{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T18:33:21Z","timestamp":1776364401054,"version":"3.51.2"},"reference-count":16,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    The Rhesus blood group system exhibits significant polymorphism, with diverse antigen distributions across populations. This study investigates the antigenic profile, haplotype frequencies, and genotype predictions in a cohort from Zakho, Kurdistan Region, Iraq, which is crucial for transfusion medicine and genetic studies. A prospective cross-sectional analysis was performed on 1,000 Kurdish individuals at Zakho Emergency Teaching Hospital. Blood samples were phenotyped for Rh (D, C, c, E, e) antigens. Haplotype assignments were made using Fisher-Race terminology, and probable genotypes were calculated based on allele frequencies and Wiener nomenclature. The most common Rhesus blood antigens are Rh(e) (95%), Rh(D) (91.9%), Rh(C) (76%), and Rh(c) (68%). Rh(E) is found in 25.8% of individuals, while only 8.1% are Rh(D) negative. Among the Rh(D) positive population, the most frequent phenotype\/haplotype and presumed genotype was DCe (\n                    <jats:italic>DCe\/DCe, R1R1<\/jats:italic>\n                    ) at 31.4%, followed by DCce (\n                    <jats:italic>DCe\/dce, R1r<\/jats:italic>\n                    ) at 29.3%, and DCcEe (\n                    <jats:italic>DCe\/DcE, R1R1<\/jats:italic>\n                    ) at 13.8%. The dce phenotype (\n                    <jats:italic>dce\/dce, rr<\/jats:italic>\n                    , in 7.2%) was the most common among Rh(D) negative individuals. No significant differences were observed between sexes. This study reveals that DCe, DCce, and DCcEe are prevalent phenotypes among Rh(D) positive individuals, whereas the dce haplotype predominates among Rh(D) negative individuals. The Rhesus phenotype\/genotype aligns with Kurdish and Arab groups in Iraq and shows partial resemblance to Western European, Indian, and Iranian populations, but significantly differs from African-American populations, except for the dce phenotype (\n                    <jats:italic>dce\/dce, rr)<\/jats:italic>\n                    . These findings are crucial for blood transfusion strategies, donor selection, maternal and fetal health, the prevention of Rh incompatibilities, and genetic research in the region.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0338158","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T17:31:55Z","timestamp":1776360715000},"page":"e0338158","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Distribution, genetic polymorphism and genotype prediction of Rhesus blood group antigens among the Kurdish population of Zakho, Kurdistan Region, Iraq"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8962-4092","authenticated-orcid":true,"given":"Shakir A.","family":"Zebari","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sawer S.","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim A.","family":"Naqid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shivan U.","family":"Muhammed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdullah S.","family":"Muhi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"issue":"5","key":"pone.0338158.ref001","doi-asserted-by":"crossref","first-page":"524","DOI":"10.4103\/0019-5049.144645","article-title":"Blood group systems","volume":"58","author":"R Mitra","year":"2014","journal-title":"Indian J Anaesth"},{"issue":"2","key":"pone.0338158.ref002","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.blre.2005.04.002","article-title":"Rh proteins: key structural and functional components of the red cell membrane","volume":"20","author":"CL Van Kim","year":"2006","journal-title":"Blood Rev"},{"issue":"1","key":"pone.0338158.ref003","doi-asserted-by":"crossref","first-page":"23","DOI":"10.21307\/immunohematology-2019-419","article-title":"Review: the molecular basis of the Rh blood group phenotypes","volume":"20","author":"FF Wagner","year":"2004","journal-title":"Immunohematology"},{"issue":"2","key":"pone.0338158.ref004","doi-asserted-by":"crossref","first-page":"167","DOI":"10.4103\/ajts.AJTS_64_20","article-title":"Distribution and frequency of principal Rh blood group antigens (D, C, c, E, and e) and their phenotypes in the blood donors attending blood bank in a tertiary care hospital in Barpeta district of Assam","volume":"16","author":"D Baruah","year":"2022","journal-title":"Asian J Transfus Sci"},{"issue":"0","key":"pone.0338158.ref005","article-title":"Pathogenesis and mechanisms of antibody-mediated hemolysis","author":"WA Flegel","year":"2015","journal-title":"Transfusion"},{"issue":"01","key":"pone.0338158.ref006","first-page":"1","article-title":"ABO and Rh blood groups polymorphism among the Kurds of Duhok, Iraq","volume":"8","author":"A Eissa","year":"2014","journal-title":"Duhok Med J"},{"issue":"2","key":"pone.0338158.ref007","doi-asserted-by":"crossref","first-page":"115","DOI":"10.33762\/mjbu.2023.133784.1104","article-title":"Frequency of Rhesus and Kell antigens among a sample of Basrah population, Southern Iraq","volume":"41","author":"A Jumaa","year":"2023","journal-title":"MJBU"},{"key":"pone.0338158.ref008","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1146\/annurev-pathol-042320-110411","article-title":"The Development and Consequences of Red Blood Cell Alloimmunization","volume":"18","author":"CM Arthur","year":"2023","journal-title":"Annu Rev 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Patients for Phenotype-Matched Transfusion","volume":"40","author":"Y Zhao","year":"2024","journal-title":"Indian J Hematol Blood Transfus"},{"issue":"3","key":"pone.0338158.ref013","doi-asserted-by":"crossref","first-page":"26","DOI":"10.3126\/ajms.v5i3.9151","article-title":"Distribution of ABO and Rh blood groups in a major ethnic group of the West Iran, the Kurdish population","volume":"5","author":"Z Ghobadian","year":"2014","journal-title":"Asian J Med Sci"},{"issue":"1","key":"pone.0338158.ref014","doi-asserted-by":"crossref","first-page":"51","DOI":"10.4103\/0973-6247.126693","article-title":"Phenotype frequencies of blood group systems (Rh, Kell, Kidd, Duffy, MNS, P, Lewis, and Lutheran) in blood donors of South Gujarat, India","volume":"8","author":"MA Kahar","year":"2014","journal-title":"Asian J Transfus Sci"},{"issue":"3","key":"pone.0338158.ref015","first-page":"29","article-title":"Evaluation of the prevalence of Rh system major antigens (D, C, c, E, e) and their phenotypes in blood donors of Golestan province, Iran","volume":"18","author":"SS Baniaghil","year":"2024","journal-title":"Med Lab J"},{"issue":"2","key":"pone.0338158.ref016","article-title":"Prevalence of Hemoglobinopathies Among the Kurdish Population in Zakho City, Kurdistan Region, Iraq","volume":"17","author":"SA Zebari","year":"2025","journal-title":"Cureus"}],"container-title":["PLOS 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