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Jeong IH, Yu S, Kim TY, Oh SY, Cho D. Guide to Rho(D) Immune Globulin in Women With Molecularly Defined Asian-type DEL (c.1227G>A). Ann Lab Med 2024; 44:307-313. [PMID: 38384203 PMCID: PMC10961623 DOI: 10.3343/alm.2023.0356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/17/2023] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
Rh hemolytic disease of the fetus and newborn is a potential risk for D-negative mothers who produce anti-D during pregnancy, which can lead to morbidity and mortality in subsequent pregnancies. To prevent this hemolytic disease, Rho(D) immune globulin (RhIG) is generally administered to D-negative mothers without anti-D at 28 weeks of gestation and shortly after delivery. However, current guidelines suggest that pregnant mothers with molecularly defined weak D types 1, 2, 3, 4.0, and 4.1 do not need RhIG as they are unlikely to produce alloanti-D when exposed to fetuses with D-positive red cells. This issue and the necessity of RHD genotyping have been extensively discussed in Western countries, where these variants are relatively common. Recent evidence indicates that women with Asian-type DEL (c.1227G>A) also do not form alloanti-D when exposed to D-positive red cells. We report that mothers with molecularly defined Asian-type DEL, similar to those with weak D types 1, 2, 3, 4.0, and 4.1, do not require RhIG before and after delivery. Collectively, this review could pave the way for the revision of international guidelines to include the selective use of RhIG based on specific genotypes, particularly in women with the Asian-type DEL.
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Affiliation(s)
- In Hwa Jeong
- Department of Laboratory Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - SooHo Yu
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Yeul Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duck Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
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Li M, Wang L, Li A, Wang B, Yang X, Zhang Y, Chen C, Sun F, Zhu Z, Ye L. Integrated analyses reveal unexpected complex inversion and recombination in RH genes. Blood Adv 2024; 8:3154-3165. [PMID: 38551808 PMCID: PMC11222952 DOI: 10.1182/bloodadvances.2023012147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/28/2024] [Indexed: 06/15/2024] Open
Abstract
ABSTRACT Phenotype D-- is associated with severe hemolytic transfusion reactions and hemolytic disease of the fetus and newborn. It is typically caused by defective RHCE genes. In this study, we identified a D-- phenotype proband and verified Rh phenotypes of other 6 family members. However, inconsistent results between the phenotypic analysis and Sanger sequencing revealed intact RHCE exons with no mutations in the D-- proband, but the protein was not expressed. Subsequent whole-genome sequencing by Oxford Nanopore Technologies of the proband revealed an inversion with ambiguous breakpoints in intron 2 and intron 7 and copy number variation loss in the RHCE gene region. Given that the RHCE gene is highly homologous to the RHD gene, we conducted a comprehensive analysis using Pacific Biosciences long-read target sequencing, Bionano optical genome mapping, and targeted next-generation sequencing. Our findings revealed that the proband had 2 novel recombinant RHCE haplotypes, RHCE∗Ce(1-2)-D(3-10) and RHCE∗Ce(1-2)-D(3-10)-Ce(10-8)-Ce(3-10), with clear-cut breakpoints identified. Furthermore, the RH haplotypes of the family members were identified and verified. In summary, we made, to our knowledge, a novel discovery of hereditary large inversion and recombination events occurring between the RHD and RHCE genes, leading to a lack of RhCE expression. This highlights the advantages of using integrated genetic analyses and also provides new insights into RH genotyping.
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Affiliation(s)
- Minghao Li
- Immunohematology Laboratory, Shanghai Institute of Blood Transfusion, Shanghai Blood Centre, Shanghai, China
| | - Liping Wang
- Blood Transfusion Department, Weifang People’s Hospital, Shandong, China
| | - Aijing Li
- Immunohematology Laboratory, Shanghai Institute of Blood Transfusion, Shanghai Blood Centre, Shanghai, China
| | - Bo Wang
- Xi’an Haorui Genomics Technology Company Limited, Chang’an District, Xi’an, Shaanxi, China
| | - Xiaohong Yang
- Xi’an Haorui Genomics Technology Company Limited, Chang’an District, Xi’an, Shaanxi, China
| | - Yue Zhang
- Xi’an Haorui Genomics Technology Company Limited, Chang’an District, Xi’an, Shaanxi, China
| | - Chaoqiong Chen
- Xi’an Haorui Genomics Technology Company Limited, Chang’an District, Xi’an, Shaanxi, China
| | - Futing Sun
- Blood Transfusion Department, Weifang People’s Hospital, Shandong, China
| | - Ziyan Zhu
- Immunohematology Laboratory, Shanghai Institute of Blood Transfusion, Shanghai Blood Centre, Shanghai, China
| | - Luyi Ye
- Immunohematology Laboratory, Shanghai Institute of Blood Transfusion, Shanghai Blood Centre, Shanghai, China
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Trueba-Gómez R, Rosenfeld-Mann F, Estrada-Juárez H. Prediction of the antigenic regions in eight RhD variants identified by computational biology. Vox Sang 2024; 119:590-597. [PMID: 38523363 DOI: 10.1111/vox.13620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/23/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND AND OBJECTIVES Changes in RHD generate variations in protein structure that lead to antigenic variants. The classical model divides them into quantitative (weak and Del) and qualitative (partial D). There are two types of protein antigens: linear and conformational. Computational biology analyses the theoretical assembly of tertiary protein structures and allows us to identify the 'topological' differences between isoforms. Our aim was to determine the theoretical antigenic differences between weak RhD variants compared with normal RhD based on structural analysis using bioinformatic techniques. MATERIALS AND METHODS We analysed the variations in secondary structures and hydrophobicity of RHD*01, RHD*01W.1, W2, W3, RHD*09.03.01, RHD*09.04, RHD*11, RHD*15 and RHD*21. We then modelled the tertiary structure and calculated their probable antigenic regions, intra-protein interactions, displacement and membrane width and compared them with Rhce. RESULTS The 10 proteins are similar in their secondary structure and hydrophobicity, with the main differences observed in the exofacial coils. We identified six potential antigenic regions: one that is unique to RhD (R3), one that is common to all D (R6), three that are highly variable among RhD isoforms (R1, R2 and R4), one that they share with Rhce (R5) and two that are unique to Rhce (Ra and Rbc). CONCLUSION The alloimmunization capacity of these subjects could be explained by the variability of the antigen pattern, which is not necessarily recognized or recognized with lower intensity by the commercially available antibodies, and not because they have a lower protein concentration in the membrane.
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Affiliation(s)
- Rocio Trueba-Gómez
- Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes," Coordinación de Hematología Perinatal, Mexico City, Mexico
- Comité de Trombosis y Hemostasia AMEH-CLAHT, A.C., Mexico City, Mexico
| | | | - Higinio Estrada-Juárez
- Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes," Coordinación de Hematología Perinatal, Mexico City, Mexico
- Comité de Trombosis y Hemostasia AMEH-CLAHT, A.C., Mexico City, Mexico
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Izard C, Laget L, Beley S, Bichel N, De Boisgrollier L, Picard C, Chiaroni J, Di Cristofaro J. Resolution of RHCE Haplotype Ambiguities in Transfusion Settings. Int J Mol Sci 2024; 25:5868. [PMID: 38892055 PMCID: PMC11172784 DOI: 10.3390/ijms25115868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
Red blood cell (RBC) transfusion, limited by patient alloimmunization, demands accurate blood group typing. The Rh system requires specific attention due to the limitations of serological phenotyping methods. Although these have been compensated for by molecular biology solutions, some RhCE ambiguities remain unresolved. The RHCE mRNA length is compatible with full-length analysis and haplotype discrimination, but the RHCE mRNA analyses reported so far are based on reticulocyte isolation and molecular biology protocols that are fastidious to implement in a routine context. We aim to present the most efficient reticulocyte isolation method, combined with an RT-PCR sequencing protocol that embraces the phasing of all haplotype configurations and identification of any allele. Two protocols were tested for reticulocyte isolation based either on their size/density properties or on their specific antigenicity. We show that the reticulocyte sorting method by antigen specificity from EDTA blood samples collected up to 48 h before processing is the most efficient and that the combination of an RHCE-specific RT-PCR followed by RHCE allele-specific sequencing enables analysis of cDNA RHCE haplotypes. All samples analyzed show full concordance between RHCE phenotype and haplotype sequencing. Two samples from the immunohematology laboratory with ambiguous results were successfully analyzed and resolved, one of them displaying a novel RHCE allele (RHCE*03 c.340C>T).
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Affiliation(s)
- Caroline Izard
- Etablissement Français du Sang PACA Corse, 13005 Marseille, France
- Aix Marseille University CNRS EFS ADES UMR7268, 13015 Marseille, France
| | - Laurine Laget
- Etablissement Français du Sang PACA Corse, 13005 Marseille, France
- Aix Marseille University CNRS EFS ADES UMR7268, 13015 Marseille, France
| | - Sophie Beley
- Etablissement Français du Sang PACA Corse, 13005 Marseille, France
| | - Nelly Bichel
- Etablissement Français du Sang PACA Corse, 13005 Marseille, France
| | | | - Christophe Picard
- Etablissement Français du Sang PACA Corse, 13005 Marseille, France
- Aix Marseille University CNRS EFS ADES UMR7268, 13015 Marseille, France
| | - Jacques Chiaroni
- Etablissement Français du Sang PACA Corse, 13005 Marseille, France
- Aix Marseille University CNRS EFS ADES UMR7268, 13015 Marseille, France
| | - Julie Di Cristofaro
- Etablissement Français du Sang PACA Corse, 13005 Marseille, France
- Aix Marseille University CNRS EFS ADES UMR7268, 13015 Marseille, France
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Srivastava K, Bueno MU, Flegel WA. Breakpoint regions of an RHD-CE(4-9)-D allele and a rare JK allele in a Pacific Islander individual. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2024; 22:189-197. [PMID: 37677094 PMCID: PMC11073622 DOI: 10.2450/bloodtransfus.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/07/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Among 710 RHD alleles, 3 alleles have been shown to express CcEe antigens and, among 67 hybrid alleles of the RHD gene, 2 alleles have evolved to include RHCE exons 4-9. No breakpoint region had been described for such RHD-CE(4-9)-D hybrid alleles. In the Kidd blood group system, the JK*02N.01 null allele is found with high prevalence in the Polynesian population. We investigated a self-identified Pacific Islander with discrepant serologic and molecular results for his C and Jkb antigens. Another 8 samples with genotype-phenotype discrepancies in the Kidd blood group system were assessed. MATERIALS AND METHODS A combination of published molecular methods and commercial kits were applied to analyze the RHD, RHCE, and SLC14A1 gene sequences, as were hemagglutination tests to determine the serologic phenotypes. RESULTS Nucleotide sequencing of the RHD gene in the index case, including relevant intron stretches, and cDNA identified an RHD-CE(4-9)-D hybrid allele. Nucleotide sequencing of his RHCE gene confirmed the presence of 2 RHCE*ce alleles despite expressing the C antigen. Sequencing of his SLC14A1 gene documented the JK*02N.01 null allele. In the other 8 samples, 5 previously known SLC14A1 nucleotide substitutions were identified. The JK*02N.17 allele was determined to be Jkb-positive. DISCUSSION We determined the 2 breakpoint regions of his RHD-CE(4-9)-D hybrid allele, which was likely distinct from the 2 previously published hybrid alleles due to the differences in the linked RHCE allele. His RHD variant was shown to express the C antigen. An SLC14A1 substitution was underlying his unexpected Jkb-negative phenotype. In a quality improvement project, we resolved 8 samples with similarly discrepant results between Jk serology and red cell genotyping.
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Affiliation(s)
- Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, United States of America
| | - Marina U Bueno
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, United States of America
| | - Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, United States of America
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Lv P, Li J, Yao Y, Fan X, Liu C, Li H, Zhou H. A novel pyrosequencing strategy for RHD zygosity for predicting risk of hemolytic disease of the fetus and newborn. Lab Med 2024; 55:145-152. [PMID: 37307496 DOI: 10.1093/labmed/lmad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE The aim of this study was the development of an accurate and quantitative pyrosequence (PSQ) method for paternal RHD zygosity detection to help risk management of hemolytic disease of the fetus and newborn (HDFN). METHODS Blood samples from 96 individuals were genotyped for RHD zygosity using pyrosequencing assay. To validate the accuracy of pyrosequencing results, all the samples were then detected by the mismatch polymerase chain reaction with sequence-specific primers (PCR-SSP) method and Sanger DNA sequencing. Serological tests were performed to assess RhD phenotypes. RESULTS Serological results revealed that 36 cases were RhD-positive and 60 cases were RhD-negative. The concordance rate between pyrosequencing assay and mismatch PCR-SSP assay was 94.8% (91/96). There were 5 discordant results between pyrosequencing and the mismatch PCR-SSP assay. Sanger sequencing confirmed that the pyrosequencing assay correctly assigned zygosity for the 5 samples. CONCLUSION This DNA pyrosequencing method accurately detect RHD zygosity and will help risk management of pregnancies that are at risk of HDFN.
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Affiliation(s)
- Piao Lv
- Department of Blood Transfusion, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jixin Li
- Department of Blood Transfusion, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuan Yao
- Department of Blood Transfusion, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xinxin Fan
- Department of Blood Transfusion, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chixiang Liu
- Department of Blood Transfusion, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui Li
- Department of Hematology, Guangdong Provincial Hospital of Traditional Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine), Guangzhou, China
| | - Huayou Zhou
- Department of Blood Transfusion, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Kaur P, Bedi RK, Sood T, Mittal K, Kaur G. DEL phenotype in RhD-negative North Indian blood donors. Asian J Transfus Sci 2024; 18:16-20. [PMID: 39036686 PMCID: PMC11259341 DOI: 10.4103/ajts.ajts_127_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/11/2023] [Accepted: 08/06/2023] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Rh-DEL type is not detected on routine serology and requires specialized adsorption elution methods which are laborious. Identifying the DEL phenotype in blood donors is important to prevent alloimmunization in transfusion recipients. The present study aimed to determine the frequency of DEL phenotype in RhD-negative North Indian blood donors and correlate the results with Rh Cc/Ee phenotype. MATERIALS AND METHODS In this prospective descriptive cross-sectional study, a total of 205 blood donors with historic blood group RhD-negative were enrolled. All samples were subjected to blood grouping using a fully automated immunohematology analyzer and samples that typed as RhD negative by two different anti-D antisera were tested for Weak D. Weak D-negative samples were subjected to adsorption and elution for DEL phenotype. All samples were also tested for extended Rh phenotype for C/c and E/e antigens. RESULTS Of the total 11934 donors during the study, 6.2% (n = 743) donors were RhD negative. Of the 205 donors enrolled in the study, two donor samples were serologically weak D positive. None of the remaining 203 donors tested positive for the DEL phenotype. The extended Rh phenotype performed for these donors showed that 6.83% (n = 14) donors were positive for RhC antigen and 1.46% (n = 3) were positive for Rh E antigen. Both weak D-positive donors were also positive for the Rh C antigen. CONCLUSION The prevalence of DEL phenotype is low in the Indian population and studies with larger sample sizes are required to determine the effectiveness of routine C/E typing as a strategy to identify DEL-positive individuals.
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Affiliation(s)
- Paramjit Kaur
- Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Ravneet K. Bedi
- Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Tanvi Sood
- Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Kshitija Mittal
- Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Gagandeep Kaur
- Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India
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Shao LN, Zheng ZW, Zhou SH, Zhang ST, Song WQ, Xia YX, Liang XH. Polymorphisms in the promoter regions of RHD and RHCE genes in the Chinese Han population. Vox Sang 2023; 118:972-979. [PMID: 37823181 DOI: 10.1111/vox.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/29/2023] [Accepted: 08/18/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The Rh blood group system is the most polymorphic human blood group system. Previous studies have investigated variants in the RHD and RHCE promoter. The relevance of these variants to the Chinese Han population is further clarified in this study. MATERIALS AND METHODS In total, 317 donors (223 Rh D-positive [D+], including 20 Del and 94 Rh D-negative [D-]) were randomly selected. The promoter regions and exon 1 of RHD and RHCE were amplified through polymerase chain reaction (PCR) whose products were directly sequenced using forward and reverse primers. RESULTS Expected PCR products of the RHD promoter and exon 1 were amplified in 223 D+ individuals, including 20 Del individuals, and were absent in 81 of 94 D- individuals. Expected PCR products of RHCE were observed in all donors. Two single nucleotide variants (SNVs) were observed in the RHD promoter region. Moreover, 11 SNVs were observed in the promoter and exon 1 of RHCE. rs4649082, rs2375313, rs2281179, rs2072933, rs2072932, rs2072931 and rs586178 with strong linkage disequilibria were significantly different between the D+ and D- groups. [A;C] was the most common haplotype in the RHD promoter (NC_000001.11:g.[-1033A>G;-831C>T]). [G;T;T;A;T;A;C;G;A;C;G] was the most predominant haplotype in both total and D- groups. In D+ individuals, [A;C;T;G;C;G;C;G;C;C;C] was the most frequent haplotype in the RHCE promoter (NC_000001.11:g.[-1080A>G;-958C>T;-390T>C;-378G>A;-369C>T;-296G>A;-144C>G;-132G>A;-122C>A;28C>T;48C>G]). CONCLUSION We speculate that the SNVs/haplotypes found in this article cannot significantly affect gene expression. The present study findings should help elucidate the molecular basis of the polymorphic expression of RHD and RHCE promoter regions.
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Affiliation(s)
| | - Zi-Wei Zheng
- College of Medical Laboratory, Dalian Medical University, Dalian, Liaoning, China
| | | | | | | | - Yue-Xin Xia
- Dalian Blood Center, Dalian, Liaoning, China
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Hutchison CJ, Srivastava K, Polin H, Bueno MU, Flegel WA. Rh flow cytometry: An updated methodology for D antigen density applied to weak D types 164 and 165. Transfusion 2023; 63:2141-2151. [PMID: 37792462 PMCID: PMC10680490 DOI: 10.1111/trf.17543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND An original methodology for determining the D antigen density on red cells was published in 2000 and has been applied in many publications since. This flow cytometry-based assay remained largely unrevised utilizing monoclonal anti-Ds that are not readily available anymore. We updated the methodology to quantify erythrocyte D antigen sites using microspheres and monoclonal anti-Ds that are commercially available today. METHODS The absolute D antigen density of a frozen standard CcDEe cell, drawn in 2003, a fresh blood donation from the same individual, drawn in 2022, and an internal control CcDEe cell, was quantified by flow cytometry using fluorescence-labeled microspheres. The internal control CcDEe cell was used in conjunction with 9 commercial anti-Ds to determine D antigen densities of 7 normal D, 4 partial D, and 11 weak D type samples, including 2 novel alleles. RESULTS The reproducibility of the updated assay was evaluated with red cells of published D antigen densities. The current results matched the known ones closely. The new weak D types 164 and 165 carried 4500 and 1505 D antigens/red cell, respectively. The absolute D antigen density decreased from 27,231 to 26,037 in an individual over 19 years. DISCUSSION The updated assay gave highly reproducible results for the D antigen densities of Rh phenotypes. Readily available anti-Ds allowed for the determination of the D antigen densities of 7 weak D types. The assay is suitable to evaluate the effects of distinct amino acid substitutions on the RhD phenotype.
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Affiliation(s)
- Chloe Jayne Hutchison
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Helene Polin
- Department of Immunogenetics, Red Cross Transfusion Service for Upper Austria, Linz, Austria
| | - Marina Ursula Bueno
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Yin Q. DEL variants: review of molecular mechanisms, clinical consequences and molecular testing strategy. Funct Integr Genomics 2023; 23:318. [PMID: 37840046 DOI: 10.1007/s10142-023-01249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
Patients with DEL phenotype, a D variant with a low number of D antigens per red blood cell, are routinely typed as RhD-negative in serology testing and are detectable only by adsorption and elution techniques or molecular methods. DEL is of clinical importance worldwide, as indicated by its genotype-phenotype discrepancies among different populations and its potential to cause anti-D alloimmunization when DEL phenotype individuals are inadvertently managed as RhD-negative. This narrative review summarized the DEL alleles causing DEL phenotype and the underlying mechanisms. The clinical consequences and current molecular testing approach were discussed to manage the transfusion needs of patients and donors with DEL phenotype.
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Affiliation(s)
- Qinan Yin
- Henan Engineering Research Center of Digital Pathology and Artificial Intelligence Diagnosis, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
- Precision Medicine Laboratory, School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China.
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11
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Ohto H, Ito S, Srivastava K, Ogiyama Y, Uchikawa M, Nollet KE, Flegel WA. Asian-type DEL (RHD*DEL1) with an allo-anti-D: A paradoxical observation in a healthy multiparous woman. Transfusion 2023; 63:1601-1611. [PMID: 37465939 PMCID: PMC10528739 DOI: 10.1111/trf.17465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The DEL phenotype is the D variant expressing the least amounts of D antigen per red cell. Asian-type DEL (RHD:c:1227G > A) is the most prevalent DEL in East Asia without any anti-D alloimmunization reported before. We investigated the first observation of an anti-D in any DEL phenotype, reported in the Japanese language at a 1987 conference, only 3 years after the discovery of DEL. METHODS We contacted the proband 35 years after the initial report. Standard hemagglutination, adsorption/elution, and flow cytometry tests were performed, as was nucleotide sequencing for the RHD, RHCE, and HLA class I and class II genes. RESULTS The healthy multiparous Japanese woman, a regular blood donor, still had the anti-D of titer 8 representing an alloantibody by standard serologic methods. Unexpectedly, she carried an Asian-type DEL without any additional RHD gene variation. All 12 HLA alleles identified were known in the Japanese population. Interestingly, one of her HLA-DRB1 and a variant of her HLA-DQB1 alleles had previously been associated with anti-D immunization. CONCLUSION We described an allo-anti-D, maintained for more than three decades, in an Asian-type DEL. The combination of two implicated HLA alleles were rare and could have contributed to the anti-D immunization. Continued monitoring of anti-D immunization events in patients with DEL is warranted, and we discuss possible mechanisms for further study. As only this single observation has been recognized in the last 35 years, the current recommendation is affirmed: Individuals with Asian-type DEL should be treated as Rh D-positive for transfusion and Rh immune prophylaxis purposes.
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Affiliation(s)
- Hitoshi Ohto
- Department of Mesenchymal Stem Cell Research, Fukushima Medical University, Fukushima, Japan
| | - Shoichi Ito
- Tohoku Block Blood Center, Japanese Red Cross Society, Sendai, Japan
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Yoshiko Ogiyama
- Tohoku Block Blood Center, Japanese Red Cross Society, Sendai, Japan
| | - Makoto Uchikawa
- Kanto-Koshinetsu Block Blood Center, Japanese Red Cross Society, Tokyo, Japan
| | - Kenneth Eric Nollet
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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Sonker A, Dubey A, Mohan Y. A comparison of serological phenotyping and molecular genotyping for Kell, Kidd, and Duffy antigens in multi-transfused thalassemia patients. Asian J Transfus Sci 2023; 17:53-57. [PMID: 37188031 PMCID: PMC10180786 DOI: 10.4103/ajts.ajts_115_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/11/2022] [Accepted: 11/06/2022] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND In multi-transfused thalassemia patients, serological phenotyping fails to test patient's actual blood group antigen profile due to the presence of donor red blood cell (RBC) in the circulation. This limitation of serological tests can be overcome by genotype determination using the polymerase chain reaction (PCR)-based methods. The aim of this study is to compare the serological phenotyping of Kell, Kidd, and Duffy blood group systems with molecular genotyping in the normal blood donors and multi-transfused thalassaemia patients. MATERIALS AND METHODS Blood samples from 100 normal blood donors and 50 thalassemia patients were tested using standard serological techniques and PCR-based methods for Kell (K/k), Kidd (Jka/Jkb), and Duffy (Fya/Fyb) blood group systems. The results were compared for concordance. RESULTS Genotyping and phenotyping results were 100% concordant for normal blood donors whereas those for thalassemia patients showed 24% discordance. The frequency of alloimmunization in thalassemia patients was 8%. The results of genotyping were used to provide Kell, Kidd, and Duffy matched blood for transfusion therapy to thalassemia patients. CONCLUSION The actual antigen profile in multitransfused thalassaemia patients can be reliably determined using genotyping. This would benefit in providing better antigen matched transfusion therapy to such patients hence reducing the rate of alloimmunization.
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Affiliation(s)
- Atul Sonker
- Department of Transfusion Medicine, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Anju Dubey
- Department of Immunohematology and Blood Transfusion, Kalyan Singh Super Speciality Cancer Institute, Lucknow, Uttar Pradesh, India
| | - Yatendra Mohan
- Department of Transfusion Medicine, S.N. Medical College, Agra, Uttar Pradesh, India
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13
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Rh Immune Globulin After the Transfusion of RhD-Positive Blood in a Patient with a Partial D Antigen. Obstet Gynecol 2022; 140:1052-1055. [PMID: 36357991 DOI: 10.1097/aog.0000000000004981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with a serologic weak D phenotype may demonstrate variable RhD expression. We present a case in which clinical management would have been simplified if RHD genotyping had been performed previously. CASE A 33-year-old patient, G11P4155, presented with an incomplete miscarriage and was transfused RhD-positive packed red blood cells after typing RhD-positive. The patient had been historically typed RhD-negative by a different testing methodology. Indirect antiglobulin testing was performed, which revealed a serologic weak D phenotype. The patient was given 9,600 micrograms of Rh immune globulin. Molecular testing revealed a partial D antigen, which was originally thought to be at risk for alloimmunization; however, this has since been disproven. CONCLUSION Although not yet universal practice, prenatal RHD genotyping for partial D antigen could have prevented the characterization of this patient as RhD-positive at the time of transfusion.
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14
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DUFOUR P, GERARD C, CHANTRAINE F, Jean‐Marc MINON. Investigation of discrepancies obtained during fifteen years of non‐invasive fetal
RHD
genotyping in apparent serologic RhD‐negative pregnant women. Prenat Diagn 2022; 42:1262-1272. [DOI: 10.1002/pd.6219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/06/2022] [Accepted: 07/26/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Patrice DUFOUR
- Department of Laboratory Medicine Immunohaematology and transfusion medicine division Centre Hospitalier Régional de la Citadelle Liège Belgium
| | - Christiane GERARD
- Blood Transfusion Service University of Liège (ULiège), CHU Liège Belgium
| | - Frédéric CHANTRAINE
- Department of Obstetrics and Gynecology Centre Hospitalier Universitaire de Liège CHR Citadelle Liège Belgium
| | - MINON Jean‐Marc
- Department of Laboratory Medicine Immunohaematology and transfusion medicine division Centre Hospitalier Régional de la Citadelle Liège Belgium
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15
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Mbalibulha Y, Natukunda B, Livex OA, Ononge S, Kalyango JN, Kajja I. ABO and Rh Antigen Distribution Among Pregnant Women in South Western Uganda. J Blood Med 2022; 13:351-355. [PMID: 35769868 PMCID: PMC9234189 DOI: 10.2147/jbm.s360769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction ABO and Rh are the major blood group systems in Transfusion Medicine, the ABO system based on two red cell antigens (A, B) while the Rh has about 50 antigens of which five are highly clinically significant (D, C, c, E, e). These vary among races and ethnic groups. Blood type phenotype incompatibility between mother and fetus may result in antigen mismatch, triggering alloimmunization, and thus causing hemolytic transfusion reaction (HTR), which results in hemolytic disease of fetus and newborn (HDFN). This study aimed to determine the frequencies of ABO and rhesus blood group antigen in the pregnant women in South Western Uganda. Methods A cross-sectional study was carried out on 1369 pregnant women who were recruited and provided consent to participate during their regular antenatal visits between August 2020 and July 2021. Four milliliters (4mL) of EDTA-anti-coagulated blood samples were collected and ABO and Rh-blood grouping including Rh antigen screening was done using the agglutination technology comprised of glass beads and reagent contained in a column of the Ortho Biovue ID Micro Typing System (Ortho Clinical Diagnostics, New Jersey, USA). The Rh antigen phenotypes and frequencies were then determined. Results There was percentage distribution of 99.8%, c 99.3%, D 94.3%, C 19.2% and E 15.9%, with Rh cDe/cDe (65.1%) being the most common phenotype followed by cDe/CDe (15%), cDe/cDE (10.8%) and cDE/cDE 0.1% least common. The ABO grouping frequency was obtained as O 49.4%, A 29.5%, B 17.0% and AB 4.1%, with D positivity at 94.3%. Discussion Population genetic variations result in varied expressions of red cell antigens that may have clinical complications. Knowledge of the presence of these Rh antigen distributions and phenotype frequencies during pregnancy help in rational management of the pregnancy, alloimmunization and better approach to safe blood transfusion.
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Affiliation(s)
- Yona Mbalibulha
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bernard Natukunda
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Okwi Andrew Livex
- Department of Pathology, College of Health Science, Makerere University, Kampala, Uganda
| | - Sam Ononge
- Department of Obstetrics & Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joan N Kalyango
- Director Clinical and Epidemiology Unit, School of Medicine, College of Health Science, Makerere University, Kampala, Uganda
| | - Isaac Kajja
- Deputy Principal College of Health Sciences, Makerere University, Kampala, Uganda
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16
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Simtong P, Phothi R, Puapairoj C, Leelayuwat C, Romphruk AV. RHD 1227 A and hybrid Rhesus box analysis in Thai RhD+ and RhD- blood donors: Prevalence, RHD zygosity, and molecular screening. Transfus Apher Sci 2022; 61:103496. [DOI: 10.1016/j.transci.2022.103496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/18/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
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17
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Srivastava K, Bueno MU, Flegel WA. Transfusion support for a woman with RHD*09.01.02 and the novel RHD*01W.161 allele in trans. Immunohematology 2022; 38:17-24. [PMID: 35852060 PMCID: PMC9364384 DOI: 10.21307/immunohematology-2022-036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
According to recent work group recommendations, individuals with the serologic weak D phenotypes should be RHD genotyped and individuals with molecular weak D types 1, 2, 3, 4.0, or 4.1 should be treated as D+. We report an African American woman with a long-standing history of metrorrhagia, who presented for infertility evaluation. Blood grouping showed AB with a possible subgroup of A, based on mixed-field agglutination, and a serologic weak D phenotype. Results from routine red cell genotyping for the RHD gene was incongruent with the serologic RhCE phenotype. For the surgical procedure, the patient was hence scheduled to receive group AB, D- RBC transfusions. Subsequent molecular analysis identified the ABO*A2.01 and ABO*B.01 alleles for the ABO genotype and the novel RHD allele [NG_007494.1(RHD):c.611T>A] along with an RHD*09.01.02 allele for the RHD genotype. Using a panel of monoclonal anti-D reagents, we showed the novel RHD(I204K) allele to represent a serologic weak D phenotype, despite occurring as a compound heterozygote, designated RHD*weak D type 161 (RHD*01W.161). Individuals with a weak D type 4.2 allele are prone to anti-D immunization, while the immunization potential of novel RHD alleles is difficult to predict. For now, patients should be treated as D- in transfusion and pregnancy management, when they harbor a novel RHD allele along with any weak D allele other than weak D types 1, 2, 3, 4.0, or 4.1. This study exemplifies strategies for how and when a laboratory should proceed from routine genotyping to nucleotide sequencing before any decisions on transfusion practice is made.
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Affiliation(s)
- K Srivastava
- Staff Scientist, Department of Transfusion Medicine, National Institutes of Health (NIH) Clinical Center, Bethesda, MD United States
| | - M U Bueno
- IRL Specialist, Department of Transfusion Medicine, NIH Clinical Center, Bethesda, MD United States
| | - W A Flegel
- Chief, Laboratory Services Section, Department of Transfusion Medicine, NIH Clinical Center, 10 Center Drive, Bethesda, MD 20892 United States
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18
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Safic Stanic H, Dogic V, Bingulac-Popovic J, Kruhonja Galic Z, Stojic Vidovic M, Puljic K, Jukic I. RhD alloimmunization by DEL variant missed in donor testing. Transfusion 2022; 62:1084-1088. [PMID: 35318689 DOI: 10.1111/trf.16862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/13/2022] [Accepted: 03/01/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Exposure to normal or variably expressed RhD antigens in an antigen-negative individual can elicit an immune response and lead to the formation of clinically significant anti-D alloantibodies. We present the case of anti-D alloimmunization by DEL variant missed in routine blood donor screening. MATERIAL AND METHODS Blood donors were typed for D antigen using the direct serologic micromethod. Nonreactive samples were confirmed in the indirect antiglobulin method with an IgM/IgG anti-D monoclonal reagent. Genomic DNA was extracted using a commercial QIAamp DNA Blood Mini kit on the QIAcube device (Qiaqen, Germany). RHD genotyping was performed using the PCR-SSP genotyping kits- Ready Gene D weak, Ready Gene D weak screen, Ready Gene CDE, and Ready Gene D AddOn (Inno-Train, Germany). Unidentified alleles were sent for DNA genome sequencing. RESULTS After identifying DEL positive blood units in RhD negative blood donor pool, a look-back study was performed to determine if their previous donations caused alloimmunization in recipients. Out of 40 D negative recipients, one developed anti-D alloantibody after 45 days. The patient did not receive other RhD positive blood products. Blood donor typed D negative in direct and indirect agglutination method. RHD screening was positive, but RHD genotyping and DNA sequencing showed no mutation indicating the normal genotype. CONCLUSION Currently used methods in RHD genotyping are insufficient to identify many variant alleles, especially intronic variations. We suggest additional gene investigation including yet unexplored regions of regulation and intron regions to justify our serological finding.
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Affiliation(s)
- Hana Safic Stanic
- Department of Immunohematology, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Vesna Dogic
- Department of Molecular Diagnostics, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Jasna Bingulac-Popovic
- Department of Molecular Diagnostics, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Zrinka Kruhonja Galic
- Department of Immunohematology, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Miljana Stojic Vidovic
- Department for Blood donor testing, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Kresimir Puljic
- Department for woman's psychotic disorders, University Psychiatric Hospital "Vrapče", Zagreb, Croatia
| | - Irena Jukic
- Medical Department, Croatian Institute of Transfusion Medicine, Zagreb, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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19
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Restivo C, Le Bras M, Deguigne P, Le Glatin L, Guerry C, Férec C, Le Maréchal C, Beloeil R, Fichou Y. The novel c.634+
4A
>G splicing variant in
RHCE
results in weak C and e antigen expression in a pregnant woman originated from Japan. Transfusion 2022; 62:758-763. [DOI: 10.1111/trf.16811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/03/2022] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Cynthia Restivo
- Univ Brest, Inserm, EFS, UMR1078, GGB Brest France
- Laboratory of Excellence GR‐Ex Paris France
| | - Myriam Le Bras
- Laboratoire d'Immuno‐Hématologie Etablissement français du sang (EFS) Centre – Pays de la Loire Angers France
| | - Pierre‐Antoine Deguigne
- Laboratoire d'Immuno‐Hématologie Etablissement français du sang (EFS) Centre – Pays de la Loire Angers France
| | - Laurence Le Glatin
- Laboratoire de Biologie Moléculaire des Groupes Sanguins (LBMGS), EFS Bretagne Brest France
| | - Christine Guerry
- Laboratoire de Biologie Moléculaire des Groupes Sanguins (LBMGS), EFS Bretagne Brest France
| | - Claude Férec
- Univ Brest, Inserm, EFS, UMR1078, GGB Brest France
- Service de Génétique Médicale, CHRU Brest Brest France
| | - Cédric Le Maréchal
- Univ Brest, Inserm, EFS, UMR1078, GGB Brest France
- Laboratoire de Biologie Moléculaire des Groupes Sanguins (LBMGS), EFS Bretagne Brest France
- Service de Génétique Médicale, CHRU Brest Brest France
| | - Rémi Beloeil
- Laboratoire de Biologie Moléculaire des Groupes Sanguins (LBMGS), EFS Bretagne Brest France
| | - Yann Fichou
- Univ Brest, Inserm, EFS, UMR1078, GGB Brest France
- Laboratory of Excellence GR‐Ex Paris France
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20
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Zhang J, Zeng Y, Wang Y, Fan J, Chen H, Yang D, Shi X, Xu H, Fu Z, Sheng F, Xuan J, Pan X, Zhang Z, Ai L, Zhang Y, Pan J, Zhao J, Wang M. RHD Genotypes in a Chinese Cohort of Pregnant Women. Front Genet 2022; 12:752485. [PMID: 34970297 PMCID: PMC8712876 DOI: 10.3389/fgene.2021.752485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/18/2021] [Indexed: 12/03/2022] Open
Abstract
RHD variants in D¯ Chinese pregnant women arose difficulties in management during pregnancy. Therefore, this study aims to precisely manage D¯ pregnant women by evaluating the spectrum of RHD mutations in D¯ pregnant women and getting insight into the possible rare alleles of RHD. A total of 76 D¯ pregnant women were analyzed by performing polymerase chain reactions with sequence-specific primers (PCR-SSP), the 10 RHD exons Sanger sequencing, RHD zygosity detection, and mRNA sequencing (mRNA-seq). About 40% of alleles are variations of RHD, including RHD 1227A homozygous, RHD-CE(2-9)-D, et al. Therefore, we developed a molecular diagnostic strategy for Chinese women, and most D¯ pregnant women can be diagnosed with this simple decision tree. After RHD genotyping for D¯ pregnancy women, we eliminated at least 15% unnecessary ante- and postpartum injections of Rh immunoglobulin (RhIG). As the first pedigree study and the first functional analysis under physiological conditions, mRNA-seq revealed that c.336-1G>A mutation mainly led to the inclusion of the intron 2, which indirectly explained the D¯ phenotype in this family. We also developed a robust protocol for determining fetal RhD status from maternal plasma. All 31 fetuses were predicted as RhD positive and confirmed the RhD status after birth.
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Affiliation(s)
- Jianjun Zhang
- Department of Blood Transfusion, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Yan Zeng
- Genetics Department, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Yuefeng Wang
- Department of Blood Transfusion, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Jiaming Fan
- Genetics Department, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Haijiang Chen
- Department of Blood Transfusion, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Dan Yang
- Department of Blood Transfusion, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Xiaoliang Shi
- Department of Obstetrics and Gynecology, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Hualin Xu
- Department of Obstetrics and Gynecology, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Zimu Fu
- Department of Gynecological Protection, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Fang Sheng
- Department of Gynecological Protection, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Jie Xuan
- Department of Gynecological Protection, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Xiaoxi Pan
- Tianjin Super Biotechnology Developing Co., Ltd., Tianjin, China
| | - Zhiming Zhang
- Tianjin Super Biotechnology Developing Co., Ltd., Tianjin, China
| | - Liping Ai
- Tianjin Super Biotechnology Developing Co., Ltd., Tianjin, China
| | - Yue Zhang
- Tianjin Super Biotechnology Developing Co., Ltd., Tianjin, China
| | - Jingjing Pan
- Zhejiang Biosan Biotechnology Co., Ltd., Hangzhou, China
| | - Jing Zhao
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Mingming Wang
- Zhejiang Biosan Biotechnology Co., Ltd., Hangzhou, China
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21
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Ying Y, Zhang J, Hong X, Xu X, He J, Zhu F. The Significance of RHD Genotyping and Characteristic Analysis in Chinese RhD Variant Individuals. Front Immunol 2021; 12:755661. [PMID: 34867989 PMCID: PMC8633534 DOI: 10.3389/fimmu.2021.755661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background RhD is the most important and complex blood group system because of its highly polymorphic and immunogenic nature. RhD variants can induce immune response by allogeneic transfusion, organ transplantation, and fetal immunity. The transfusion strategies are different for RhD variants formed by various alleles. Therefore, extensive investigation of the molecular mechanism underlying RhD variants is critical for preventing immune-related blood transfusion reactions and fetal immunity. Methods RhD variants were collected from donors and patients in Zhejiang Province, China. The phenotypes were classified using the serologic method. The full coding regions of RHD gene were analyzed using the PCR-SBT method. The multiplex ligation-dependent probe amplification (MLPA) assay was used to analyze the genotype and gene copy number. SWISS-MODLE and PyMOL software were used to analyze 3D structures of RhD caused by the variant alleles. The effect of non-synonymous substitutions was predicted using Polymorphism Phenotyping algorithm (PolyPhen-2), Sorting Intolerant From Tolerant (SIFT), and Protein Variation Effect Analyzer (PROVEAN) software. Results In the collected RhD variants, 28 distinct RHD variant alleles were identified, including three novel variant alleles. RH-MLPA assay is advantageous for determining the copy number of RHD gene. 3D homology modeling predicted that protein conformation was disrupted and may explain RhD epitope differential expression. A total of 14 non-synonymous mutations were determined to be detrimental to the protein structure. Discussion We revealed the diversity of RHD alleles present in eastern Chinese RhD variants. The bioinformatics of these variant alleles extended our knowledge of RhD variants, which was crucial for evaluating their impact to guide transfusion support and avoid immune-related blood transfusion reactions.
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Affiliation(s)
- Yanling Ying
- Blood Center of Zhejiang Province, Institute of Transfusion Medicine, Hangzhou, China.,Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
| | - Jingjing Zhang
- Blood Center of Zhejiang Province, Institute of Transfusion Medicine, Hangzhou, China.,Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
| | - Xiaozhen Hong
- Blood Center of Zhejiang Province, Institute of Transfusion Medicine, Hangzhou, China.,Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
| | - Xianguo Xu
- Blood Center of Zhejiang Province, Institute of Transfusion Medicine, Hangzhou, China.,Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
| | - Ji He
- Blood Center of Zhejiang Province, Institute of Transfusion Medicine, Hangzhou, China.,Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
| | - Faming Zhu
- Blood Center of Zhejiang Province, Institute of Transfusion Medicine, Hangzhou, China.,Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
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22
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The importance of being heterozygote: effects of RHD-genotype-sex interaction on the physical and mental health of a non-clinical population. Sci Rep 2021; 11:21960. [PMID: 34753960 PMCID: PMC8578618 DOI: 10.1038/s41598-021-00977-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/14/2021] [Indexed: 11/15/2022] Open
Abstract
Human populations, especially European, are polymorphic in the RHD gene. A significant fraction of their members carry no copy of the coding section of RHD gene, which results in their Rh-negative blood type. Theoretically, this polymorphism should be unstable. Carriers of the less frequent allele are penalized by reduced fertility because of the immunization of RhD-negative mothers by their RhD-positive babies, which results in hemolytic disease of the fetus and newborn in their subsequent progeny. For about 90 years, some form of balancing selection has been suspected to sustain this polymorphism. Several recent studies showed that the RhD-positive heterozygotes express higher viability than both types of homozygotes. However, the genotype of subjects in these studies was estimated only by indirect methods. Here we compared the physical and mental health of 178 women and 86 men who were directly tested for their RHD genotype. The results showed that RhD-positive homozygotic women had worse and RhD-positive homozygotic men better physical health than RhD-negative homozygotes; the difference between RhD-negative homozygotes and heterozygotes was not significant. Our results confirmed that health of RhD-positive heterozygotes and homozygotes differ. Therefore, any result of the comparison of subjects with RhD-positive and RhD-negative phenotype depends on the heterozygote-to-homozygote ratio in the RhD-positive sample. It is, therefore, crucial to analyze the effects of RHD-genotypes, not phenotypes in future studies.
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23
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Pandey P, Zhang N, Curtis BR, Newman PJ, Denomme GA. Generation of 'designer erythroblasts' lacking one or more blood group systems from CRISPR/Cas9 gene-edited human-induced pluripotent stem cells. J Cell Mol Med 2021; 25:9340-9349. [PMID: 34547166 PMCID: PMC8500969 DOI: 10.1111/jcmm.16872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 12/19/2022] Open
Abstract
Despite the recent advancements in transfusion medicine, red blood cell (RBC) alloimmunization remains a challenge for multiparous women and chronically transfused patients. At times, diagnostic laboratories depend on difficult-to-procure rare reagent RBCs for the identification of different alloantibodies in such subjects. We have addressed this issue by developing erythroblasts with custom phenotypes (Rh null, GPB null and Kx null/Kell low) using CRISPR/Cas9 gene-editing of a human induced pluripotent stem cell (hiPSC) parent line (OT1-1) for the blood group system genes: RHAG, GYPB and XK. Guide RNAs were cloned into Cas9-puromycin expression vector and transfected into OT1-1. Genotyping was performed to select puromycin-resistant hiPSC KOs. CRISPR/Cas9 gene-editing resulted in the successful generation of three KO lines, RHAG KO, GYPB KO and XK KO. The OT1-1 cell line, as well as the three KO hiPSC lines, were differentiated into CD34+ CD41+ CD235ab+ hematopoietic progenitor cells (HPCs) and subsequently to erythroblasts. Native OT1-1 erythroblasts were positive for the expression of Rh, MNS, Kell and H blood group systems. Differentiation of RHAG KO, GYPB KO and XK KO resulted in the formation of Rh null, GPB null and Kx null/Kell low erythroblasts, respectively. OT1-1 as well as the three KO erythroblasts remained positive for RBC markers-CD71 and BAND3. Erythroblasts were mostly at the polychromatic/ orthochromatic stage of differentiation. Up to ~400-fold increase in erythroblasts derived from HPCs was observed. The availability of custom erythroblasts generated from CRISPR/Cas9 gene-edited hiPSC should be a useful addition to the tools currently used for the detection of clinically important red cell alloantibodies.
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Affiliation(s)
| | | | - Brian R. Curtis
- Versiti Blood Research InstituteMilwaukeeWIUSA
- Diagnostic LaboratoriesVersiti Blood Center of WisconsinMilwaukeeWIUSA
| | - Peter J. Newman
- Versiti Blood Research InstituteMilwaukeeWIUSA
- Departments of Pharmacology and Cellular BiologyMedical College of WisconsinMilwaukeeWIUSA
| | - Gregory A. Denomme
- Versiti Blood Research InstituteMilwaukeeWIUSA
- Diagnostic LaboratoriesVersiti Blood Center of WisconsinMilwaukeeWIUSA
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24
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Sadeghi-Bojd Y, Amirizadeh N, Oodi A. RHD Genotyping of Rh-Negative and Weak D Phenotype among Blood Donors in Southeast Iran. Int J Hematol Oncol Stem Cell Res 2021; 15:213-220. [PMID: 35291662 PMCID: PMC8888359 DOI: 10.18502/ijhoscr.v15i4.7476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/31/2020] [Indexed: 11/29/2022] Open
Abstract
Background: The D antigen is a subset of Rh blood group antigens involved in the hemolytic disease of the newborn [HDFN] and hemolytic transfusion reaction [HTR]. The hybrid Rhesus box that was created after RH gene deletion, was known as a mechanism of the Rh-negative phenotype. Hybrid marker identification is used to confirm the deletion of the RHD gene and to determine zygosity. This study aims to detect this marker in Rh-negative and weak D phenotype blood donors of the southeast of Iran. Materials and Methods: The molecular analysis of the hybrid Rhesus box was performed on the 200 Rh-negative blood donors in Sistan and Baluchestan province, southeast Iran. The presence of alleles responsible for the D variants was assessed by DNA sequencing in 26 weak D phenotype donors. Results: Of the 200 Rh-negative blood samples, 198 samples were homozygous (99%), and two samples were heterozygous (1%). Heterozygous samples had RHD*01N.73 allele and the RHD*01N.18 allele. Of the 26 samples with weak D phenotype, 16 partial DLO (61%), 4 partial DBT1 (15.3%), 2 partial DV type 2 (7.7%), 1 weak D type 1, 1 weak D type 4.2.3, 1weak D type 105 and 1 RHD (S103P) (4%) were determined. Conclusion: Since RHD gene deletion is the main mechanism of the Rh-negativity in Sistan and Baluchestan provinces, a hybrid Rhesus box marker can be used in resolving RhD typing discrepancies by RHD genotyping methods.
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Affiliation(s)
- Younes Sadeghi-Bojd
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Naser Amirizadeh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Arezoo Oodi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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Miranda MR, Dos Santos TD, Castilho L. Systematic RHD genotyping in Brazilians reveals a high frequency of partial D in transfused patients serologically typed as weak D. Transfus Apher Sci 2021; 60:103235. [PMID: 34389204 DOI: 10.1016/j.transci.2021.103235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The discrimination between weak D types and partial D can be of clinical importance because carriers of partial D antigen may develop anti-D when transfused with D-positive red blood cell units. The aim of this study was to determine by molecular analysis the type of D variants among Brazilian patients requiring transfusions with serologic weak D phenotypes. MATERIAL AND METHODS Samples from 87 patients (53 with sickle cell disease, 10 with thalassemia and 24 with myelodysplastic syndrome), serologic typed as weak D by manual tube indirect antiglobulin test or gel test were first RHD genotyped by using the RHD BeadChip Kit (BioArray, Immucor). Sanger sequencing was performed when necessary. RESULTS RHD molecular analysis revealed 32 (36.8 %) variant RHD alleles encoding weak D phenotypes and 55 (63.2 %) alleles encoding partial D antigens. RHD variant alleles were present in the homozygous state or as a single RHD allele, one variant RHD allele associated with the RHDΨ allele, or two different variant RHD alleles in compound heterozygosity with each other in 70 patients, 4 patients and 13 patients, respectively. Alloanti-D was found in 9 (16.4 %) cases with RHD alleles predicting a partial D. DISCUSSION The frequency of partial D was higher than weak D types in Brazilian patients serologically typed as weak D, showing the importance to differentiate weak D types and partial D in transfused patients to establish a transfusion policy recommendation.
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Leiva-Torres GA, Chevrier MC, Constanzo-Yanez J, Lewin A, Lavoie J, Laganière J, Baillargeon N, Trépanier P, Robitaille N. High prevalence of weak D type 42 in a large-scale RHD genotyping program in the province of Quebec (Canada). Transfusion 2021; 61:2727-2735. [PMID: 34121202 DOI: 10.1111/trf.16518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The determination of the RhD phenotype is crucial to avoid alloimmunization, especially in childbearing women. Following the 2015 recommendation from the Work Group on RHD Genotyping, a large-scale RHD genotyping program was implemented in the province of Quebec (Canada) and offered to women ≤45 years old with a serological weak D or discordant results. Since weak D type 42 was previously shown to be prevalent among French Canadians, genotyping for that variant was also performed. Our aim was to report the prevalence of the weak D alleles in the province of Quebec. STUDY DESIGN AND METHODS A retrospective study of 2105 women with serological weak D referred to Hema-Quebec's immunohematology reference laboratory (IRL) between June 2016 and May 2020 was conducted. Results from the serological tests performed by the referring hospital were compiled and RHD were genotyped. RESULTS Most patients presented at least one serological result ≤2+ before being referred to Hema-Quebec. Weak D type 42 was the most prevalent variant, representing 17.5% (368/2105) of all individuals tested. Only 15.3% (323/2105) of patients were weak D type 1, 3.3% (69/2105) were type 2, and 8.6% (180/2105) were type 3. Weak D type 42 is highly expressed in regions with low immigration rate and known for their founder effect. CONCLUSION Our RHD genotyping program allowed for a better management of weak D. The province of Quebec presents a unique RHD genotype distribution. We confirmed that weak D type 42 is associated with a founder effect found in Caucasian French Canadians.
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Affiliation(s)
| | | | | | - Antoine Lewin
- Medical Affairs and Innovation, Hema-Quebec, Quebec, Quebec, Canada
| | - Josée Lavoie
- Medical Affairs and Innovation, Hema-Quebec, Quebec, Quebec, Canada
| | - Josée Laganière
- Medical Affairs and Innovation, Hema-Quebec, Quebec, Quebec, Canada
| | - Nadia Baillargeon
- Immunohematology Reference Laboratory, Hema-Quebec, Montreal, Quebec, Canada
| | | | - Nancy Robitaille
- Immunohematology Reference Laboratory, Hema-Quebec, Montreal, Quebec, Canada
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27
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Raud L, Le Tertre M, Vigneron L, Ka C, Richard G, Callebaut I, Chen JM, Férec C, Le Gac G, Fichou Y. Missense RHD single nucleotide variants induce weakened D antigen expression by altering splicing and/or protein expression. Transfusion 2021; 61:2468-2476. [PMID: 34110623 DOI: 10.1111/trf.16538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/09/2021] [Accepted: 04/28/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although D variant phenotype is known to be due to genetic defects, including rare missense single nucleotide variants (SNVs), within the RHD gene, few studies have addressed the molecular and cellular mechanisms driving this altered expression. We and others showed previously that splicing is commonly disrupted by SNVs in constitutive splice sites and their vicinity. We thus sought to investigate whether rare missense SNVs located in "deep" exonic regions could also impair this mechanism. STUDY DESIGN AND METHODS Forty-six missense SNVs reported within exons 6 and 7 were first selected from the Human RhesusBase. Their respective effect on splicing was assessed by using an in vitro assay. An RhD-negative cell model was further generated by using the CRISPR-Cas9 approach. RhD-mutated proteins were overexpressed in the newly created model, and cell membrane expression of the D antigen was measured by flow cytometry. RESULTS Minigene splicing assay showed that 14 of 46 (30.4%) missense SNVs alter splicing. Very interestingly, further investigation of two missense SNVs, which both affect codon 338 and confer a weak D phenotype, showed various mechanisms: c.1012C>G (p.Leu338Val) disrupts splicing only, while c.1013T>C (p.Leu338Pro) alters only the protein structure, in agreement with in silico prediction tools and 3D protein structure visualization. CONCLUSION Our functional data set suggests that missense SNVs damage quantitatively D antigen expression by, at least, two different mechanisms (splicing alteration and protein destabilization) that may act independently. These data thereby contribute to extend the current knowledge of the molecular mechanisms governing weakened D expression.
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Affiliation(s)
- Loann Raud
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Marlène Le Tertre
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France.,Service de Génétique Médicale, CHRU Brest, Brest, France
| | | | - Chandran Ka
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France.,Service de Génétique Médicale, CHRU Brest, Brest, France
| | - Gaëlle Richard
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Isabelle Callebaut
- Sorbonne Université, Muséum National d'Histoire Naturelle, UMR CNRS 7590, Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie (IMPMC), Paris, France
| | - Jian-Min Chen
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Claude Férec
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France.,Service de Génétique Médicale, CHRU Brest, Brest, France
| | - Gérald Le Gac
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France.,Service de Génétique Médicale, CHRU Brest, Brest, France
| | - Yann Fichou
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
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Frequency and characterization of RHD variant alleles in a population of blood donors from southeastern Brazil: Comparison with other populations. Transfus Apher Sci 2021; 60:103135. [PMID: 33867285 DOI: 10.1016/j.transci.2021.103135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/28/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The correct determination of D antigen could help to avoid alloimmunization in pregnant women and patients receiving blood transfusions. However, there are limitations in the identification of D variants as the partial and weak D phenotypes make the determination of D antigen a great challenge in the transfusion routine.' STUDY DESIGN AND METHODS The molecular characterization of D variants was performed on blood donors from southeastern Brazil with atypical D typing. Furthermore, the serological profile of all RHD variant alleles identified was analyzed using different Anti-D clones. The prevalence of RHD alleles and genotypes found was compared with those described in other countries and in other regions from Brazil. RESULTS Atypical serologic D typing occurred in 0.79 % of blood donors. The majority of RHD variant alleles (88 %) were first characterized by multiplex PCR and PCR-SSP as RHD*weak partial 4 (47 %), followed by RHD*weak D type 3 (29.9 %), RHD*weak D type 2 (3.9 %) and RHD*weak D type 1 (3.1 %). Genomic DNA sequencing characterized the RHD*weak partial 4 variants found in RHD*DAR1.2 (weak 4.2.2) (22 %), RHD*DAR3 (weak 4.0.1) (2.4 %), RHD*DAR3.1 (weak 4.0) (22 %) and RHD*DAR4 (weak 4.1) (0.8 %). RHD variant alleles associated with partial D, such as, RHD*DAU-4 (1.6 %), RHD*DAU-5 (2.4 %), RHD*DAU-6 (1.6 %), RHD* DIII type 8 (1.6 %), RHD*DVII (3.9 %) and RHD* DMH (0.8 %) were also observed. CONCLUSION The prevalence of RHD variant alleles observed in this cohort differ from those found in other populations, including Brazilians from other regions. RHD allele distribution in specific regions should be considered for implementation of algorithms and genotyping strategies aiming at a more effective and safe transfusion.
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29
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Afroz T, Mishra G, Saleh AJM, Madkaikar M, Kulkarni S. Molecular characterization of a rare Rh phenotype Dc-from the Indian subcontinent. Transfus Apher Sci 2021; 60:103109. [PMID: 33752990 DOI: 10.1016/j.transci.2021.103109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 11/17/2022]
Abstract
Unusual Rh phenotypes such as Rhnull, D-- and Dc- etc. are rarely encountered in routine blood bank testing. The Rhnull phenotype is characterized by the absence of all Rh antigens, D-- phenotype does not express any RhCcEe antigens whereas Dc- phenotype individual lacks expression of antithetical E /e antigens. These individuals may produce multiple Rh antibodies against missing antigens. An old woman (B RhD positive) from Bangladesh with end-stage renal disease developed severe anaemia. Cross-matching with ABO and RhD compatible blood units showed +3 agglutination reaction. Detailed immunohaematological investigations showed a lack of C, E and e antigens, thus identifying the rare Rh variant as Dc-. Antibodies against C and e antigens were also detected in the patient's serum. PCR-SSP confirmed the absence of the molecular region defining the C, E and e antigens. Copy number analysis by QMPSF revealed the homozygous state of (RHCE-D(4-9)-CE) allele at the RHCE gene locus. This is the first report of the rare Dc- variant individual from the Indian subcontinent.
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Affiliation(s)
- Tamanna Afroz
- Department of transfusion medicine, Evercare Hospital, Dhaka, Bangladesh
| | - Garima Mishra
- Department of transfusion medicine, ICMR- National institute of immunohematology, Mumbai, India
| | | | - Manisha Madkaikar
- Department of transfusion medicine, ICMR- National institute of immunohematology, Mumbai, India
| | - Swati Kulkarni
- Department of transfusion medicine, ICMR- National institute of immunohematology, Mumbai, India.
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Pazourkova E, Zednikova I, Korabecna M, Kralova J, Pisacka M, Novotna M, Calda P, Horinek A. Optimization of diagnostic strategy for non-invasive cell-free foetal RHD determination from maternal plasma. Vox Sang 2021; 116:1012-1019. [PMID: 33761162 DOI: 10.1111/vox.13099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/20/2020] [Accepted: 03/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of the study was to optimize routine non-invasive prenatal detection of fetal RHD gene from plasma of RhD-negative pregnant women (the median of gestational age was 25 weeks, range 10-38) to detect RhD materno-fetal incompatibility and to avoid the redundant immunoprophylaxis. MATERIALS AND METHODS Initially only one exon of RHD gene (exon 10) was investigated in 281 plasma samples (144 verified after delivery), in the second phase three RHD exons (5, 7, 10) were analyzed in 246 samples of plasma and maternal genomic DNA (204 verified) by real-time PCR method. Detection of Y-chromosomal sequence DYS-14 and five X-chromosomal insertion/deletion polymorphisms was used to confirm the fetal cfDNA detectability in plasma. Specific polymorphisms in RHD gene were detected by sequence-specific primer PCR in nine samples. RESULTS When only the RHD exon 10 was tested, 2·8% of verified samples were false positive and 3·5% false negative. With three RHD exons (5, 7, 10) and maternal genomic DNA testing, only one case was false negative (0·5%). Nine samples were inconclusive due to RHD-positive results in maternal genomic DNA. These samples were analyzed for specific mutations in RHD gene. Combination of both methods for fetal cfDNA verification succeeded in 75% of tested group. CONCLUSION Implementation of analysis of three RHD exons and maternal genomic DNA to routine practice lowers dramatically the ratio of false positive and negative results. This method enables more accurate determination of fetal RHD status with the reduction of unnecessary medical care and RhD immunoprophylaxis.
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Affiliation(s)
- Eva Pazourkova
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic.,Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
| | - Iveta Zednikova
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
| | - Marie Korabecna
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
| | - Jana Kralova
- Department of Immunohematology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Martin Pisacka
- Department of Immunohematology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Michaela Novotna
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
| | - Pavel Calda
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
| | - Ales Horinek
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic.,3rd Department of Medicine, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
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31
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Maryam DU, Mukhtar IG, Yusuf AA, Salisu AI. High prevalence of serological weak D phenotype and preponderance of weak D type 4.0.1. genetic variant in a Nigerian population: implications for transfusion practice in a resource-limited setting. Hematol Transfus Cell Ther 2021; 44:386-391. [PMID: 33744228 PMCID: PMC9477752 DOI: 10.1016/j.htct.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Prevalence of RhD negative phenotype in Nigeria is low; this leads to scarcity of RhD negative red cells for transfusion. Serological and molecular genotyping of RhD negative individuals for weak D types could reduce this scarcity. The aim of this study was to determine the serological prevalence and molecular types of weak D phenotypes among blood donors and pregnant women in Kano, Nigeria. Methods A total of 4482 blood donors and pregnant women from three hospitals in Kano were recruited. An indirect antiglobulin test was used to determine weak D phenotypes. Molecular genotyping was performed on genomic DNA from whole blood amplified by polymerase chain reaction sequence-specific primers (PCR-SSP) with agarose gel electrophoresis. Results The mean age of the participants was 26.50 ± 5.79 years. The prevalence of the RhD negative phenotype was 4.2% (189/4482). Of the 189 RhD negative phenotypes, 20 (10.6%) were weak D positive. Molecular genotyping of the 20 Weak D positive phenotypes revealed 15 (75%) weak D type 4, of which 11 were due to the RHD*09.03 and RHD*DAR3 (T201R, F223V) polymorphisms and 4, due to RHD* 08.01 and RHD* DFV polymorphisms; 2 (10%) were due to the 602 C>G polymorphism, while the remaining 3 (15%) constituted partial D or other rare weak D types. Conclusion The prevalence of weak D positive phenotypes is high in this study; weak D type 4 is the most common RhD genetic variant. Routine serologic weak D testing of RhD negative blood and molecular genotyping should be encouraged in resource-limited settings.
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Affiliation(s)
| | | | - Aminu Abba Yusuf
- Faculty of Clinical Sciences, Bayero University, Kano, Nigeria; Aminu Kano Teaching Hospital, Kano, Nigeria
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32
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Alshehri AA, Jackson DE. Non-Invasive Prenatal Fetal Blood Group Genotype and Its Application in the Management of Hemolytic Disease of Fetus and Newborn: Systematic Review and Meta-Analysis. Transfus Med Rev 2021; 35:85-94. [PMID: 33781630 DOI: 10.1016/j.tmrv.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 11/17/2022]
Abstract
Hemolytic disease of fetus and newborn (HDFN) imposes great healthcare burden being associated with maternal alloimmunization against parental-inherited fetal red blood cell antigens causing fetal anemia or death. Noninvasive prenatal analysis (NIPT) provides safe fetal RHD genotyping for early identification of risk pregnancies and proper management guidance. We aimed to conduct systematic review and meta-analysis on NIPT's beneficial application, in conjunction with quantitative maternal alloantibody analysis, for early diagnosis of pregnancies at risk. Search for relevant articles was done in; PubMed/Medline, Scopus, and Ovid (January 2006April 2020), including only English-written articles reporting reference tests and accuracy data. Nineteen eligible studies were critically appraised. NIPT was estimated highly sensitive/specific for fetal RHD genotyping beyond 11-week gestation. Amplifications from ≥2 exons are optimum to increase accuracy. NIPT permits cost-effectiveness, precious resources sparing, and low emotional stress. Knowledge of parental ethnicity is important for correct NIPT result interpretations and quantitative screening. Cut-off titer ≥8-up-to-32 is relevant for anti-D alloantibodies, while, lower titer is for anti-K. Alloimmunization is influenced by maternal RHD status, gravida status, and history of adverse obstetrics. In conclusion, NIPT allows evidence-based provision of routine anti-D immunoprophylaxis and estimates potential fetal risks for guiding further interventions. Future large-scale studies investigating NIPT's non-RHD genotyping within different ethnic groups and in presence of clinically significant alloantibodies are needed.
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Affiliation(s)
- Abdulrahman Ali Alshehri
- Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Denise E Jackson
- Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
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Floch A, Pirenne F, Barrault A, Chami B, Toly-Ndour C, Tournamille C, de Brevern AG. Insights into anti-D formation in carriers of RhD variants through studies of 3D intraprotein interactions. Transfusion 2021; 61:1286-1301. [PMID: 33586199 DOI: 10.1111/trf.16301] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/04/2020] [Accepted: 01/13/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Many RhD variants associated with anti-D formation (partial D) in carriers exposed to the conventional D antigen carry mutations affecting extracellular loop residues. Surprisingly, some carry mutations affecting transmembrane or intracellular domains, positions not thought likely to have a major impact on D epitopes. STUDY DESIGN AND METHODS A wild-type Rh trimer (RhD1 RhAG2 ) was modeled by comparative modeling with the human RhCG structure. Taking trimer conformation, residue accessibility, and position relative to the lipid bilayer into account, we redefine the domains of the RhD protein. We generated models for RhD variants carrying one or two amino acid substitutions associated with anti-D formation in published articles (25 variants) or abstracts (12 variants) and for RHD*weak D type 38. We determined the extracellular substitutions and compared the interactions of the variants with those of the standard RhD. RESULTS The findings of the three-dimensional (3D) analysis were correlated with anti-D formation for 76% of RhD variants: 15 substitutions associated with anti-D formation concerned extracellular residues, and structural differences in intraprotein interactions relative to standard RhD were observed in the others. We discuss the mechanisms by which D epitopes may be modified in variants in which the extracellular residues are identical to those of standard RhD and provide arguments for the benignity of p.T379M (RHD*DAU0) and p.G278D (RHD*weak D type 38) in transfusion medicine. CONCLUSION The study of RhD intraprotein interactions and the precise redefinition of residue accessibility provide insight into the mechanisms through which RhD point mutations may lead to anti-D formation in carriers.
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Affiliation(s)
- Aline Floch
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - France Pirenne
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Aurélie Barrault
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Btissam Chami
- Etablissement francais du sang Ile-de-France, Creteil, France
| | - Cécile Toly-Ndour
- Unité Fonctionnelle d'expertise en Immuno-Hémobiologie Périnatale, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Service de Médecine Fœtale, Pôle Périnatalité, Hôpital Trousseau, GH HUEP, APHP, Paris, France
| | - Christophe Tournamille
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Alexandre G de Brevern
- Laboratoire d'Excellence GR-Ex, Paris, France.,Université de Paris, Biologie Intégrée du Globule Rouge UMR_S1134, Inserm, Université de la Réunion, Université des Antilles, Paris, France.,Institut National de la Transfusion Sanguine (INTS), Paris, France
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34
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Srivastava A, Dhote S, Singh I. A retrospective study on the prevalence of weak D antigen (Du) in a blood bank in a tertiary care hospital in Maharashtra, India. MGM JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/mgmj.mgmj_77_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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35
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Thongbut J, Laengsri V, Raud L, Promwong C, I-Na-Ayudhya C, Férec C, Nuchnoi P, Fichou Y. Nation-wide investigation of RHD variants in Thai blood donors: Impact for molecular diagnostics. Transfusion 2020; 61:931-938. [PMID: 33377204 DOI: 10.1111/trf.16242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/23/2020] [Accepted: 12/06/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Knowledge of the molecular determinants driving antigen expression is critical to design, optimize, and implement a genotyping approach on a population-specific basis. Although RHD gene variability has been extensively reported in Caucasians, Africans, and East-Asians, it remains to be explored in Southeast Asia. Thus the molecular basis of non-D+ blood donors was investigated in Thailand. STUDY DESIGN AND METHODS First, 1176 blood samples exhibiting an inconclusive or negative result by automated serological testing were collected in the 12 Regional Blood Centres of the Thai Red Cross located throughout Thailand. Second, the RHD gene was analyzed in all samples by 1) quantitative multiplex PCR of short fluorescent fragments, and 2) direct sequencing, when necessary, for identifying structural variants and single nucleotide variants, respectively. RESULTS Additional serological typing yielded 51 and 1125 samples with weak/partial D and D-negative (D-) phenotype, respectively. In the first subset, partial RHD*06.03 was the most common variant allele (allele frequency: 18.6%). In the second subset, the whole deletion of the gene is largely the most frequent (allele frequency: 84.9%), followed by the Asian DEL allele found in 15.6% of the samples. Eight novel alleles with various mutational mechanisms were identified. CONCLUSION We report, for the first time at the national level, the molecular basis of weak/partial D and serologically D- phenotypes in Thai blood donors. The design and implementation of a dedicated diagnostic strategy in blood donors and patients are the very next steps for optimizing the management and supply of RBC units in Thailand.
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Affiliation(s)
- Jairak Thongbut
- Center of Research and Innovation, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand.,National Blood Centre, Thai Red Cross Society, Bangkok, Thailand
| | - Vishuda Laengsri
- Center of Research and Innovation, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | | | - Charuporn Promwong
- National Blood Centre, Thai Red Cross Society, Bangkok, Thailand.,Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - Chartchalerm I-Na-Ayudhya
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Claude Férec
- Univ Brest, Inserm, EFS, Brest, France.,Service de Génétique Médicale, CHRU Brest, Brest, France
| | - Pornlada Nuchnoi
- Center of Research and Innovation, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand.,Department of Clinical Microscopy, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Yann Fichou
- Univ Brest, Inserm, EFS, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
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Yanasik M, Oguz FS, Besisik SK, Huslu M, Ozturk G, Temurhan S, Aydin F. Frequency of RHD variants in serologically weak D Turkish blood donors. Transfus Apher Sci 2020; 60:103024. [PMID: 33308979 DOI: 10.1016/j.transci.2020.103024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND RhD typing has remained of primary importance, as being the leading cause of hemolytic disease of the newborn. Among Rh system's 55 blood group antigens, RhD is the most immunogenic. We aimed with this study to determine weak D/partial D variant frequency in blood donors who were admitted to our blood center and have serologically designated blood group weak D. MATERIALS AND METHODS We screened blood donors who admitted between 2011 and 2017 to our blood center. Sixty-seven serologically weak D phenotyped donors have participated in the study. These donors' samples were studied further by Polymerase Chain Reaction Sequence- Specific Primers (PCR-SSP) for determining D variants. RESULTS Weak D phenotype was detected in 228(0.12 %) out of 177,554 donors. Sixty-seven of them agreed to take part in the study. The frequency of weak D and partial D was 68.7 % (n = 46), and 22.4 % (n = 15), in order. The most encountered weak D and partial D variant was type 15 and DFR type, respectively. CONCLUSIONS The prevalence of serologically weak D phenotypes varies by race and ethnicity. Turkey is a country covering a mixture of European and Asian DNA with different ethnic groups. Thus, our research as giving the overall distribution of RHD variants from the largest city of Turkey, which may reflect the general ethnic background of the country, would help to the establishment of a databank for blood banking. This paper is the first molecular study on RHD variants in Turkey. New molecular research would be more reliable and precise.
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Affiliation(s)
- Melek Yanasik
- Istanbul Medical Faculty Hospital Blood Center, Istanbul University, Istanbul, Turkey
| | - Fatma Savran Oguz
- Istanbul Medical Faculty, Department of Medical Biology, Istanbul University, Istanbul, Turkey.
| | | | - Mukadder Huslu
- Istanbul Medical Faculty Hospital Blood Center, Istanbul University, Istanbul, Turkey
| | - Gulyuz Ozturk
- Department of Pediatric Hematology/Oncology & Bone Marrow Transplantation Unit, School of Medicine, Altunizade Hospital, Acıbadem University, Istanbul, Turkey
| | - Sonay Temurhan
- Istanbul Medical Faculty, Department of Medical Biology, Istanbul University, Istanbul, Turkey
| | - Filiz Aydin
- Istanbul Science University, Department of Medical Biology, Istanbul, Turkey
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Flegr J, Toman J, Hůla M, Kaňková Š. The role of balancing selection in maintaining human RhD blood group polymorphism: A preregistered cross-sectional study. J Evol Biol 2020; 34:426-438. [PMID: 33244840 DOI: 10.1111/jeb.13745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 01/05/2023]
Abstract
Maintenance of genetic polymorphism remains one of the big questions of evolutionary biology, which for a long time tended to be explained by balancing selection. This explanation was later criticized, but now is again accepted as an important mechanism in evolution. Human blood group systems seem affected by balancing selection especially strongly. In this preregistered study, we focused on stable coexistence of RhD-positive and RhD-negative subjects in a population. This is an evolutionary conundrum, because carriers of the less frequent negative allele suffer from lower fecundity due to haemolytic disease of the newborn affecting RhD-positive infants born to RhD-negative women. One explanation of persisting stability of RhD polymorphism points to heterozygote advantage. Over the past decade, numerous studies demonstrated that RhD-positive subjects score better than RhD-negative homozygotes in psychomotor tests and physical health-related variables. Still, evidence of better health and performance of heterozygotes is scarce and merely indirect. We compared the physical and mental health of 2,539 subjects whose RhD genotype was estimated based on their and their parents' RhD phenotype. We confirmed that RhD-negative homozygotes fare worse in terms of physical and mental health than subjects with RhD-positive phenotype and that RhD-positive heterozygotes enjoy better health than both homozygotes. For the first time, we demonstrated that RhD-positive homozygotes might suffer from worse health than RhD-negative homozygotes. Our results strongly support the hypothesis that RhD polymorphism is maintained by heterozygote advantage and that balancing selection may have played an important role in human evolution in this context and in general.
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Affiliation(s)
- Jaroslav Flegr
- Department of Philosophy and History of Science, Faculty of Science, Charles University, Prague, Czech Republic
| | - Jan Toman
- Department of Philosophy and History of Science, Faculty of Science, Charles University, Prague, Czech Republic
| | - Martin Hůla
- Department of Philosophy and History of Science, Faculty of Science, Charles University, Prague, Czech Republic
| | - Šárka Kaňková
- Department of Philosophy and History of Science, Faculty of Science, Charles University, Prague, Czech Republic.,Department of Applied Neuroscience and Neuroimaging, National Institute of Mental Health, Klecany, Czech Republic
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Srivastava K, Doescher A, Wagner FF, Flegel WA. NG_007494.1(RHD):c.[4A>T;5G>C;6_7insG] with an RhD-negative phenotype. Transfusion 2020; 60:E45-E47. [PMID: 33043462 DOI: 10.1111/trf.16115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrea Doescher
- DRK Blutspendedienst NSTOB, Institutes Springe and Bremen-Oldenburg, Springe, Germany
| | - Franz F Wagner
- DRK Blutspendedienst NSTOB, Institutes Springe and Bremen-Oldenburg, Springe, Germany
| | - Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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Flegel WA, Srivastava K. Frameshift variations in the RHD coding sequence: Molecular mechanisms permitting protein expression. Transfusion 2020; 60:2737-2744. [PMID: 33037655 DOI: 10.1111/trf.16123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/08/2020] [Accepted: 07/17/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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Vege S, Sprogøe U, Lomas-Francis C, Jakobsen MA, Antonsen B, Aeschlimann J, Yazer M, Westhoff CM. Impact of RHD genotyping on transfusion practice in Denmark and the United States and identification of novel RHD alleles. Transfusion 2020; 61:256-265. [PMID: 32975828 DOI: 10.1111/trf.16100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Reduced D antigen on red blood cells (RBCs) may be due to "partial" D phenotypes associated with loss of epitope(s) and risk for alloimmunization or "weak" D phenotypes that do not lack major epitopes with absence of clinical complications. Genotyping of samples with weak and discrepant D typing is recommended to guide transfusion and RhIG prophylaxis. The goal was to compare the impact of RHD genotyping on transfusion practice in two centers serving different populations. STUDY DESIGN AND METHODS Fifty-seven samples from Denmark and 353 from the United States with weak or discrepant D typing were genotyped. RBC typing was by multiple methods and reagents. DNA isolated from white blood cells was tested with RBC-Ready Gene D weak or CDE in Denmark or RHD BeadChip in the United States. RHD was sequenced for those unresolved. RESULTS Of Caucasian samples from Denmark, 90% (n = 51) had weak D types 1, 2, or 3; two had other weak D, two partial D, and two new alleles. In diverse ethnic U.S. samples, 44% (n = 155) had weak D types 1, 2, or 3 and 56% (n = 198) had other alleles: uncommon weak D (n = 13), weak 4.0 (n = 62), partial D (n = 107), no RHD (n = 9), and new alleles (n = 7). CONCLUSION Most samples with weak or variable D typing from Denmark had alleles without risk for anti-D. In U.S. samples, 48% could safely be treated as D+, 18% may require consideration if pregnancy possible, and 34% could potentially benefit from being treated as D-. Black and multiracial ethnicities were overrepresented relative to population.
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Affiliation(s)
- Sunitha Vege
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
| | - Ulrik Sprogøe
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Christine Lomas-Francis
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
| | - Marianne A Jakobsen
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Berit Antonsen
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Judith Aeschlimann
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
| | - Mark Yazer
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.,Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Connie M Westhoff
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
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Two Reliable Methodical Approaches for Non-Invasive RHD Genotyping of a Fetus from Maternal Plasma. Diagnostics (Basel) 2020; 10:diagnostics10080564. [PMID: 32764529 PMCID: PMC7460148 DOI: 10.3390/diagnostics10080564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/27/2022] Open
Abstract
Noninvasive fetal RHD genotyping is an important tool for predicting RhD incompatibility between a pregnant woman and a fetus. This study aimed to assess a methodological approach other than the commonly used one for noninvasive fetal RHD genotyping on a representative set of RhD-negative pregnant women. The methodology must be accurate, reliable, and broadly available for implementation into routine clinical practice. A total of 337 RhD-negative pregnant women from the Czech Republic region were tested in this study. The fetal RHD genotype was assessed using two methods: real-time PCR and endpoint quantitative fluorescent (QF) PCR. We used exon-7-specific primers from the RHD gene, along with internal controls. Plasma samples were analyzed and measured in four/two parallel reactions to determine the accuracy of the RHD genotyping. The RHD genotype was verified using DNA analysis from a newborn buccal swab. Both methods showed an excellent ability to predict the RHD genotype. Real-time PCR achieved its greatest accuracy of 98.6% (97.1% sensitivity and 100% specificity (95% CI)) if all four PCRs were positive/negative. The QF PCR method also achieved its greatest accuracy of 99.4% (100% sensitivity and 98.6% specificity (95% CI)) if all the measurements were positive/negative. Both real-time PCR and QF PCR were reliable methods for precisely assessing the fetal RHD allele from the plasma of RhD-negative pregnant women.
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Chun S, Kim H, Yun JW, Yu H, Seo JY, Cho D. RHD genotyping is recommended for all patients with serological weak-D phenotypes in Asian populations – Cases with coexistence of weak-D and Asia type DEL alleles results in complete expression of D-antigen. Transfus Apher Sci 2020; 59:102807. [DOI: 10.1016/j.transci.2020.102807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 04/08/2020] [Accepted: 04/19/2020] [Indexed: 11/25/2022]
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Classification of major and minor blood group antigens in the Kuwaiti Arab population. Transfus Apher Sci 2020; 59:102748. [DOI: 10.1016/j.transci.2020.102748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 11/24/2022]
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Flegr J, Kuba R, Kopecký R. Rhesus-minus phenotype as a predictor of sexual desire and behavior, wellbeing, mental health, and fecundity. PLoS One 2020; 15:e0236134. [PMID: 32687529 PMCID: PMC7371180 DOI: 10.1371/journal.pone.0236134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/29/2020] [Indexed: 12/25/2022] Open
Abstract
Background Since its discovery in the 1930s, the effects of Rh phenotype on human health and wellbeing, with the exception of the effects of Rh-negativity of a mother on the risk of hemolytic anemia of Rh-positive children, has only rarely been studied. In the last few years, however, several studies have shown that Rh-negative subjects have worse health and performance in certain tests than their Rh-positive peers. Nothing is known about the effect of Rh phenotype on the quality of life of subjects as measured by a standard instrument. Methods We hereby analyzed the data of 1768 male (24% Rh-negative) and 3759 female participants (23% Rh-negative) of an anonymous internet study using the partial Kendall test with the age and the population of the hometown of subjects controlled. Results The results showed that the Rh-negative women, but not men, scored worse in wellbeing measured with the WHO-BREFF. The Rh-negative men scored worse in mental health-related variables and in their reported economic situation and the Rh-negative women scored better in physical health-related variables. Both the Rh-negative men and women reported higher sexual activity than their Rh-positive peers. Conclusions The effects of the Rh phenotype were significant after the correction for multiple tests. However, they were usually weaker and less numerous than those of smoking, consuming alcohol, and high body mass index, which were used as a sort of internal control.
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Affiliation(s)
- Jaroslav Flegr
- Department of Applied Neurosciences and Brain Imagination, National Institute of Mental Health, Klecany, Czech Republic
- Department of Philosophy and History of Science, Faculty of Science, Charles University, Prague, Czech Republic
- * E-mail:
| | - Radim Kuba
- Department of Philosophy and History of Science, Faculty of Science, Charles University, Prague, Czech Republic
- Department of Teaching and Didactics of Biology, Faculty of Science, Charles University, Prague, Czech Republic
| | - Robin Kopecký
- Department of Philosophy and History of Science, Faculty of Science, Charles University, Prague, Czech Republic
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Asif M, Aldarweesh F. Educational Case: Partial D Phenotype and Role of RhoGAM. Acad Pathol 2020; 7:2374289520934088. [PMID: 32671197 PMCID: PMC7338731 DOI: 10.1177/2374289520934088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/27/2020] [Accepted: 05/09/2020] [Indexed: 11/16/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1.
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Serological Detection of Rh-Del Phenotype among Rh-Negative Blood Donors at National Blood Center, Yangon, Myanmar. Adv Hematol 2020; 2020:3482124. [PMID: 32148507 PMCID: PMC7049430 DOI: 10.1155/2020/3482124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/16/2020] [Indexed: 11/21/2022] Open
Abstract
Background Red cell Rhesus (Rh) antigen expression is influenced by the genetic polymorphism of RHD and RHCE genes and reveals serologically different reactions of RhD variants such as partial D, weak D, and Rh-Del. Serologically, Rh-Del type can only be detected by an adsorption-elution technique, and it might be mistyped as Rh-negative. The prevalence of Rh-Del has not been reported yet in Myanmar. Method A total of 222 Rh-negative blood donors in the National Blood Center were tested for weak D and Rh-Del by indirect antihuman globulin and adsorption-elution method, respectively. RhCE typing was performed among Rh-negative and Rh-Del. Results Of them, 75.2% (167/222) were Rh-negative, 15.8% (35/222) were Rh-Del, and 9% (20/222) were weak D. Of 202 blood donors (167 true Rh-negative and 35 Rh-Del), all of the Rh-Del positives were C-antigen-positive with 94.3% Ccee phenotype (33/35) and 5.7% CCee (2/35). Most of the Rh-negative donors (80.2%) were ccee phenotype (134/167). Conclusion About half of Rh-Del subjects were repeated donors, and attention was needed to avoid transfusion of truly Rh-negative patients to prevent alloimmunization. It is recommended to do Rh-Del typing of Rh-negative donors who are C-antigen-positive and consider moving them to the Rh-positive pool. Further study is needed to clarify the alloimmunization status for transfusion of Rh-Del blood to Rh-negative recipients. Molecular markers for RhD-negative and D variants should be established in the Myanmar population to improve selection of antisera for Rh typing and enhance safety of the transfusion services.
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Zhang Y, Xu H, Wang X, Wang L, Liu R, Li L, Zhou H. Single‑strained DNA aptamers mask RhD antigenic epitopes on human RhD+ red blood cells to escape alloanti‑RhD immunological recognition. Mol Med Rep 2020; 21:1841-1848. [PMID: 32319623 PMCID: PMC7057830 DOI: 10.3892/mmr.2020.10985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/24/2020] [Indexed: 02/07/2023] Open
Abstract
Rhesus D‑ (RhD‑) individuals should receive Rh‑matched blood to prevent hemolytic anemia. However, there is a shortage of RhD‑ blood. This study aimed to generate RhD antigen‑specific single‑stranded DNA (ssDNA) aptamers, and test their efficacy in masking RhD antigens on RhD+ red blood cells (RBCs) to prevent their immunoreactivity in vitro. In the present study, ssDNA aptamer candidates were synthesized as a central randomized sequence of 40 nucleotides (nt) flanked by 21‑nt primer hybridization sequences. The functional aptamers were screened using the cell‑based systematic evolution of ligands by exponential enrichment technique and RhD+ RBCs. Two bioactive ssDNA aptamers significantly inhibited the binding of an anti‑RhD antibody to RhD+ RBCs and bound to RhD antigens with high affinity (dissociation constant values of 580.5±142.0 and 737.7±161.8 nM, respectively). Furthermore, treatment with both ssDNA aptamers (500 pmol) effectively masked RhD antigens on 4,000,000 RhD+ RBCs to prevent human anti‑RhD alloantibody‑mediated binding, RBC agglutination and monocyte recognition in vitro. Collectively, such data suggested that these ssDNA aptamers may be feasible for masking RhD antigens on RBCs, and thus valuable for prevention or at least amelioration of RhD+‑related hemolytic anemia in RhD‑ individuals.
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Affiliation(s)
- Yinze Zhang
- Department of Transfusion, International Cancer Center, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, Guangdong 518055, P.R. China
| | - Hua Xu
- Shaanxi Blood Center, Institute of Transfusion Medicine, Xi'an, Shaanxi 710061, P.R. China
| | - Xin Wang
- Department of Transfusion, International Cancer Center, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, Guangdong 518055, P.R. China
| | - Lin Wang
- Department of Transfusion, International Cancer Center, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, Guangdong 518055, P.R. China
| | - Ruiqi Liu
- Department of Transfusion, International Cancer Center, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, Guangdong 518055, P.R. China
| | - Lu Li
- Department of Transfusion, International Cancer Center, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, Guangdong 518055, P.R. China
| | - Huayou Zhou
- Department of Transfusion, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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de Almeida FAA, Dezan MR, Oliveira VB, Alencar CS, Luz F, Krieger JE, Pereira AC, Sabino EC, Rocha V, Mendrone-Júnior A, Dinardo CL. Effectiveness of strategies to screen for blood donors with RH variants in a mixed population. Transfus Apher Sci 2020; 59:102720. [PMID: 31980333 DOI: 10.1016/j.transci.2020.102720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/26/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patients with RH variants presenting antibodies directed to RH high frequency antigens or multiple RH antibodies might, in some occasions, be better served with RH genotype-matched units, requiring screening for RH variants among blood donors. To date, strategies to identify donors with RH variants were restricted to selecting individuals of African descent based on self-reported race, what can be inaccurate in racially mixed population. Our goal was to: 1) Screen for donors with RH variants in a mixed population using self-declared race and Rh phenotype as selection criteria; and 2) Verify if including the Duffy null genotype in the screening algorithm increases its effectiveness. METHODS Brazilian donors were included if self-declared as black and phenotyped as R0r or R1r. All individuals were genotyped for RHCE exons 1, 5, 6 and 7 and for the FY*B c.-67 T > C polymorphism in order to determine the Duffy null genotype. RHD variants were searched for in cases of altered RHCE. RESULTS Among 2500 blood donors, 217 fulfilled the inclusion criteria and were enrolled. Fifty-three (24.4 %) had a predicted clinically relevant Rh phenotype (partial antigens or lack of high frequency antigens). Twelve donors (5.5 %) had a predicted RhCE phenotype lacking either hrB or hrS. Most cases with predicted lack of high frequency antigens (66.7 %) occurred in donors with the Duffy null genotype. CONCLUSION Selecting donors based on self-declared race, Rh phenotype and Duffy null genotype is feasible and effective in identifying RH variants lacking Rh high frequency antigens among racially mixed donors.
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Affiliation(s)
- Fabio Augusto Abreu de Almeida
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina da USP, São Paulo, Brazil
| | | | - Valeria Brito Oliveira
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina da USP, São Paulo, Brazil
| | - Cecilia Salete Alencar
- Instituto de Medicina Tropical, Faculdade de Medicina da USP, São Paulo, Brazil; Central Laboratory, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil
| | - Fabio Luz
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
| | - José Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), São Paulo, Brazil
| | | | | | - Vanderson Rocha
- Serviço de Hematologia, Hemoterapia e Terapia Celular Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Department of Hematology, Churchill Hospital, NHS BT, Oxford University, Oxford, United Kingdom
| | | | - Carla Luana Dinardo
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina da USP, São Paulo, Brazil.
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Kaňková Š, Flegr J, Toman J, Calda P. Maternal RhD heterozygous genotype is associated with male biased secondary sex ratio. Early Hum Dev 2020; 140:104864. [PMID: 31500940 DOI: 10.1016/j.earlhumdev.2019.104864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies suggest that RhD positive heterozygotes express better health status than RhD positive homozygotes and especially RhD negative subjects. This also applies to pregnant women. According to the Trivers-Willard hypothesis, women in better physical condition should have more sons. AIM To test the hypothesis that RhD positive heterozygous mothers have a male-skewed sex ratio. STUDY DESIGN Cross-sectional study. The data was analysed using Chi-Square test for all women, separately for RhD positive and RhD negative women, and separately for primiparous and multiparous women. The effects of maternal weight as a continuous predictor and the RhD phenotype of newborn as a categorical predictor of newborn sex were evaluated by the generalized linear model (GLZ) separately for RhD positive and RhD negative women using binomial distribution and logit link function. OUTCOME MEASURES Clinical records comprised maternal weight before pregnancy, number of previous deliveries, sex of the newborn, maternal RhD phenotype, and RhD phenotype of the newborn. SUBJECTS We analysed data from 5655 women who gave birth between 2008 and 2012 in General University Hospital in Prague. RESULTS Secondary sex ratio was significantly higher (P = 0.028) in RhD positive mothers who had RhD negative newborns, i.e., in heterozygotes (SR = 1.23), than in RhD positive mothers who had RhD positive newborns, i.e., in a mixed population of heterozygotes and homozygotes (SR = 1.00), especially in primiparous women (P = 0.013; SR = 1.37 and 0.99 resp.). CONCLUSION The sex ratio at birth was significantly higher in RhD positive mothers who had RhD negative newborns than in RhD positive mothers who had RhD positive newborns.
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Affiliation(s)
- Šárka Kaňková
- Department of Philosophy and History of Science, Faculty of Science, Charles University, Prague CZ-128 44, Prague 2, Czech Republic.
| | - Jaroslav Flegr
- Department of Philosophy and History of Science, Faculty of Science, Charles University, Prague CZ-128 44, Prague 2, Czech Republic
| | - Jan Toman
- Department of Philosophy and History of Science, Faculty of Science, Charles University, Prague CZ-128 44, Prague 2, Czech Republic
| | - Pavel Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague CZ-128 08, Prague 2, Czech Republic
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Bakry RM, Nasreldin E, Hassaballa AE, Mansour SM, Aboalia SA. Evaluation of molecular typing and serological methods in solving discrepant results of weak and partial D (Rh) in South Egypt. Asian J Transfus Sci 2019; 13:110-114. [PMID: 31896917 PMCID: PMC6910034 DOI: 10.4103/ajts.ajts_162_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/31/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Rh discrepancies produced by partial and weak D phenotypes are a problem during routine testing. Some blood units with weak and partial D expression may be missed by serology. Overcoming the limitations of serology can be achieved by molecular typing. Our objective was to evaluate currently used serologic methods with the molecular analysis in solving discrepant results of weak and partial D (Rh) in South Egypt. PATIENTS AND METHODS Fifty blood donor and patient samples with undetermined D phenotype were subjected to serology to define their phenotype using identification (ID)-Card "ID-partial RhD typing set" using six monoclonal anti-D panels, followed by molecular typing using polymerase chain reaction sequence-specific primer kit. RESULTS Molecular typing confirmed most of the serology results; two samples previously resolved as partial D Type 3 and DFR by serological methods were clarified by molecular techniques - one sample as weak Type 4 and the other sample as weak Type 3. Among the weak D alleles found in our study, Type 4 was the most common, with a frequency of 20%, followed by Type 3 (14%), Type 1 (8%), Type 2 (6%), and finally, Type 5 with a frequency of 3%. The most common types of partial D were partial D Type D5 (14%) and Type D3 (10%). CONCLUSION Our study identified D variants (weak D and partial D categories) of the antigen D and determined the frequency and composition of partial D and weak D alleles in our population. Molecular typing also confirmed most of the results obtained from serological methods.
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Affiliation(s)
- Rania M Bakry
- Department of Oncological Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Eman Nasreldin
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ashraf E Hassaballa
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Samar M Mansour
- Department of Oncological Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Sahar A Aboalia
- Department of Oncological Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
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