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With the advent of red cell genotyping and the emphasis on precision medicine, transfusion strategy should be based on molecular typing whenever a serologic weak D phenotype1 is detected in patients, including pregnant women, newborns, and potential transfusion recipients. A US-based Work Group concluded in March 2015 that such patients carrying any of the 3 molecular weak D types most prevalant in Caucasians should be treated as D positive, receiving D-positive red cell transfusions and no RhIG administration2,3. The recommendation has practical relevance for all European populations2 because it concerns their prevalent weak D types, even though prevalence varies4-6 and an even greater diversity is observed in subtypes7. The Work Group rated this as a strong recommendation, based on high-quality evidence from observational studies, but limited its recommendation to weak D types 1, 2, and 3, which is standard practice in many European health care systems. However, one issue had remained under discussion, as a recommendation for weak D types 4.0 and 4.1 had been postponed until more data were available. Now this time has come. [ … ]
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