Risk and prevention strategies for RhCE alloantibodies after blood transfusion in the Chinese population

Objective To explore a new approach to assess the risk of RhCE alloantibodies after transfusion and to establish a strategy for selecting RhCE compatible donors. Methods The Landsteiner’s law and the principle of population genetics were used to determine the combinations of RhCE antigen mismatch between donor and recipient in random blood transfusion, and the big data of Rh blood group distribution in the Chinese population were used to calculate mismatch probability and the chance of finding compatible donors. Results An analysis was performed for the data of RhD, C, c, E, and e antigen typing for 458 542 Chinese individuals reported in the literature, and the results showed that in the strategy of only using RhD matched donors, RhCE antigen mismatches accounted for 25.16% of all blood transfusions, among which the mismatch of Rh phenotypes DCCee, DccEE, DCcee, and DccEe accounted for 14.97%, 5.01%, 2.21%, and 2.26%, respectively, and the mismatch of the phenotypes Dccee, DCCEE, DCCEe, and DCcEE accounted for 0.71% in total. The individuals with DCcEe phenotype could accept the blood from a donor with any Rh phenotype. Conclusion The Rh blood group in the Chinese population is characterized by a high frequency of DCe haplotype, and individuals with Rh phenotype DCCee are the high-risk population for producing RhCE alloantibodies after blood transfusion. RhC, c, E, and e antigen typing is of great significance in searching for Rh antigen matched donors. Blood transfusion from donors compatible with common RhCE phenotypes can prevent the appearance of RhCE alloantibodies in approximately 90% of recipients.