Download RhD Antigen Genotyping

[Date]
[Insurance Company]
[Address 1]
[Address 2]
[City State Zip]
Re: [Patient Name]
Insurance ID: [ID #]
DOB: XX/XX/XXXX
To whom it may concern,
I am writing on behalf of my patient to recommend RhD Antigen Genotyping. The RhD blood group system is
complex with many highly immunogenic antigens. Antibodies that target RhD antigens can cause hemolytic
disease of the newborn (HDN). HDN is a potentially fatal alloimmune condition in which transplacentally
acquired maternal antibodies target and destroy fetal red blood cell (RBC) precursors, thereby suppressing the
fetal production of RBCs. Anemia due to hemolysis leads to reduced oxygen delivery, resulting in the following
complications:




Endothelial damage
Increase in capillary permeability with fetal hypoproteinemia and ascites
Extramedullary hematopoiesis with decreased liver function
Reduced protein synthesis, culminating in fetal hydrops
This patient has been shown to have a high antibody titer to RhD. If the fetus is RhD positive, management of the
pregnancy will be significantly altered due to an increased risk for HDN.
Please note that this test is performed for clinical management in a laboratory that is CLIA approved for high
complexity testing.
Authorization should be obtained for:
Test name: [Test name]
Facility: ARUP Laboratories
CPT codes: [CPT codes]
Diagnosis code: [Diagnosis code]
Thank you for your time and attention to this matter.
Sincerely,
[Name of Ordering Physician]
From www.aruplab.com
Revision 1
Created: 02/25/2013
References:
1. Avent N, et al. The Rh blood group system: a review. Blood 2000; 95:375–87.
2. Singleton B, et al. The presence of an RhD pseudogene containing a 37 base pair duplication and a nonsense mutation in Africans with
the RhD-negative blood group phenotype. Blood 2000; 95;12–8.
3. Suto Y, et al. Gene organization and rearrangements at the human Rhesus blood group locus revealed by fiber-Fish analysis. Hum Genet
2000; 106:164–71.
From www.aruplab.com
Revision 1
Created: 02/25/2013