Testing for the D zygosity with three different methods revealed altered Rhesus boxes and a new weak D type

BACKGROUND: The discrimination of D+/D+ from D+/D- partners of D- mothers with anti-D is important to estimate the risk for HDN. This may be achieved if the presence or absence of the hybrid Rhesus box in the father can be demonstrated. STUDY DESIGN AND METHODS: A new PCR-SSP method specific for the hybrid Rhesus box comprising an internal amplification control was compared with two published PCR-based methods (PCR-SSP and PCR-RFLP) in 83 D+, 13 D-, and 37 weak D samples. RESULTS: The deletion of RHD was detectable in all D- and weak D samples. By all three methods, concordant results were obtained in 82 of 83 D+ samples, with one sample showing discrepant results. The control band in the PCR-RFLP method, specific for the downstream Rhesus box, was missing in two weak D samples, namely a weak D type 4.0 and a novel weak D type dubbed weak D type 29. Further investigations revealed an altered downstream Rhesus box in the weak D type 29 sample. In the weak D type 4.0 sample, no amplicon was achieved with any primer specific for the upstream and downstream Rhesus box. CONCLUSION: A PCR-SSP method with internal control was established for the detection of the hybrid Rhesus box. Polymorphisms in the downstream Rhesus box may interfere with the detection of RHD.