant of her <jats:italic>HLA\u2010DQB1<\/jats:italic> alleles had previously been associated with anti\u2010D immunization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We described an allo\u2010anti\u2010D, maintained for more than three decades, in an Asian\u2010type DEL. The combination of two implicated <jats:italic>HLA<\/jats:italic> alleles were rare and could have contributed to the anti\u2010D immunization. Continued monitoring of anti\u2010D immunization events in patients with DEL is warranted, and we discuss possible mechanisms for further study. As only this single observation has been recognized in the last 35\u2009years, the current recommendation is affirmed: Individuals with Asian\u2010type DEL should be treated as Rh D\u2010positive for transfusion and Rh immune prophylaxis purposes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.17465","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T10:07:28Z","timestamp":1689761248000},"page":"1601-1611","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Asian\u2010type <scp>DEL<\/scp> (<i>RHD*DEL1<\/i>) with an allo\u2010anti\u2010D: A paradoxical observation in a healthy multiparous woman"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0340-883X","authenticated-orcid":false,"given":"Hitoshi","family":"Ohto","sequence":"first","affiliation":[{"name":"Department of Mesenchymal Stem Cell Research Fukushima Medical University  Fukushima 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