51
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Srivastava K, Wollenberg KR, Flegel WA. The phylogeny of 48 alleles, experimentally verified at 21 kb, and its application to clinical allele detection. J Transl Med 2019; 17:43. [PMID: 30744658 PMCID: PMC6371619 DOI: 10.1186/s12967-019-1791-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/04/2019] [Indexed: 01/19/2023] Open
Abstract
Background Sequence information generated from next generation sequencing is often computationally phased using haplotype-phasing algorithms. Utilizing experimentally derived allele or haplotype information improves this prediction, as routinely used in HLA typing. We recently established a large dataset of long ERMAP alleles, which code for protein variants in the Scianna blood group system. We propose the phylogeny of this set of 48 alleles and identify evolutionary steps to derive the observed alleles. Methods The nucleotide sequence of > 21 kb each was used for all physically confirmed 48 ERMAP alleles that we previously published. Full-length sequences were aligned and variant sites were extracted manually. The Bayesian coalescent algorithm implemented in BEAST v1.8.3 was used to estimate a coalescent phylogeny for these variants and the allelic ancestral states at the internal nodes of the phylogeny. Results The phylogenetic analysis allowed us to identify the evolutionary relationships among the 48 ERMAP alleles, predict 4243 potential ancestral alleles and calculate a posterior probability for each of these unobserved alleles. Some of them coincide with observed alleles that are extant in the population. Conclusions Our proposed strategy places known alleles in a phylogenetic framework, allowing us to describe as-yet-undiscovered alleles. In this new approach, which relies heavily on the accuracy of the alleles used for the phylogenetic analysis, an expanded set of predicted alleles can be used to infer alleles when large genotype data are analyzed, as typically generated by high-throughput sequencing. The alleles identified by studies like ours may be utilized in designing of microarray technologies, imputing of genotypes and mapping of next generation sequencing data. Electronic supplementary material The online version of this article (10.1186/s12967-019-1791-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kshitij Srivastava
- Laboratory Services Section, Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Kurt R Wollenberg
- Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Willy A Flegel
- Laboratory Services Section, Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.
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52
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Choi SJ, Cho H, Eom KS, Lee JW, Kim Y, Lim J. Effective sickle hemoglobin reduction by automated red cell exchange using Spectra Optia in three Emirati patients with sickle cell disease before allogeneic hematopoietic stem cell transplantation. Blood Res 2018; 53:325-329. [PMID: 30588471 PMCID: PMC6300674 DOI: 10.5045/br.2018.53.4.325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/09/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- Seung Jun Choi
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hanwool Cho
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Seong Eom
- Division of Hematology, Department of Internal Medicine, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Wook Lee
- Division of Hematology, Department of Internal Medicine, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yonggoo Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jihyang Lim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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53
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Szittner Z, Bentlage AE, Donk E, Ligthart PC, Lissenberg‐Thunnissen S, Schoot CE, Vidarsson G. Multiplex blood group typing by cellular surface plasmon resonance imaging. Transfusion 2018; 59:754-761. [DOI: 10.1111/trf.15071] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/21/2018] [Accepted: 10/16/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Zoltan Szittner
- Department of Experimental ImmunohematologySanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Arthur E.H. Bentlage
- Department of Experimental ImmunohematologySanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Eric Donk
- Department of ReagentsSanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Peter C. Ligthart
- Department of Diagnostics, Sanquin Research and Landsteiner LaboratoryAcademic Medical Centre, University of Amsterdam Amsterdam The Netherlands
| | - Suzanne Lissenberg‐Thunnissen
- Department of Experimental ImmunohematologySanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - C. Ellen Schoot
- Department of Experimental ImmunohematologySanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Gestur Vidarsson
- Department of Experimental ImmunohematologySanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
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54
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Romphruk AV, Simtong P, Butryojantho C, Pimphumee R, Junta N, Srichai S, Komvilaisak P, Puapairoj C. The prevalence, alloimmunization risk factors, antigenic exposure, and evaluation of antigen‐matched red blood cells for thalassemia transfusions: a 10‐year experience at a tertiary care hospital. Transfusion 2018; 59:177-184. [DOI: 10.1111/trf.15002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Amornrat V. Romphruk
- Blood Transfusion CenterFaculty of Medicine, Khon Kaen University Khon Kaen Thailand
| | - Piyapong Simtong
- Department of Clinical Immunology and Transfusion SciencesFaculty of Associated Medical Sciences, Khon Kaen University Khon Kaen Thailand
| | - Chalawan Butryojantho
- Blood Transfusion CenterFaculty of Medicine, Khon Kaen University Khon Kaen Thailand
| | | | - Ninnate Junta
- Blood Transfusion CenterFaculty of Medicine, Khon Kaen University Khon Kaen Thailand
| | - Supawadee Srichai
- Blood Transfusion CenterFaculty of Medicine, Khon Kaen University Khon Kaen Thailand
| | - Patcharee Komvilaisak
- Department of PediatricsFaculty of Medicine, Khon Kaen University Khon Kaen Thailand
| | - Chintana Puapairoj
- Blood Transfusion CenterFaculty of Medicine, Khon Kaen University Khon Kaen Thailand
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55
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Richards AL, Sheldon K, Wu X, Gruber DR, Hudson KE. The Role of the Immunological Synapse in Differential Effects of APC Subsets in Alloimmunization to Fresh, Non-stored RBCs. Front Immunol 2018; 9:2200. [PMID: 30344520 PMCID: PMC6182098 DOI: 10.3389/fimmu.2018.02200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/05/2018] [Indexed: 01/19/2023] Open
Abstract
Background: Each year, over 5 million red blood cell (RBC) transfusions are administered to patients in the USA. Despite the therapeutic benefits of RBC transfusions, there are associated risks. RBC-specific alloantibodies may form in response to antigenic differences between RBC donors and recipients; these alloantibodies can be a problem as they may mediate hemolysis or pose barriers to future transfusion support. While there is currently no reliable way to predict which RBC recipients will make an alloantibody response, risk factors such as inflammation have been shown to correlate with increased rates of RBC alloimmunization. The underlying mechanisms behind how inflammation mediates alloantibody production are incompletely defined. Methods: To assess erythrophagocytosis, mice were treated with PBS or inflammatory stimuli followed by a transfusion of allogeneic RBCs labeled with a lipophilic dye. At multiple time points, RBC consumption and expression of activation makers by leukocytes was evaluated. To determine which antigen presenting cell (APC) subset(s) were capable of promoting allogeneic T cell activation, sorted leukocyte populations (which had participated in erythrophagocytosis) were co-cultured in vitro with allogeneic CD4+ T cells; T cell proliferation and ability to form immunological synapses with APCs were determined. Results: Upon transfusion of fresh allogeneic RBCs, multiple APCs consumed transfused RBCs. However, only CD8+ and CD11b+ dendritic cells formed productive immunological synapses with allogeneic T cells and stimulated proliferation. Importantly, allogeneic T cell activation and RBC alloantibody production occurred in response to RBC transfusion alone, and transfusion in the context of inflammation enhanced RBC consumption, the number of immune synapses, allogeneic T cell proliferation, and the rate and magnitude of alloantibody production. Conclusions: These data demonstrate that regardless of the ability to participate in RBC consumption, only a subset of APCs are capable of forming an immune synapse with T cells thereby initiating an alloantibody response. Additionally, these data provide mechanistic insight into RBC alloantibody generation.
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Affiliation(s)
| | - Kathryn Sheldon
- Bloodworks Northwest Research Institute, Seattle, WA, United States
| | - Xiaoping Wu
- Bloodworks Northwest Research Institute, Seattle, WA, United States
| | - David R Gruber
- Bloodworks Northwest Research Institute, Seattle, WA, United States
| | - Krystalyn E Hudson
- Bloodworks Northwest Research Institute, Seattle, WA, United States.,Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA, United States
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56
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Tzounakas VL, Valsami SI, Kriebardis AG, Papassideri IS, Seghatchian J, Antonelou MH. Red cell transfusion in paediatric patients with thalassaemia and sickle cell disease: Current status, challenges and perspectives. Transfus Apher Sci 2018; 57:347-357. [PMID: 29880248 DOI: 10.1016/j.transci.2018.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Notwithstanding the high safety level of the currently available blood for transfusion and the decreasing frequency of transfusion-related complications, administration of labile blood products to paediatric patients still poses unique challenges and considerations. The incidence of thalassaemia and sickle cell disease in the paediatric population may be high enough under specific racial and geographical contexts. Red cell transfusion is the cornerstone of β-thalassaemia treatment and one of the most effective ways to prevent or correct specific acute and chronic complications of sickle cell disease. However, this life-saving strategy comes with its own complications, such as additional iron overload, alloimmunization and haemolytic reactions, among others. In paediatrics, the dependency of the transfusion outcome upon disease and other recipient characteristics is more prominent compared with the adults, owing to differences in developmental maturity and physiology that render them more susceptible to common risks, exacerbate the host response to transfused cells, and modify the type or the clinical severity of the transfusion-related morbidity. The adverse branch of red cell transfusion is likely the overall effect of several factors acting synergistically to shape the clinical phenotype of this therapy, including inherent donor/blood unit variables, like antigenicity, red cell deformability and extracellular vesicles, as well as recipient variables, such as history of alloimmunization and inflammation level at time of transfusion. This review focuses on paediatric patients with β-thalassaemia and sickle cell disease as a recipient group with distinct transfusion-related characteristics, and introduces new concepts for consideration, not adequately studied and elucidated so far.
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Affiliation(s)
- Vassilis L Tzounakas
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Serena I Valsami
- Department of Blood Transfusion, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios G Kriebardis
- Department of Medical Laboratories, Technological and Educational Institute of Athens, Athens, Greece
| | - Issidora S Papassideri
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Jerard Seghatchian
- International Consultancy in Blood Component Quality/Safety Improvement, Audit/Inspection and DDR Strategy, London, UK.
| | - Marianna H Antonelou
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece.
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57
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How I safely transfuse patients with sickle-cell disease and manage delayed hemolytic transfusion reactions. Blood 2018; 131:2773-2781. [PMID: 29724898 DOI: 10.1182/blood-2018-02-785964] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/01/2018] [Indexed: 12/15/2022] Open
Abstract
Transfusions can be a life-saving treatment of patients with sickle-cell disease (SCD). However, availability of matched units can be limiting because of distinctive blood group polymorphisms in patients of African descent. Development of antibodies against the transfused red blood cells (RBCs), resulting in delayed hemolytic transfusion reactions (DHTRs), can be life-threatening and pose unique challenges for this population with regard to treatment strategies and transfusion management protocols. In cases where the transfused cells and the patient's own RBCs are destroyed, diagnosis of DHTR can be difficult because symptoms may mimic vaso-occlusive crisis, and frequently, antibodies are undetectable. Guidelines are needed for early diagnosis of DHTR because treatment may need to include temporarily withholding any new transfusions to avoid further hemolysis. Also needed are case-control studies to optimally tailor treatments based on the severity of DHTR and develop preventive transfusion strategies for patients at DHTR risk. Here, we will review gaps in knowledge and describe through case studies our recommended approach to prevent alloimmunization and to diagnose and treat symptomatic DHTRs for which complementary mechanistic studies to understand their pathogenesis are sorely needed.
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58
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Compernolle V, Chou ST, Tanael S, Savage W, Howard J, Josephson CD, Odame I, Hogan C, Denomme G, Shehata N. Red blood cell specifications for patients with hemoglobinopathies: a systematic review and guideline. Transfusion 2018; 58:1555-1566. [DOI: 10.1111/trf.14611] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/18/2018] [Accepted: 01/24/2018] [Indexed: 01/01/2023]
Affiliation(s)
| | - Stella T. Chou
- The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine; Philadelphia Pennsylvania
| | - Susano Tanael
- Center for Innovation, Canadian Blood Services; Toronto Canada
| | - William Savage
- Blood Bank, Division of Transfusion Medicine; Brigham and Women's Hospital; Boston Massachusetts
| | - Jo Howard
- Guy's and St. Thomas’ NHS Foundation Trust; London, United Kingdom
| | - Cassandra D. Josephson
- Departments of Pathology and Pediatrics, Emory University School of Medicine, and Blood, Tissue and Apheresis Services; Children's Healthcare of Atlanta; Atlanta Georgia
| | - Isaac Odame
- Departments of Paediatrics and Medicine; University of Toronto, Division of Paediatric and Adult Haematology, Hospital for Sick Children, University of Toronto; Toronto Canada
| | - Christopher Hogan
- Pathology Services, Australian Red Cross Blood Services; Austin Hospital; and The Royal Melbourne Hospital; Melbourne Australia
| | - Gregory Denomme
- Diagnostic Laboratories and Blood Research Institute, BloodCenter of Wisconsin; Milwaukee, Wisconsin
| | - Nadine Shehata
- Center for Innovation, Canadian Blood Services; Toronto Canada
- Department of Medicine; University of Toronto, Division of Hematology, Mount Sinai Hospital; Toronto Canada
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59
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Darvishi P, Sharifi Z, Azarkeivan A, Akbari A, Pourfathollah AA. HLA-DRB1*15:03 and HLA-DRB1*11: useful predictive alleles for alloantibody production in thalassemia patients. Transfus Med 2018; 29:179-184. [DOI: 10.1111/tme.12531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/24/2018] [Accepted: 04/02/2018] [Indexed: 12/29/2022]
Affiliation(s)
- P. Darvishi
- Department of Immunology, Faculty of Medical Sciences; Ilam University of Medical Sciences; Ilam Iran
| | - Z. Sharifi
- Blood Transfusion Research Center; High Institute for Research and Education in Transfusion Medicine; Tehran Iran
| | - A. Azarkeivan
- Blood Transfusion Research Center; High Institute for Research and Education in Transfusion Medicine; Tehran Iran
- Iranian Blood Transfusion Organization; Adult Thalassemia Clinic; Tehran Iran
| | - A. Akbari
- Abadan School of Medical Sciences; Abadan Iran
| | - A. A. Pourfathollah
- Blood Transfusion Research Center; High Institute for Research and Education in Transfusion Medicine; Tehran Iran
- Department of Immunology, Faculty of Medical Sciences; Tarbiat Modares University; Tehran Iran
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60
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Yee MEM, Josephson CD, Winkler AM, Webb J, Luban NLC, Leong T, Stowell SR, Roback JD, Fasano RM. Hemoglobin A clearance in children with sickle cell anemia on chronic transfusion therapy. Transfusion 2018; 58:1363-1371. [PMID: 29664198 DOI: 10.1111/trf.14610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/24/2018] [Accepted: 01/29/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chronic transfusion therapy for sickle cell anemia reduces disease complications by diluting sickle-erythrocytes with hemoglobin A (HbA)-containing erythrocytes and suppressing erythropoiesis. Minor antigen mismatches may result in alloimmunization, but it is unknown if antigen mismatches or recipient characteristics influence HbA clearance posttransfusion. STUDY DESIGN AND METHODS Children with sickle cell anemia on chronic transfusion therapy were followed prospectively for 12 months. All patients received units serologically matched for C/c, E/e, and K; patients with prior red blood cell (RBC) antibodies had additional matching for Fya , Jkb , and any previous alloantibodies. Patients' RBC antigen genotypes, determined by multiplexed molecular assays (PreciseType Human Erythrocyte Antigen, and RHCE and RHD BeadChip, Immucor) were compared to genotypes of transfused RBC units to assess for antigen mismatches. Decline in hbA (ΔHbA) from posttransfusion to the next transfusion was calculated for each transfusion episode. RESULTS Sixty patients received 789 transfusions, 740 with ΔHbA estimations, and 630 with donor Human Erythrocyte Antigen genotyping. In univariate mixed-model analysis, ΔHbA was higher in patients with past RBC antibodies or splenomegaly and lower in patients with splenectomy. RBC antigen mismatches were not associated with ΔHbA. In multivariate linear mixed-effects modeling, ΔHbA was associated with RBC antibodies (2.70 vs. 2.45 g/dL/28 d, p = 0.0028), splenomegaly (2.87 vs. 2.28 g/dL/28 d, p = 0.019), and negatively associated with splenectomy (2.46 vs. 2.70 g/dL/28 d, p = 0.011). CONCLUSIONS HbA decline was increased among patients with sickle cell anemia with prior immunologic response to RBC antigens and decreased among those with prior splenectomy, demonstrating that recipient immunologic characteristics influenced the clearance of transfused RBCs.
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Affiliation(s)
- Marianne E M Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics and Hematology/Oncology, Emory University School of Medicine and the
| | - Cassandra D Josephson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics and Hematology/Oncology, Emory University School of Medicine and the.,Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; the
| | - Anne M Winkler
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; the
| | - Jennifer Webb
- Center for Cancer and Blood Disorders, Children's National Medical Center, Departments of Hematology and Laboratory Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Naomi L C Luban
- Center for Cancer and Blood Disorders, Children's National Medical Center, Departments of Hematology and Laboratory Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Traci Leong
- Department of Biostatistics and Bioinformatics, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Sean R Stowell
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; the
| | - John D Roback
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; the
| | - Ross M Fasano
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; the
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61
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Al-Riyami AZ, Daar S. Transfusion in Haemoglobinopathies: Review and recommendations for local blood banks and transfusion services in Oman. Sultan Qaboos Univ Med J 2018; 18:e3-e12. [PMID: 29666675 DOI: 10.18295/squmj.2018.18.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/06/2017] [Accepted: 01/11/2017] [Indexed: 01/19/2023] Open
Abstract
Sickle cell disease and homozygous β-thalassaemia are common haemoglobinopathies in Oman, with many implications for local healthcare services. The transfusions of such patients take place in many hospitals throughout the country. Indications for blood transfusions require local recommendations and guidelines to ensure standardised levels of care. This article summarises existing transfusion guidelines for this group of patients and provides recommendations for blood banks and transfusion services in Oman. This information is especially pertinent to medical professionals and policy-makers developing required services for the standardised transfusion support of these patients.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shahina Daar
- Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch, South Africa
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62
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Al-Riyami AZ, Al-Muqbali A, Al-Sudiri S, Murthi Panchatcharam S, Zacharia M, Al-Mahrooqi S, Al-Hosni S, Al-Marhoobi A, Daar S. Risks of red blood cell alloimmunization in transfusion-dependent β-thalassemia in Oman: a 25-year experience of a university tertiary care reference center and a literature review. Transfusion 2018; 58:871-878. [DOI: 10.1111/trf.14508] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/04/2017] [Accepted: 12/18/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Arwa Z. Al-Riyami
- Department of Hematology; Sultan Qaboos University Hospital; Muscat Oman
| | - Ayman Al-Muqbali
- College of Medicine and Health Sciences; Sultan Qaboos University; Muscat Oman
| | - Saif Al-Sudiri
- College of Medicine and Health Sciences; Sultan Qaboos University; Muscat Oman
| | | | - Mathew Zacharia
- Department of Child Health; Sultan Qaboos University Hospital; Muscat Oman
| | - Sabah Al-Mahrooqi
- Department of Hematology; Sultan Qaboos University Hospital; Muscat Oman
| | - Saif Al-Hosni
- Department of Hematology; Sultan Qaboos University Hospital; Muscat Oman
| | - Ali Al-Marhoobi
- Department of Hematology; Sultan Qaboos University Hospital; Muscat Oman
| | - Shahina Daar
- Department of Hematology, College of Medicine and Health Sciences; Sultan Qaboos University; Muscat Oman
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63
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Zheng Y, Pollak J, Henderson K, Hendrickson JE, Tormey CA. A novel association between high red blood cell alloimmunization rates and hereditary hemorrhagic telangiectasia. Transfusion 2017; 58:775-780. [DOI: 10.1111/trf.14451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/28/2017] [Accepted: 11/01/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Yan Zheng
- Department of Laboratory Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Jeffrey Pollak
- Department of Radiology and Biomedical Imaging; Yale University School of Medicine; New Haven Connecticut
| | - Katharine Henderson
- Department of Radiology and Biomedical Imaging; Yale University School of Medicine; New Haven Connecticut
| | - Jeanne E. Hendrickson
- Department of Laboratory Medicine; Yale University School of Medicine; New Haven Connecticut
- Department of Pediatrics; Yale University School of Medicine; New Haven Connecticut
| | - Christopher A. Tormey
- Department of Laboratory Medicine; Yale University School of Medicine; New Haven Connecticut
- Pathology & Laboratory Medicine Service; VA Connecticut Healthcare System; West Haven Connecticut
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64
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Paccapelo C. Managing a rare donor programme: the immunohaematology laboratory perspective. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/voxs.12399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- C. Paccapelo
- Immunohaematology Reference Laboratory - Centro Trasfusionale; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
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65
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Nonclassical FCGR2C haplotype is associated with protection from red blood cell alloimmunization in sickle cell disease. Blood 2017; 130:2121-2130. [PMID: 28899854 DOI: 10.1182/blood-2017-05-784876] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/06/2017] [Indexed: 01/21/2023] Open
Abstract
Red blood cell (RBC) transfusions are of vital importance in patients with sickle cell disease (SCD). However, a major complication of transfusion therapy is alloimmunization. The low-affinity Fcγ receptors, expressed on immune cells, are important regulators of antibody responses. Genetic variation in FCGR genes has been associated with various auto- and alloimmune diseases. The aim of this study was to evaluate the association between genetic variation of FCGR and RBC alloimmunization in SCD. In this case-control study, DNA samples from 2 cohorts of transfused SCD patients were combined (France and The Netherlands). Cases had a positive history of alloimmunization, having received ≥1 RBC unit. Controls had a negative history of alloimmunization, having received ≥20 RBC units. Single nucleotide polymorphisms and copy number variation of the FCGR2/3 gene cluster were studied in a FCGR-specific multiplex ligation-dependent probe amplification assay. Frequencies were compared using logistic regression. Two hundred seventy-two patients were included (130 controls, 142 cases). The nonclassical open reading frame in the FCGR2C gene (FCGR2C.nc-ORF) was strongly associated with a decreased alloimmunization risk (odds ratio [OR] 0.26, 95% confidence [CI] 0.11-0.64). This association persisted when only including controls with exposure to ≥100 units (OR 0.30, CI 0.11-0.85) and appeared even stronger when excluding cases with Rh or K antibodies only (OR 0.19, CI 0.06-0.59). In conclusion, SCD patients with the FCGR2Cnc-ORF polymorphism have over a 3-fold lower risk for RBC alloimmunization in comparison with patients without this mutation. This protective effect was strongest for exposure to antigens other than the immunogenic Rh or K antigens.
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66
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Chou ST, Westhoff CM. Application of genomics for transfusion therapy in sickle cell anemia. Blood Cells Mol Dis 2017; 67:148-154. [DOI: 10.1016/j.bcmd.2017.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 08/07/2017] [Indexed: 12/23/2022]
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67
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Alloimmunisation and nephropathy in sickle cell disease patients in Jeddah, Saudi Arabia. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/voxs.12362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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68
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Yee MEM, Josephson CD, Winkler AM, Webb J, Luban NLC, Leong T, Stowell SR, Fasano RM. Red blood cell minor antigen mismatches during chronic transfusion therapy for sickle cell anemia. Transfusion 2017; 57:2738-2746. [PMID: 28840600 DOI: 10.1111/trf.14282] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/08/2017] [Accepted: 06/13/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Red blood cell (RBC) alloimmunization occurs at a high frequency in sickle cell anemia (SCA) despite serologic matching for Rh (C/c, E/e) and K antigens. RBC minor antigen genotyping allows for prediction of antigens and RH variants that may lead to alloimmunization. STUDY DESIGN AND METHODS RBC antigen genotyping was performed on chronically transfused pediatric SCA patients, using PreciseType human erythrocyte antigen (HEA), RHCE, and RHD BeadChip arrays. All patients received C/c, E/e, and K serologically matched units (Category 1); patients with prior RBC antibodies were also matched for Fya , Jkb , and any antibodies (Category 2). The RBC genotypes of all leukoreduced (LR) units transfused over a 12-month period were determined by the prototype HEA-LR BeadChip assay. RESULTS There were 2320 RBC units transfused to 90 patients in 1135 transfusion episodes. Thirty-five (38.9%) patients had homozygous or compound heterozygous RH variants. Seven new alloantibodies were detected, with alloantibody incidence of 0.706 in 100 units for Category 2 transfusions and 0.068 in 100 units for Category 1 (p = 0.02). Three patients on Category 2 transfusions formed new anti-Jsa and had a higher rate of exposure to Jsa than those who did not form anti-Jsa (20.4 vs. 8.33 exposures/100 units, p = 0.02). The most frequent mismatches were S (43.9%), Doa (43.9%), Fya (29.2%), M (28.4%), and Jkb (28.1%). CONCLUSIONS Alloimmunization incidence was higher in those with prior RBC antibodies, suggesting that past immunologic responders are at higher risk for future alloimmunization and therefore may benefit from more extensive antigen matching beyond C/c, E/e, K, Fya , and Jkb .
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Affiliation(s)
- Marianne E M Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Division of Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Cassandra D Josephson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Division of Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia.,Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Anne M Winkler
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer Webb
- Center for Cancer and Blood Disorders, Children's National Health System, Departments of Hematology and Laboratory Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Naomi L C Luban
- Center for Cancer and Blood Disorders, Children's National Health System, Departments of Hematology and Laboratory Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Traci Leong
- Department of Biostatistics and Bioinformatics, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Sean R Stowell
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Ross M Fasano
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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69
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Whole-exome sequencing for RH genotyping and alloimmunization risk in children with sickle cell anemia. Blood Adv 2017; 1:1414-1422. [PMID: 29296782 DOI: 10.1182/bloodadvances.2017007898] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/03/2017] [Indexed: 01/30/2023] Open
Abstract
RH genes are highly polymorphic and encode the most complex of the 35 human blood group systems. This genetic diversity contributes to Rh alloimmunization in patients with sickle cell anemia (SCA) and is not avoided by serologic Rh-matched red cell transfusions. Standard serologic testing does not distinguish variant Rh antigens. Single nucleotide polymorphism (SNP)-based DNA arrays detect many RHD and RHCE variants, but the number of alleles tested is limited. We explored a next-generation sequencing (NGS) approach using whole-exome sequencing (WES) in 27 Rh alloimmunized and 27 matched non-alloimmunized patients with SCA who received chronic red cell transfusions and were enrolled in a multicenter study. We demonstrate that WES provides a comprehensive RH genotype, identifies SNPs not interrogated by DNA array, and accurately determines RHD zygosity. Among this multicenter cohort, we demonstrate an association between an altered RH genotype and Rh alloimmunization: 52% of Rh immunized vs 19% of non-immunized patients expressed variant Rh without co-expression of the conventional protein. Our findings suggest that RH allele variation in patients with SCA is clinically relevant, and NGS technology can offer a comprehensive alternative to targeted SNP-based testing. This is particularly relevant as NGS data becomes more widely available and could provide the means for reducing Rh alloimmunization in children with SCA.
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70
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Allali S, Peyrard T, Amiranoff D, Cohen JF, Chalumeau M, Brousse V, de Montalembert M. Prevalence and risk factors for red blood cell alloimmunization in 175 children with sickle cell disease in a French university hospital reference centre. Br J Haematol 2017; 177:641-647. [PMID: 28402005 DOI: 10.1111/bjh.14609] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 12/27/2016] [Indexed: 12/27/2022]
Abstract
Patients with sickle cell disease (SCD) show a high prevalence of red blood cell (RBC) alloimmunization, but few studies have focused on children. We aimed to study the prevalence and risk factors of RBC alloimmunization in SCD children. We retrospectively analysed the medical and transfusion files for 245 SCD children hospitalized in our centre in 2014 and included 175 patients who had received at least one RBC unit in their lifetime. The main clinical and immuno-haematological characteristics of alloimmunized and non-alloimmunized patients were compared. The prevalence of alloimmunization was 13·7% [95% confidence interval (CI) (8·6-18·6)], and 7·4% [95% CI (3·5-11·3)] after excluding the probable irregular natural antibodies (anti-M, anti-Lea , anti-Leb , anti-Lex ). Main risk factors for alloimmunization were increased number of RBC units received (median of 65 vs. 10 units per patient; P = 0·01) and the presence of one or more red cell autoantibodies (46·2% vs. 4·7%; P < 0·0001). The alloimmunization rate was higher for episodically transfused than chronically transfused patients (1·43 vs. 0·24/100 units received; P < 0·001). The presence of red cell autoantibodies appears to be a major risk factor for alloimmunization in SCD children and could justify specific transfusion guidelines.
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Affiliation(s)
- Slimane Allali
- Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Thierry Peyrard
- Laboratory of Excellence GR-Ex, Paris, France.,Département Centre National de Référence pour les Groupes Sanguins (CNRGS), Institut National de la Transfusion Sanguine (INTS), Paris, France.,Inserm UMR_S1134, Paris Diderot University, Paris, France
| | - Denise Amiranoff
- Etablissement Français du Sang (EFS), Necker Hospital for Sick Children, Paris, France
| | - Jérémie F Cohen
- Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.,Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Inserm UMR1153, Paris, France
| | - Martin Chalumeau
- Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France.,Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Inserm UMR1153, Paris, France
| | - Valentine Brousse
- Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Mariane de Montalembert
- Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
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71
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Dezan MR, Ribeiro IH, Oliveira VB, Vieira JB, Gomes FC, Franco LAM, Varuzza L, Ribeiro R, Chinoca KZ, Levi JE, Krieger JE, Pereira AC, Gualandro SFM, Rocha VG, Mendrone-Junior A, Sabino EC, Dinardo CL. RHD and RHCE genotyping by next-generation sequencing is an effective strategy to identify molecular variants within sickle cell disease patients. Blood Cells Mol Dis 2017; 65:8-15. [PMID: 28388467 DOI: 10.1016/j.bcmd.2017.03.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/21/2017] [Accepted: 03/21/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND The complexity of Rh genetic variation among sickle cell disease (SCD) patients is high. Conventional molecular assays cannot identify all genetic variants already described for the RH locus as well as foresee novel alleles. Sequencing RHD and RHCE is indicated to broaden the search for Rh genetic variants. AIMS To standardize the Next Generation Sequencing (NGS) strategy to assertively identify Rh genetic variants among SCD patients with serologic suspicion of Rh variants and evaluate if it can improve the transfusion support. METHODS Thirty-five SCD patients with unexplained Rh antibodies were enrolled. A NGS-based strategy was developed to genotype RHD and RHCE using gene-specific primers. Genotype and serological data were compared. RESULTS Data obtained from the NGS-based assay were gene-specific. Ten and 25 variant RHD and RHCE alleles were identified, respectively. Among all cases of unexplained Rh antibodies, 62% had been inaccurately classified by serological analysis and, of these, 73.1% were considered as relevant, as were associated with increased risk of hemolytic reactions and shortage of units suitable for transfusion. CONCLUSION The NGS assay designed to genotype RH coding regions was effective and accurate in identifying variants. The proposed strategy clarified the Rh phenotype of most patients, improving transfusion support.
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Affiliation(s)
- Marcia R Dezan
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Lucas A M Franco
- Institute of Tropical Medicine, Department of Infectious Disease, University of São Paulo, São Paulo, Brazil
| | - Leonardo Varuzza
- Institute of Tropical Medicine, Department of Infectious Disease, University of São Paulo, São Paulo, Brazil
| | - Roberto Ribeiro
- Institute of Tropical Medicine, Department of Infectious Disease, University of São Paulo, São Paulo, Brazil
| | - Karen Ziza Chinoca
- Discipline of Hematology, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - José Eduardo Krieger
- Discipline of Hematology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Alexandre Costa Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo school of Medicine
| | - Sandra F M Gualandro
- Discipline of Hematology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Vanderson G Rocha
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil; Discipline of Hematology, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Ester Cerdeira Sabino
- Institute of Tropical Medicine, Department of Infectious Disease, University of São Paulo, São Paulo, Brazil
| | - Carla Luana Dinardo
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil; Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo school of Medicine.
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72
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Cure P, Bembea M, Chou S, Doctor A, Eder A, Hendrickson J, Josephson CD, Mast AE, Savage W, Sola-Visner M, Spinella P, Stanworth S, Steiner M, Mondoro T, Zou S, Levy C, Waclawiw M, El Kassar N, Glynn S, Luban NLC. 2016 proceedings of the National Heart, Lung, and Blood Institute's scientific priorities in pediatric transfusion medicine. Transfusion 2017; 57:1568-1581. [PMID: 28369923 DOI: 10.1111/trf.14100] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/30/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Pablo Cure
- Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Melania Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Stella Chou
- Department of Hematology and the Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Allan Doctor
- Department of Pediatrics, St Louis Children's Hospital, St Louis, Missouri
| | - Anne Eder
- National Institutes of Health, Bethesda, Maryland
| | - Jeanne Hendrickson
- Department of Laboratory Medicine, Yale University, New Haven, Connecticut
| | | | - Alan E Mast
- Blood Research Institute, Blood Center of Wisconsin, and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Martha Sola-Visner
- Department of Newborn Medicine, Children's Hospital, Boston, Massachusetts
| | | | - Simon Stanworth
- NHS Blood and Transplant, John Radcliffe Hospital, and Oxford Clinical Research in Transfusion Medicine, Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Marie Steiner
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | | | - Shimian Zou
- Division of Blood Diseases and Resources, NHLBI/NIH
| | | | - Myron Waclawiw
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | - Simone Glynn
- Division of Blood Diseases and Resources, NHLBI/NIH
| | - Naomi L C Luban
- Division of Laboratory Medicine, Children's National Health System, Washington, DC
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73
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Primary and Secondary Stroke Prevention in Children With Sickle Cell Disease. J Pediatr Health Care 2017; 31:145-154. [PMID: 27423528 DOI: 10.1016/j.pedhc.2016.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 01/09/2023]
Abstract
Children with sickle cell disease (SCD) have numerous acute and chronic complications, including central nervous system (CNS) disease, which can be debilitating over their life span. Recognition of risk factors for CNS disease and overt CNS disease should be properly identified by primary care providers, including physicians, physician assistants, and nurse practitioners. Here, we discuss an emerging and important early indicator of CNS disease in the form of silent cerebral infarcts and review overt stroke in patients with SCD. We also discuss transcranial Doppler ultrasonography, when and how often transcranial Doppler ultrasounds should be performed, and management of abnormal results. Lastly, we review the clinical data for the management and prevention of silent cerebral infarcts and overt stroke in children with SCD.
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74
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Belsito A, Magnussen K, Napoli C. Emerging strategies of blood group genotyping for patients with hemoglobinopathies. Transfus Apher Sci 2016; 56:206-213. [PMID: 28040400 DOI: 10.1016/j.transci.2016.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 02/06/2023]
Abstract
Red cell alloimmunization is a serious problem in chronically transfused patients. A number of high-throughput DNA assays have been developed to extend or replace traditional serologic antigen typing. DNA-based typing methods may be easily automated and multiplexed, and provide reliable information on a patient. Molecular genotyping promises to become cheaper, being not dependent on serologic immunoglobulin reagents. Patients with hemoglobinopathies could benefit from receiving extended genomic typing. This could limit post transfusional complications depending on subtle antigenic differences between donors and patients. Patient/donor compatibility extended beyond the phenotype Rh/Kell may allows improved survival of transfused units of red blood cells (RBC) and lead to reduced need for blood transfusion and leading to less iron overload and reduced risk of alloimmunization. Here we discuss the advantages and limitations of current techniques, that detect only predefined genetic variants. In contrast, target enrichment next-generation sequencing (NGS) has been used to detect both known and de novo genetic polymorphisms, including single-nucleotide polymorphisms, indels (insertions/deletions), and structural variations. NGS approaches can be used to develop an extended blood group genotyping assay system.
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Affiliation(s)
- A Belsito
- Department of Internal Medicine and Specialistic Units Clinical Immunoematology Immunohematology U.O.C. Immunohematology, Transfusion Medicine and Organ Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Department of Internal Medicine and Specialist Units, Azienda Universitaria Policlinico (AOU), Second University of Naples (SUN), Naples, Italy.
| | - K Magnussen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - C Napoli
- Department of Internal Medicine and Specialistic Units Clinical Immunoematology Immunohematology U.O.C. Immunohematology, Transfusion Medicine and Organ Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Department of Internal Medicine and Specialist Units, Azienda Universitaria Policlinico (AOU), Second University of Naples (SUN), Naples, Italy
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75
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Dezan MR, Oliveira VB, Bianchi JVS, Rodrigues V, Solano JH, Gomes FC, Bonifácio SL, Levi JE, Guallandro SFM, Krieger JE, Pereira AC, Sabino EC, Mendrone-Júnior A, Dinardo CL. Effectiveness of a red cell antigen-matching transfusion protocol in sickle cell disease patients. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12281] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- M. R. Dezan
- Division of Immunohematology; Fundação Pró-Sangue Hemocentro de São Paulo; São Paulo Brazil
| | - V. B. Oliveira
- Division of Immunohematology; Fundação Pró-Sangue Hemocentro de São Paulo; São Paulo Brazil
| | - J. V. S. Bianchi
- Division of Immunohematology; Fundação Pró-Sangue Hemocentro de São Paulo; São Paulo Brazil
| | - V. Rodrigues
- Division of Immunohematology; Fundação Pró-Sangue Hemocentro de São Paulo; São Paulo Brazil
| | - J. H. Solano
- Division of Immunohematology; Fundação Pró-Sangue Hemocentro de São Paulo; São Paulo Brazil
| | - F. C. Gomes
- Division of Immunohematology; Fundação Pró-Sangue Hemocentro de São Paulo; São Paulo Brazil
| | - S. L. Bonifácio
- Division of Immunohematology; Fundação Pró-Sangue Hemocentro de São Paulo; São Paulo Brazil
| | - J. E. Levi
- Division of Immunohematology; Fundação Pró-Sangue Hemocentro de São Paulo; São Paulo Brazil
| | - S. F. M. Guallandro
- Division of Hematology; University of São Paulo School of Medicine; São Paulo Brazil
| | - J. E. Krieger
- Laboratory of Genetics and Molecular Cardiology; Heart Institute (InCor); University of São Paulo School of Medicine; São Paulo Brazil
| | - A. C. Pereira
- Laboratory of Genetics and Molecular Cardiology; Heart Institute (InCor); University of São Paulo School of Medicine; São Paulo Brazil
| | - E. C. Sabino
- Institute of Tropical Medicine (IMT); University of São Paulo School of Medicine; São Paulo Brazil
| | - A. Mendrone-Júnior
- Division of Immunohematology; Fundação Pró-Sangue Hemocentro de São Paulo; São Paulo Brazil
| | - C. L. Dinardo
- Division of Immunohematology; Fundação Pró-Sangue Hemocentro de São Paulo; São Paulo Brazil
- Laboratory of Genetics and Molecular Cardiology; Heart Institute (InCor); University of São Paulo School of Medicine; São Paulo Brazil
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76
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Younesi MR, Louni Aligoudarzi S, Bigdeli R, Lashgari M, Mazaheri H, Asgary V. Alloimmunization against platelets, granulocytes and erythrocytes in multi-transfused patients in Iranian population. Transfus Apher Sci 2016; 55:205-211. [DOI: 10.1016/j.transci.2016.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/13/2016] [Accepted: 06/10/2016] [Indexed: 12/20/2022]
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77
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Fasano RM, Chou ST. Red Blood Cell Antigen Genotyping for Sickle Cell Disease, Thalassemia, and Other Transfusion Complications. Transfus Med Rev 2016; 30:197-201. [DOI: 10.1016/j.tmrv.2016.05.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 01/19/2023]
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78
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Petrakos G, Andriopoulos P, Tsironi M. Pregnancy in women with thalassemia: challenges and solutions. Int J Womens Health 2016; 8:441-51. [PMID: 27660493 PMCID: PMC5019437 DOI: 10.2147/ijwh.s89308] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Advances in treatment of thalassemia have led to the aging of thalassemic patients, and consequently concern about successful reproductive outcome is augmented. Although women with thalassemia intermedia only were considered competent of achieving pregnancy, case series reveal the willingness of both thalassemia major and thalassemia intermedia women to have a family. Pregnancy in general is characterized by dynamic multiple-system changes and increased susceptibility to oxidative stress, while homozygous, transfusion-dependent, β-thalassemia patients manifest cardiac, hepatic, endocrine, and metabolic disorders attributable to chronic anoxia and iron overload and thalassemia intermedia, usually nontransfused, is associated with augmented risk of thromboembolic events. Pregnancy in thalassemia should be considered a high risk for both mother and fetus, and favorable outcomes are the result of continuous preconception, antenatal, and postpartum assessment and management by a team of thalassemia experts.
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Affiliation(s)
- George Petrakos
- Department of Nursing, University of Peloponnese, Sparta, Greece
| | | | - Maria Tsironi
- Department of Nursing, University of Peloponnese, Sparta, Greece
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79
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Sins JW, Biemond BJ, van den Bersselaar SM, Heijboer H, Rijneveld AW, Cnossen MH, Kerkhoffs JLH, van Meurs AH, von Ronnen F, Zalpuri S, de Rijke YB, Ellen van der Schoot C, de Haas M, van der Bom JG, Fijnvandraat K. Early occurrence of red blood cell alloimmunization in patients with sickle cell disease. Am J Hematol 2016; 91:763-9. [PMID: 27102719 DOI: 10.1002/ajh.24397] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 12/14/2022]
Abstract
Red blood cell (RBC) alloimmunization is a major complication of transfusion therapy in sickle cell disease (SCD). Identification of high-risk patients is hampered by lack of studies that take the cumulative transfusion exposure into account. In this retrospective cohort study among previously non-transfused SCD patients in the Netherlands, we aimed to elucidate the association between the cumulative transfusion exposure, first alloimmunization and independent risk factors. A total of 245 patients received 11 952 RBC units. Alloimmunization occurred in 43 patients (18%), half of them formed their first alloantibody before the 8th unit. In patients with exposure to non-extended matched transfusions (ABO and RhD) the cumulative alloimmunization risk increased up to 35% after 60 transfused units. This was significantly higher compared to a general transfused population (HR 6.6, CI 4.2-10.6). Receiving the first transfusion after the age of 5 was an independent risk factor for alloimmunization (HR 2.3, CI 1.0-5.1). Incidental, episodic transfusions in comparison to chronic scheme transfusions (HR 2.3, CI 0.9-6.0), and exposure to non-extended matched units in comparison to extended matching (HR 2.0, CI 0.9-4.6) seemed to confer a higher alloimmunization risk. The majority of first alloantibodies are formed after minor transfusion exposure, substantiating suggestions of a responder phenotype in SCD and stressing the need for risk factor identification. In this study, older age at first transfusion, episodic transfusions and non-extended matched transfusions appeared to be risk factors for alloimmunization. Am. J. Hematol. 91:763-769, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joep W.R. Sins
- Department of Pediatric Hematology; Emma Children's Hospital, Academic Medical Center; Amsterdam The Netherlands
- Department of Hematology; Academic Medical Center; Amsterdam The Netherlands
| | - Bart J. Biemond
- Department of Hematology; Academic Medical Center; Amsterdam The Netherlands
| | - Sil M. van den Bersselaar
- Department of Pediatric Hematology; Emma Children's Hospital, Academic Medical Center; Amsterdam The Netherlands
- Department of Hematology; Academic Medical Center; Amsterdam The Netherlands
| | - H. Heijboer
- Department of Pediatric Hematology; Emma Children's Hospital, Academic Medical Center; Amsterdam The Netherlands
| | - Anita W. Rijneveld
- Department of Hematology; Erasmus MC, University Medical Center; Rotterdam The Netherlands
| | - Marjon H. Cnossen
- Department of Pediatric Hematology; Erasmus MC, University Medical Center-Sophia Children's Hospital; Rotterdam The Netherlands
| | | | | | - F.B. von Ronnen
- Department of Pediatric Hematology; Emma Children's Hospital, Academic Medical Center; Amsterdam The Netherlands
- Department of Hematology; Academic Medical Center; Amsterdam The Netherlands
| | - Saurabh Zalpuri
- Center for Clinical Transfusion; Sanquin Blood Supply Foundation; Leiden and Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
| | - Yolanda B. de Rijke
- Department of Clinical Chemistry; Erasmus MC, University Medical Center Rotterdam; The Netherlands
| | - C. Ellen van der Schoot
- Department of Experimental Immunohematology; Sanquin Blood Supply Foundation; Amsterdam The Netherlands
| | - Masja de Haas
- Department of Experimental Immunohematology; Sanquin Blood Supply Foundation; Amsterdam The Netherlands
| | - Johanna G. van der Bom
- Center for Clinical Transfusion; Sanquin Blood Supply Foundation; Leiden and Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology; Emma Children's Hospital, Academic Medical Center; Amsterdam The Netherlands
- Unit of Clinical Transfusion Medicine; Sanquin Blood Supply Foundation; Amsterdam The Netherlands
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80
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Fichou Y, Mariez M, Le Maréchal C, Férec C. The experience of extended blood group genotyping by next-generation sequencing (NGS): investigation of patients with sickle-cell disease. Vox Sang 2016; 111:418-424. [PMID: 27442304 DOI: 10.1111/vox.12432] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/04/2016] [Accepted: 06/06/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients suffering from haemoglobinopathies may be treated by red blood cell (RBC) transfusion on a regular basis and then exposed to multiple antigens with a recurrent, potential risk of alloimmunization routinely prevented by extended RBC antigen cross-matching. While time-consuming and labour-intensive serological analyses are the gold standard for RBC typing, genotyping by current high-throughput molecular tools, including next-generation sequencing (NGS), appears to offer a potent alternative. STUDY DESIGN AND METHODS The potential of extended blood group genotyping (EBGG) by NGS of 17 genes involved in 14 blood group systems was evaluated in a cohort of 48 patients with sickle-cell disease. Sample preparation and sequencing were simplified and automated for future routine implementation. RESULTS Sequencing data were obtained for all DNA samples with two different sequencing machines. Prediction of phenotypes could be made in 12 blood group systems and partially in two other blood group systems (Rh and MNS). Importantly, predicted phenotypes in the MNS (S/s), Duffy, Kidd and Kell systems matched well with serological data (98·9%), when available. Unreferenced alleles in the ACHE and ART4 genes, respectively, involved in the Yt and Dombrock blood groups, were identified, then contributing to extend the current knowledge of blood group molecular genetics. CONCLUSIONS Overall, we consider that our strategy for NGS-based EBGG, assisted by a simple method for genotyping exons 1 and 2 of the pairs of homologous genes (i.e. RHD/RHCE and GYPA/GYPB), as well as the future support of potent bioinformatics tools, may be implemented for routine diagnosis in specific populations.
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Affiliation(s)
- Y Fichou
- Etablissement Français du Sang (EFS) - Région Bretagne, Brest, France.,Institut National de la Santé et de la Recherche Médicale (Inserm), UMR1078, Brest, France
| | - M Mariez
- Etablissement Français du Sang (EFS) - Région Bretagne, Brest, France.,Institut National de la Santé et de la Recherche Médicale (Inserm), UMR1078, Brest, France
| | - C Le Maréchal
- Etablissement Français du Sang (EFS) - Région Bretagne, Brest, France.,Institut National de la Santé et de la Recherche Médicale (Inserm), UMR1078, Brest, France.,Laboratoire de Génétique Moléculaire et d'Histocompatibilité, Centre Hospitalier Régional Universitaire (CHRU), Hôpital Morvan, Brest, France.,Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale (UBO), Brest, France
| | - C Férec
- Etablissement Français du Sang (EFS) - Région Bretagne, Brest, France.,Institut National de la Santé et de la Recherche Médicale (Inserm), UMR1078, Brest, France.,Laboratoire de Génétique Moléculaire et d'Histocompatibilité, Centre Hospitalier Régional Universitaire (CHRU), Hôpital Morvan, Brest, France.,Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale (UBO), Brest, France
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81
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Abdelrazik AM, Elshafie SM, El Said MN, Ezzat Ahmed GM, Al-Gamil AKA, El Nahhas MGM, Sady AAB. Study of red blood cell alloimmunization risk factors in multiply transfused thalassemia patients: role in improving thalassemia transfusion practice in Fayoum, Egypt. Transfusion 2016; 56:2303-7. [PMID: 27351342 DOI: 10.1111/trf.13695] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND β-Thalassemia is considered the most common chronic hemolytic anemia in Egypt. Alloimmunization can lead to serious clinical complications in transfusion-dependent patients. The objective of this study was to determine the frequency and types of alloantibodies, and, in addition, to study the risk factors that might influence alloimmunization in multiply transfused thalassemia patients in Fayoum, Egypt, with the goal that this study could help minimize some of the transfusion-associated risks in those patients. STUDY DESIGN AND METHODS A total of 188 multiply transfused thalassemia patients attending Fayoum University Hospital were analyzed. Alloantibody identification was performed by DiaMed-ID microtyping system. RESULTS Alloimmunization prevalence was 7.98%. The most common alloantibody was D-related; anti-D was the most frequent alloantibody found in eight of the 188 patients (4.25 %), followed by anti-C in two patients (1.1%), anti- E in two (1.1 %), anti-c in two (1.1 %), anti-Fya in two (1.1%), anti-K in one (0.53 %), and an unknown antibody in one patient (0.53%). Higher rates of alloimmunization were found in female patients, in patients with β-thalassemia intermedia, in splenectomized patients, in D- patients, and in patients who started blood transfusion after 3 years of age. CONCLUSION The study reemphasizes the need for cost-effective strategy for thalassemia transfusion practice in developing countries. Red blood cell antigen typing before transfusion and issue of antigen-matched or antigen-negative blood can be made available to alloimmunized multiply transfused patients. Early institution of transfusion therapy after diagnosis is another means of decreasing alloimmunization.
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Affiliation(s)
| | | | - Manal Niazi El Said
- Clinical Pathology Department, Faculty of Medicine, DewanAam El Mohafza, Fayoum, Egypt
| | - Ghada M Ezzat Ahmed
- Clinical Pathology Department, Faculty of Medicine, DewanAam El Mohafza, Fayoum, Egypt
| | | | | | - Ahmed Ali Badie Sady
- Clinical Pathology Department, Faculty of Medicine, DewanAam El Mohafza, Fayoum, Egypt
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82
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Zheng Y, Maitta RW. Alloimmunisation rates of sickle cell disease patients in the United States differ from those in other geographical regions. Transfus Med 2016; 26:225-30. [DOI: 10.1111/tme.12314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 02/16/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Y. Zheng
- Department of Pathology/ Division of Transfusion Medicine; University Hospitals Case Medical Center, Case Western Reserve University School of Medicine; Cleveland Ohio USA
| | - R. W. Maitta
- Department of Pathology/ Division of Transfusion Medicine; University Hospitals Case Medical Center, Case Western Reserve University School of Medicine; Cleveland Ohio USA
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83
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Saliba AN, Taher AT. Morbidities in non-transfusion-dependent thalassemia. Ann N Y Acad Sci 2016; 1368:82-94. [DOI: 10.1111/nyas.13083] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Antoine N. Saliba
- Department of Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Ali T. Taher
- Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
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84
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Cohen D, Hartung H, Evans P, Friedman DF, Chou ST. Red blood cell alloimmunization in transfused patients with bone marrow failure syndromes. Transfusion 2016; 56:1314-9. [PMID: 27080340 DOI: 10.1111/trf.13608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/12/2016] [Accepted: 02/28/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Red blood cell (RBC) alloimmunization is a concern for patients who receive multiple or chronic transfusions. Alloimmunization prevalence in transfused patients with bone marrow failure syndrome (BMFS) is unknown. This study aimed to determine physician practice for RBC antigen matching, immunization rates, and antibody specificities in patients with BMFS. STUDY DESIGN AND METHODS The clinical records of all patients with BMFS seen at the Children's Hospital of Philadelphia between 2001 and 2015 were reviewed. Immunization rate was determined per 100 units transfused. RESULTS ABO/D, C, E, and K (CEK) RBC matching was requested for 21.8% of patients. A total of 3782 RBC units were transfused to 87 patients, of which 2551 (67.5%) were CEK matched and 1231 (32.5%) were ABO/D only matched. The majority of units transfused to patients on a chronic transfusion regimen were CEK matched (89.6% of 2728 units). No anti-C, -E, or -K antibodies formed in any patient during the 14-year study period. Two alloantibodies and two autoantibodies formed, resulting in a rate of 0.05 alloantibodies and 0.05 autoantibodies per 100 units transfused. The prevalence of alloimmunization was 2.3%. CONCLUSION The rate and prevalence of RBC alloimmunization were low in patients with BMFS. CEK matching avoided alloimmunization to these antigens in chronically transfused patients.
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Affiliation(s)
| | | | - Perry Evans
- Department of Biomedical and Health Informatics
| | - David F Friedman
- Department of Pediatrics.,Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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85
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Ngoma AM, Mutombo PB, Ikeda K, Nollet KE, Natukunda B, Ohto H. Red blood cell alloimmunization in transfused patients in sub-Saharan Africa: A systematic review and meta-analysis. Transfus Apher Sci 2016; 54:296-302. [DOI: 10.1016/j.transci.2015.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/07/2015] [Accepted: 10/28/2015] [Indexed: 01/20/2023]
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86
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Richards AL, Hendrickson JE, Zimring JC, Hudson KE. Erythrophagocytosis by plasmacytoid dendritic cells and monocytes is enhanced during inflammation. Transfusion 2016; 56:905-16. [PMID: 26843479 DOI: 10.1111/trf.13497] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/05/2015] [Accepted: 11/13/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Generation of antibodies against red blood cell (RBC) antigens can be a clinically significant problem. The underlying mechanisms that regulate the production of RBC antibodies are only partially understood; however, factors such as inflammation significantly increase the rates of RBC antibody generation. Humoral alloimmunization begins with consumption of transfused RBCs by antigen-presenting cells (APCs). Recently, it has become appreciated that there are multiple different types of APCs. The relative contribution of APC subsets to RBC antibodies has not been described in either the quiescent or the inflamed states. STUDY DESIGN AND METHODS To evaluate the types of APCs that consume RBCs, and how inflammation affects this process, C56Bl/6 mice were treated with polyinosinic-polycytidylic acid (poly(I:C)) to induce an inflammatory response and/or were transfused with 3,3'-dihexadecyloxacarbocyanine perchlorate-labeled syngeneic RBCs. Erythrophagocytosis (both at baseline and during inflammation) was analyzed for different subsets of macrophages (MΦ), dendritic cells (DCs), B cells, and monocytes, by a combined approach using flow cytometry and fluorescent microscopy technology. RESULTS In four independent experiments, erythrophagocytosis at baseline was predominately performed by red pulp MΦ; however, during inflammation both plasmacytoid DCs (pDCs) and monocytes increased RBC consumption. Furthermore, pDCs up regulated MHC-II and activation markers CD80 and CD86. In addition to changing patterns of erythrophagocytosis, inflammation also led to a significant decrease in CD11c+ conventional DC populations and an increase in granulocytes. CONCLUSIONS The nature of APCs that consume transfused RBCs is changed by inflammation. Given that APCs initiate humoral immune responses, these findings provide potential mechanistic insight into how inflammation regulates RBC alloimmunization.
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Affiliation(s)
| | - Jeanne E Hendrickson
- Departments of Laboratory Medicine and Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - James C Zimring
- Bloodworks NW Research Institute, Seattle, Washington.,Departments of Laboratory Medicine and Hematology Division, University of Washington, Seattle, Washington
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87
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Nickel RS, Horan JT, Fasano RM, Meyer E, Josephson CD, Winkler AM, Yee ME, Kean LS, Hendrickson JE. Immunophenotypic parameters and RBC alloimmunization in children with sickle cell disease on chronic transfusion. Am J Hematol 2015; 90:1135-41. [PMID: 26361243 DOI: 10.1002/ajh.24188] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 09/03/2015] [Accepted: 09/09/2015] [Indexed: 12/16/2022]
Abstract
Alloimmunization against red blood cell (RBC) antigens is a cause of morbidity and mortality in transfused patients with sickle cell disease (SCD). To investigate distinguishing characteristics of patients who develop RBC alloantibodies after transfusion (responders) versus those who do not (non-responders), a cross-sectional study of 90 children with SCD on chronic RBC transfusion therapy at a single institution was conducted in which 18 immune parameters (including T and B cell subsets) were tested via flow cytometry, and medical records were reviewed. RBC alloimmunization was present in 26/90 (29%) patients, with anti-E, K, and C among the most commonly detected alloantibodies despite prophylactic matching for these antigens at the study institution. In addition, RBC autoantibodies had been detected in 18/26 (69%) of alloimmunized versus 7/64 (11%) of non-alloimmunized patients (P < 0.0001). Alloimmunized patients were significantly older (median 13.0 years vs. 10.7 years, P = 0.010) and had more RBC unit exposures (median 148 U vs. 82 U, P = 0.020) than non-alloimmunized patients. Sex, age at initiation of chronic transfusion, splenectomy, stroke, and transfusion outside of the study institution were not significantly associated with RBC alloimmunization. Alloimmunized patients had a significantly increased percentage of CD4+ T memory cells compared to non-alloimmunized patients (57% vs. 49%, P = 0.0047), with no other significant differences in immune cell subsets or laboratory values detected between these groups. Additional research of RBC alloimmunization is needed to optimize transfusion therapy and to develop strategies to prevent alloimmunization.
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Affiliation(s)
- Robert S. Nickel
- Division of Hematology; Children's National Health System; Washington District of Columbia
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University; Atlanta Georgia
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine; Emory University; Atlanta Georgia
| | - John T. Horan
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University; Atlanta Georgia
| | - Ross M. Fasano
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University; Atlanta Georgia
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine; Emory University; Atlanta Georgia
| | - Erin Meyer
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine; Emory University; Atlanta Georgia
| | - Cassandra D. Josephson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University; Atlanta Georgia
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine; Emory University; Atlanta Georgia
| | - Anne M. Winkler
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine; Emory University; Atlanta Georgia
| | - Marianne E.M. Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University; Atlanta Georgia
| | - Leslie S. Kean
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University; Atlanta Georgia
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Department of Pediatrics, University of Washington, and the Fred Hutchinson Cancer Research Center; Seattle Washington
| | - Jeanne E. Hendrickson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University; Atlanta Georgia
- Department of Laboratory Medicine; Yale University; New Haven Connecticut
- Department of Pediatrics; Yale University; New Haven Connecticut
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88
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Svensson AM, Delaney M. Considerations of red blood cell molecular testing in transfusion medicine. Expert Rev Mol Diagn 2015; 15:1455-64. [PMID: 26367503 DOI: 10.1586/14737159.2015.1086646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The field of transfusion medicine is on the threshold of a paradigm shift, as the technology for genotyping of red blood cell antigens, including US FDA-approved arrays, is now moving into standard practice. Access to cost-efficient, high-resolution genotyping has the potential to increase the quality of care by decreasing the risk for alloimmunization and incompatible transfusions in individuals on long-term blood transfusion protocols, including patient groups with hemoglobinopathies and other chronic diseases. Current and future applications of molecular methods in transfusion medicine and blood banking are discussed, with emphasis on indications for genotyping in various clinical scenarios. Furthermore, limitations of the current gold standard methodology and serology, as well as of contemporary molecular methodology, are examined.
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Affiliation(s)
- Annika M Svensson
- a 1 Department of Pathology, School of Medicine, University of Colorado , Denver, USA.,b 2 Department of Pathology and Laboratory Medicine, Children's Hospital Colorado , Colorado, USA
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89
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Al-Mousawi MMN, Al-Allawi NAS, Alnaqshabandi R. Predictors of Red Cell Alloimmunization in Kurdish Multi Transfused Patients with Hemoglobinopathies in Iraq. Hemoglobin 2015; 39:423-6. [PMID: 26327166 DOI: 10.3109/03630269.2015.1077460] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hemoglobinopathies are significant health problems in Iraq, including its Northern Kurdistan region. One of the essential components of management of these disorders is regular lifelong blood transfusions. The latter is associated with several complications including red cell alloimmunization. No study has looked at the frequency of alloimmunization and its associations in the country. To address the latter issue, 401 multi transfused patients [311 with β-thalassemia (β-thal) syndrome and 90 with sickle cell disease], registered at a large thalassemia care center in Iraqi Kurdistan had their records reviewed, and their sera tested for atypical antibodies using screening and extended red cell panels. Red cell alloimmunization was detected in 18 patients (4.5%) with a total of 20 alloantibodies, while no autoantibodies were detected. The most frequent alloantibody was anti-E, followed by anti-D, anti-K, anti-C(w), anti-C, anti-c and anti-Le(a). Ethnicity was an important predictor of alloimmunization, while age at start of transfusion (>2 vs. ≤2 years) (p = 0.005), Rhesus D (RhD) negative status (p = 0.0017) and history of previous transfusion reactions (p = 0.007) showed a statistically significant higher rate of alloimmunization. However, patients' age, gender, number of units transfused, underlying diagnosis and splenectomy were not significantly associated with alloimmunization. Based on our observations, measures to reduce alloimmunization rates may include extended matching for Rhesus and Kell antigens and early initiation of blood transfusions.
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Affiliation(s)
| | - Nasir A S Al-Allawi
- b Scientific Research Centre, Faculty of Medical Sciences, University of Duhok , Duhok , Iraq
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90
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Nouraie M, Gordeuk VR. Blood transfusion and 30-day readmission rate in adult patients hospitalized with sickle cell disease crisis. Transfusion 2015; 55:2331-8. [PMID: 26126756 DOI: 10.1111/trf.13155] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/04/2015] [Accepted: 04/09/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) patients hospitalized with vasoocclusive pain crisis tend to have prolonged length of stay (LOS) and high 30-day readmission rates. We investigated the associations of demographic characteristics, comorbidities, and blood transfusion during hospitalization with these outcomes. STUDY DESIGN AND METHODS Repeated regression analysis was used to analyze 39,324 admissions of 4348 adults with sickle cell crisis from 2007 to 2012 in the Truven Health MarketScan Medicaid Databases. RESULTS The mean (95% range) LOS was 5.9 (1.0-19.0) days and the 30-day readmission rate was 39.6% (95% confidence interval [CI], 39.1%-40.0%). Older age; chronic cardiopulmonary, renal, or liver disease; and sepsis were associated with both longer LOS and greater 30-day readmission rate. Female sex, iron overload, acute chest syndrome, acute renal failure, and stroke were additional predictors of longer LOS. Simple red blood cell transfusion was administered in 31.8% of the admissions, and these patients tended to have more severe disease (chronic cardiopulmonary or kidney disease, acute chest syndrome, acute kidney or liver failure, sepsis). Nevertheless, transfusion was associated with a reduced estimated odds ratio (OR) of inpatient mortality of 0.75 (95% CI, 0.57-0.99) and a decreased OR of 30-day readmission of 0.78 (95% CI, 0.73-0.83). CONCLUSION Our findings point to blood transfusion as a potential means to reduce the 30-day readmission rate among Medicaid patients hospitalized with sickle cell crisis. There is a need for a prospective study to examine the potential benefit and safety of simple blood transfusion for this purpose.
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Affiliation(s)
- Mehdi Nouraie
- Center for Sickle Cell Disease and Department of Medicine, Howard University, Washington, DC
| | - Victor R Gordeuk
- Sickle Cell Center and Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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91
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Guidelines for the Standard Monitoring of Patients With Thalassemia: Report of the Thalassemia Longitudinal Cohort. J Pediatr Hematol Oncol 2015; 37. [PMID: 26201037 PMCID: PMC4511957 DOI: 10.1097/mph.0000000000000307] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Chronic transfusion therapy has played a central role in extending life expectancy for patients with hemoglobinopathies such as thalassemia. However, this life-saving therapy is associated with numerous complications that now comprise the bulk of management considerations for patients with thalassemia. This review reports on the experience of the Thalassemia Longitudinal Cohort and reviews available literature to establish guidelines for the management of patients with thalassemia.
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92
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Casas J, Friedman DF, Jackson T, Vege S, Westhoff CM, Chou ST. Changing practice: red blood cell typing by molecular methods for patients with sickle cell disease. Transfusion 2015; 55:1388-93. [PMID: 25573464 PMCID: PMC9003876 DOI: 10.1111/trf.12987] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/20/2014] [Accepted: 11/20/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Extended red blood cell (RBC) antigen matching is recommended to limit alloimmunization in patients with sickle cell disease (SCD). DNA-based testing to predict blood group phenotypes has enhanced availability of antigen-negative donor units and improved typing of transfused patients, but replacement of routine serologic typing for non-ABO antigens with molecular typing for patients has not been reported. STUDY DESIGNS AND METHODS This study compared the historical RBC antigen phenotypes obtained by hemagglutination methods with genotype predictions in 494 patients with SCD. For discrepant results, repeat serologic testing was performed and/or investigated by gene sequencing for silent or variant alleles. RESULTS Seventy-one typing discrepancies were identified among 6360 antigen comparisons (1.1%). New specimens for repeat serologic testing were obtained for 66 discrepancies and retyping agreed with the genotype in 64 cases. One repeat Jk(b-) serologic phenotype, predicted Jk(b+) by genotype, was found by direct sequencing of JK to be a silenced allele, and one N typing discrepancy remains under investigation. Fifteen false-negative serologic results were associated with alleles encoding weak antigens or single-dose Fy(b) expression. CONCLUSIONS DNA-based RBC typing provided improved accuracy and expanded information on RBC antigens compared to hemagglutination methods, leading to its implementation as the primary method for extended RBC typing for patients with SCD at our institution.
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Affiliation(s)
- Jessica Casas
- Department of Pediatrics; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania
| | - David F. Friedman
- Department of Pediatrics; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania
- Department of Pathology and Laboratory Medicine; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania
| | - Tannoa Jackson
- Department of Pediatrics; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania
| | - Sunitha Vege
- Immunohematology and Genomics Laboratory; New York Blood Center; New York City New York
| | - Connie M. Westhoff
- Immunohematology and Genomics Laboratory; New York Blood Center; New York City New York
| | - Stella T. Chou
- Department of Pediatrics; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania
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93
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Taher AT, Radwan A, Viprakasit V. When to consider transfusion therapy for patients with non-transfusion-dependent thalassaemia. Vox Sang 2015; 108:1-10. [PMID: 25286743 PMCID: PMC4302976 DOI: 10.1111/vox.12201] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 07/17/2014] [Accepted: 08/05/2014] [Indexed: 01/19/2023]
Abstract
Non-transfusion-dependent thalassaemia (NTDT) refers to all thalassaemia disease phenotypes that do not require regular blood transfusions for survival. Thalassaemia disorders were traditionally concentrated along the tropical belt stretching from sub-Saharan Africa through the Mediterranean region and the Middle East to South and South-East Asia, but global migration has led to increased incidence in North America and Northern Europe. Transfusionists may be familiar with β-thalassaemia major because of the lifelong transfusions needed by these patients. Although patients with NTDT do not require regular transfusions for survival, they may require transfusions in some instances such as pregnancy, infection or growth failure. The complications associated with NTDT can be severe if not properly managed, and many are directly related to chronic anaemia. Awareness of NTDT is important, and this review will outline the factors that should be taken into consideration when deciding whether to initiate and properly plan for transfusion therapy in these patients in terms of transfusion interval and duration of treatment.
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Affiliation(s)
- A T Taher
- American University of Beirut, Beirut, Lebanon
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94
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Johnsen JM. Using red blood cell genomics in transfusion medicine. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2015; 2015:168-176. [PMID: 26637717 DOI: 10.1182/asheducation-2015.1.168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Blood types (blood group antigens) are heritable polymorphic antigenic molecules on the surface of blood cells. These were amongst the first human Mendelian traits identified, and the genetic basis of nearly all of the hundreds of blood types is known. Clinical laboratory methods have proven useful to identify selected blood group gene variants, and use of genetic blood type information is becoming widespread. However, the breadth and complexity of clinically relevant blood group genetic variation poses challenges. With recent advances in next-generation sequencing technologies, a more comprehensive DNA sequence-based genetic blood typing approach is now feasible. This chapter introduces the practitioner to high-resolution genetic blood typing beginning with an overview of the genetics of blood group antigens, the clinical problem of allosensitization, current blood type testing methods, and then discussion of next-generation sequencing and its application to the problem of genetic blood typing.
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Affiliation(s)
- Jill M Johnsen
- Bloodworks Research Institute, and Division of Hematology, University of Washington School of Medicine, Seattle, WA
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95
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Harb AR, Saliba AN, Taher AT. Non-Transfusion Dependent Thalassemia: Translating Evidence to Guidelines. THALASSEMIA REPORTS 2014. [DOI: 10.4081/thal.2014.4863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The thalassemias are a group of inherited disorders of hemoglobin synthesis characterized by various degrees of defective production of the α- or β-globin chains of adult hemoglobin A. Non-transfusion- dependent thalassemia (NTDT) includes a group of thalassemia patients who do not require regular RBC transfusions for survival, but may require occasional transfusions due to infection or pregnancy or may require more regular transfusions later in life due to splenomegaly or other complications. Due to the rising phenomenon of global migration, this previously well-localized entity is currently spreading more and more worldwide reaching Northern America and Northern Europe. The clinical picture of NTDT is governed by the severity of the ineffective erythropoiesis and the chronic hemolytic anemia, which, in turn, lead to iron overload, hypercoagulability, and an array of clinical complications involving almost every organ system. Patients with NTDT suffer from complications that are distinct from those encountered in patients with transfusion- dependent thalassemia (TDT) in addition to the complications shared by both TDT and NTDT. As a consequence, patients with NTDT deserve a care specifically tailored to their needs. In the care of patients with NTDT, aiming at a standardized yet personalized care is not an easy task especially that NTDT patients lie on a heterogeneous spectrum with a wide variability in their clinical presentation and response to therapy. Therefore, guidelines emerge as a necessity to answer the specific needs of NTDT patients and the clinicians caring for them. In this article, we summarize the complications most commonly associated with NTDT and the recommendations of the guidelines for the management of patients with NTDT, based on the best available evidence.
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Elhence P, Solanki A, Verma A. Red blood cell antibodies in thalassemia patients in northern India: risk factors and literature review. Indian J Hematol Blood Transfus 2014; 30:301-8. [PMID: 25435732 PMCID: PMC4243402 DOI: 10.1007/s12288-013-0311-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 12/17/2013] [Indexed: 01/28/2023] Open
Abstract
Study of the factors responsible for red cell alloimmunization can help in adopting appropriate strategy to minimize alloimmunization. However data for thalassemia patients from our region is limited. Therefore, a study was conducted to find out the frequency and the factors associated with red cell allo and autoimmunization in thalassemia patients at our center so as to enable us to take appropriate action to reduce alloimmunization. Clinical, demographic, allo and autoantibody and transfusion records of 280 thalassemia patients at our hospital were studied. Patients with and without alloantibodies were compared to find significant differences for age, gender, race, age at start of regular transfusions and splenectomy. Red cell antigen frequencies in thalassemia patients and published antigen frequencies in blood donors from the same center were compared to look antigen differences as a risk factor for alloimmunization. Twenty four thalassemia patients (8.6 %) developed 28 clinically significant alloantibodies. 18 (65 %) of the alloantibodies were of Rh system. The three most common antibodies detected was anti E (11, 39.3 %) followed by anti K (6, 21.4 %) and anti c (10.8 %). Five (1.8 %) of the 280 patients developed autoantibodies. Patient age was found to be significantly higher in alloimmunized patients than in non alloimmunized patients. Red cell antigen frequencies between blood donor and recipient populations were found to be homogenous for most of the relevant RBC antigens. The frequency of red cell alloimmunization in thalassemia patients from our center is moderate. In this setting of red cell phenotype concordant donor-recipient population requirement of extended phenotype matched transfusions may not be cost effective.
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Affiliation(s)
- Priti Elhence
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India
| | - Archana Solanki
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India
| | - Anupam Verma
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India
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Josephson CD, Mondoro TH, Ambruso DR, Sanchez R, Sloan SR, Luban NL, Widness JA. One size will never fit all: the future of research in pediatric transfusion medicine. Pediatr Res 2014; 76:425-31. [PMID: 25119336 PMCID: PMC4408868 DOI: 10.1038/pr.2014.120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 05/21/2014] [Indexed: 01/19/2023]
Abstract
There is concern at the National Heart, Lung, and Blood Institute (NHLBI) and among transfusion medicine specialists regarding the small number of investigators and studies in the field of pediatric transfusion medicine (PTM). Accordingly, the objective of this article is to provide a snapshot of the clinical and translational PTM research considered to be of high priority by pediatricians, neonatologists, and transfusion medicine specialists. Included is a targeted review of three research areas of importance: (i) transfusion strategies, (ii) short- and long-term clinical consequences, and (iii) transfusion-transmitted infectious diseases. The recommendations by PTM and transfusion medicine specialists represent opportunities and innovative strategies to execute translational research, observational studies, and clinical trials of high relevance to PTM. With the explosion of new biomedical knowledge and increasingly sophisticated methodologies over the past decade, this is an exciting time to consider transfusion medicine as a paradigm for addressing questions related to fields such as cell biology, immunology, neurodevelopment, outcomes research, and many others. Increased awareness of PTM as an important, fertile field and the promotion of accompanying opportunities will help establish PTM as a viable career option and advance basic and clinical investigation to improve the health and wellbeing of children.
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Affiliation(s)
- Cassandra D. Josephson
- Department of Pathology and Laboratory Medicine and Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, US
| | - Traci Heath Mondoro
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, US
| | | | - Rosa Sanchez
- Blood Systems Research Institute, San Francisco, CA, US
| | - Steven R. Sloan
- Joint Program in Transfusion Medicine, Children’s Hospital, Boston, MA, US
| | | | - John A. Widness
- Department of Pediatrics, University of Iowa, Iowa City, IA, US
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98
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Ryder AB, Zimring JC, Hendrickson JE. Factors Influencing RBC Alloimmunization: Lessons Learned from Murine Models. Transfus Med Hemother 2014; 41:406-19. [PMID: 25670928 PMCID: PMC4280453 DOI: 10.1159/000368995] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/01/2014] [Indexed: 01/25/2023] Open
Abstract
Red blood cell (RBC) alloimmunization may occur following transfusion or pregnancy/delivery. Although observational human studies have described the immunogenicity of RBC antigens and the clinical significance of RBC alloantibodies, studies of factors influencing RBC alloimmunization in humans are inherently limited by the large number of independent variables involved. This manuscript reviews data generated in murine models that utilize transgenic donor mice, which express RBC-specific model or authentic human blood group antigens. Transfusion of RBCs from such donors into nontransgenic but otherwise genetically identical recipient mice allows for the investigation of individual donor or recipient-specific variables that may impact RBC alloimmunization. Potential donor-related variables include methods of blood product collection, processing and storage, donor-specific characteristics, RBC antigen-specific factors, and others. Potential recipient-related variables include genetic factors (MHC/HLA type and polymorphisms of immunoregulatory genes), immune activation status, phenotype of regulatory immune cell subsets, immune cell functional characteristics, prior antigen exposures, and others. Although murine models are not perfect surrogates for human biology, these models generate phenomenological and mechanistic hypotheses of RBC alloimmunization and lay the groundwork for follow-up human studies. Long-term goals include improving transfusion safety and minimizing the morbidity/mortality associated with RBC alloimmunization.
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Affiliation(s)
- Alex B. Ryder
- Yale University School of Medicine, Department of Laboratory Medicine, New Haven, CT, USA
| | - James C. Zimring
- Puget Sound Blood Center Research Institute, Seattle, WA, USA
- University of Washington, Department of Laboratory Medicine, Seattle, WA, USA
| | - Jeanne E. Hendrickson
- Yale University School of Medicine, Department of Laboratory Medicine, New Haven, CT, USA
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100
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Fichou Y, Audrézet MP, Guéguen P, Le Maréchal C, Férec C. Next-generation sequencing is a credible strategy for blood group genotyping. Br J Haematol 2014; 167:554-62. [PMID: 25135605 DOI: 10.1111/bjh.13084] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/04/2014] [Indexed: 01/06/2023]
Abstract
Although several medium/high-throughput tools have been engineered for molecular analysis of blood group genes, they usually rely on the targeting of single nucleotide polymorphisms, while other variants remain unidentified. To circumvent this limitation a strategy for genotyping blood group genes by next-generation sequencing (NGS) was set up. Libraries consisting of exons, flanking introns and untranslated regions of 18 genes involved in 15 blood systems were generated by the Ion AmpliSeq(™) Library Kit 2.0 and by fragmenting polymerase chain reaction products, normalized by two different approaches, mixed and sequenced by the Ion Torrent Personal Genome Machine (PGM(™) ) Sequencer. In our conditions, defined to limit both intra- and inter-sample variability, sequences from mixed libraries were read in a single run for a total coverage of 86·03% of the coding DNA sequences, including all loci defining the most clinically relevant antigens in all genes, except ABO. Importantly, the challenging attempt to generate gene-specific data for the homologous genes was successful. This work, which combines two complementary approaches to generate libraries, defines technical conditions for genotyping blood group genes, illustrates that NGS is suitable for such an application and suggests that, after automation, this novel tool could be used for molecular typing at the laboratory level.
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Affiliation(s)
- Yann Fichou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1078, Brest, France; Etablissement Français du Sang (EFS) - Bretagne, Brest, France
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