The RHCE allele ceRT: D epitope 6 expression does not require D-specific amino acids

Transfusion. 2003 Sep;43(9):1248-54. doi: 10.1046/j.1537-2995.2003.00495.x.


Background: False-positive D typing in patients may lead to anti-D immunization caused by D+ transfusions or by omission of anti-D prophylaxis. Known causes of such errors are RhCE variants carrying RhD-specific amino acids and cold agglutinin activity of some frequently used monoclonal anti-D.

Study design and methods: The molecular basis of eight samples referred because of "false-positive" reactions with some commercial monoclonal anti-D was investigated by PCR and nucleotide sequencing from genomic DNA. PCR with sequence-specific priming was developed to specifically detect the underlying aberrant RHCE allele. The D epitope profile of the allele was determined by serology.

Results: The aberrant reactivity of the samples was caused by the RHCE allele RHCE(R154T) that occurred in a cde haplotype. The phenotype dubbed ceRT expressed the important D epitope 6, which is the target epitope of most monoclonal anti-D used in routine typing.

Discussion: The characterization of ceRT demonstrated a previously unknown mechanism of antigen D expression that does not require any D-specific amino acid. At least for some D epitopes, D-like structures may be mimicked by RhCE proteins carrying amino acid substitutions not representative for RhD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetyltransferases
  • Agglutination Tests
  • Alleles
  • Amino Acid Sequence
  • Amino-Acid N-Acetyltransferase
  • Antibodies, Monoclonal
  • Antibody Specificity
  • Blood Grouping and Crossmatching / standards
  • Epitopes / blood*
  • Epitopes / genetics
  • Epitopes / immunology
  • False Positive Reactions
  • Genotype
  • Glycoproteins / genetics*
  • Glycoproteins / immunology
  • Humans
  • Phenotype
  • Prevalence
  • Rh-Hr Blood-Group System / genetics*
  • Rh-Hr Blood-Group System / immunology


  • Antibodies, Monoclonal
  • Epitopes
  • Glycoproteins
  • RHCE protein, human
  • Rh-Hr Blood-Group System
  • Acetyltransferases
  • Amino-Acid N-Acetyltransferase
  • NAGS protein, human