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Weidner L, Allhoff W, Pistorius C, Witt V, Rohde E, Schistal E, Jungbauer C. When the available blood supply mismatches the needs of the patient. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2023; 21:378-384. [PMID: 36346886 PMCID: PMC10497382 DOI: 10.2450/2022.0166-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Substantial regional differences in the genetic patterns related to blood group have been observed across different continents. This diversity means that the blood supply, as an essential part of patient care, is increasingly impacted by global migration. Consequently, the Austrian blood donor population does not match the immigrant patient population. This mismatch is likely to result in the formation of alloantibodies to red cell antigens in the chronically transfused. Subsequently, major difficulties in providing compatible blood emerge. MATERIAL AND METHODS The study included patients of African origin (n=290) and Caucasians who represent the Austrian donor population (n=1,017). Genetic typing was performed for up to 69 blood group polymorphisms with a multiplex sequence specific primer-PCR including high frequency antigens and antigens for which antisera are not commercially available. By assessing differences in antigen frequencies between the two populations, and using these data for prophylactic matching, we aim to develop tools to increase the quality of patient care. RESULTS Results indicate various and significant differences (p<0.0001) in antigen frequencies between African patients and the European donor population, especially in the MNS, Duffy, Knops and Rhesus systems. DISCUSSION Our data highlight the importance of matching the donor population to the demographics of the patient population. In addition, it underlines the need to recruit donors of African origin and to focus on the upcoming challenges, such as malaria semi-immunity and a significantly higher rate of infectious disease in this population. It is also recommended to apply extended genetic typing to detect rare blood types, and (cryo)storage of rare blood in national and international rare blood banks. Co-operation with regional blood banks should also be encouraged.
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Affiliation(s)
- Lisa Weidner
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
| | - Wolfgang Allhoff
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
| | - Charlotte Pistorius
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
| | - Volker Witt
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
- St. Anna Kinderspital, Department for Pediatrics, Medical University of Vienna (MUW),Vienna, Austria
| | - Eva Rohde
- Department of Transfusion Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Elisabeth Schistal
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
| | - Christof Jungbauer
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
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2
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Genotyping and the Future of Transfusion in Sickle Cell Disease. Hematol Oncol Clin North Am 2022; 36:1271-1284. [DOI: 10.1016/j.hoc.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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3
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Ohto H, Albert Flegel W, Safic Stanic H. When should RhD-negative recipients be spared the transfusion of DEL red cells to avoid anti-D alloimmunization? Transfusion 2022; 62:2405-2408. [PMID: 36156264 PMCID: PMC9643616 DOI: 10.1111/trf.17122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hitoshi Ohto
- Department of Mesenchymal Stem Cell Research, and 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, MD, USA
| | - Hana Safic Stanic
- Department of Immunohematology, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
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4
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Abstract
Thalassaemia is a diverse group of genetic disorders with a worldwide distribution affecting globin chain synthesis. The pathogenesis of thalassaemia lies in the unbalanced globin chain production, leading to ineffective erythropoiesis, increased haemolysis, and deranged iron homoeostasis. The clinical phenotype shows heterogeneity, ranging from close to normal without complications to severe requiring lifelong transfusion support. Conservative treatment with transfusion and iron chelation has transformed the natural history of thalassaemia major into a chronic disease with a prolonged life expectancy, albeit with co-morbidities and substantial disease burden. Curative therapy with allogeneic haematopoietic stem cell transplantation is advocated for suitable patients. The understanding of the pathogenesis of the disease is guiding therapeutic advances. Novel agents have shown efficacy in improving anaemia and transfusion burden, and initial results from gene therapy approaches are promising. Despite scientific developments, worldwide inequality in the access of health resources is a major concern, because most patients live in underserved areas.
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Affiliation(s)
- Antonis Kattamis
- Division of Paediatric Haematology-Oncology, First Department of Paediatrics, National and Kapodistrian University of Athens, Athens, Greece.
| | - Janet L Kwiatkowski
- Division of Haematology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Paediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yesim Aydinok
- Department of Paediatric Heamatology and Oncology, Ege University School of Medicine, Izmir, Turkey
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5
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Luken JS, Ritsema SP, Van der Wal MM, van der Schoot CE, Rouwette EAJA, de Haas M, Janssen MP. Mapping anticipated advantages and disadvantages of implementation of extensive donor genotyping: A focus group approach. Transfus Med 2022; 32:366-374. [PMID: 35668008 DOI: 10.1111/tme.12887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/11/2022] [Accepted: 04/24/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Current genotyping techniques allow typing of all relevant red cell, human leukocyte and platelet antigens in a single analysis. Even genetic markers related to donor health can be added. Implementation of this technology will affect various stakeholders within the transfusion chain. This study aims to systematically map the anticipated advantages and disadvantages of a national rollout of blood group genotyping of donors, which will affect the availability of rare donors and the implementation of an extensively typed blood transfusion policy. MATERIALS AND METHODS Two focus-group sessions were held with a wide representation of stakeholders, including representatives of donor and patient organisations. A dedicated software tool was used to collect the reflections of participants on genotyping for blood group antigens and extensive matching. Additionally, stakeholders and experts discussed various prepared propositions. All information collected was categorised. RESULTS From 162 statements collected, 59 statements (36%) were labelled as 'hopes' and 77 (48%) as 'fears'. Twenty-six (16%) statements remained unlabelled. The statements were divided in 18 categories under seven main themes: patient health, genotyping, privacy issues and ethical aspects, donor management, inventory management and logistics, hospital and transfusion laboratory and general aspects. The discussion on the propositions was analysed and summarised. CONCLUSION Stakeholders believe that a genotyped donor pool can result in a reduction of alloimmunization and higher availability of typed blood products. There are concerns regarding logistics, costs, consent for extended typing, data sharing, privacy issues and donor management. These concerns need to be carefully addressed before further implementation.
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Affiliation(s)
- Jessie S Luken
- Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Sebastien P Ritsema
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
| | - Merel M Van der Wal
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
| | | | - Masja de Haas
- Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mart P Janssen
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
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6
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van Sambeeck JHJ, van der Schoot CE, van Dijk NM, Schonewille H, Janssen MP. Extended red blood cell matching for all transfusion recipients is feasible. Transfus Med 2021; 32:221-228. [PMID: 34845765 DOI: 10.1111/tme.12831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/08/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To demonstrate the feasibility and effectiveness of extended matching of red blood cells (RBC) in practice. BACKGROUND At present, alloimmunisation preventing matching strategies are only applied for specific transfusion recipient groups and include a limited number of RBC antigens. The general assumption is that providing fully matched RBC units to all transfusion recipients is not feasible. In this article we refute this assumption and compute the proportion of alloimmunisation that can be prevented, when all donors and transfusion recipients are typed for A, B, D plus twelve minor blood group antigens (C, c, E, e, K, Fya , Fyb , Jka , Jkb , M, S and s). METHODS We developed a mathematical model that determines the optimal sequence for antigen matching. The model allows for various matching strategies, issuing policies and inventory sizes. RESULTS For a dynamic inventory composition (accounting for randomness in the phenotypes supplied and requested) and an antigen identical issuing policy 97% and 94% of alloimmunisation events can be prevented, when respectively one and two RBC units per recipient are requested from an inventory of 1000 units. Although this proportion decreases with smaller inventory sizes, even for an inventory of 60 units almost 50% of all alloimmunisation events can be prevented. CONCLUSION In case antigen of both donors and recipients are comprehensively typed, extended preventive matching is feasible for all transfusion recipients in practice and will significantly reduce transfusion-induced alloimmunisation and (alloantibody-induced) haemolytic transfusion reactions.
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Affiliation(s)
- Joost H J van Sambeeck
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Center for Healthcare Operations Improvement and Research, University of Twente, Enschede, The Netherlands.,Department of Stochastic Operations Research, University of Twente, Enschede, The Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nico M van Dijk
- Center for Healthcare Operations Improvement and Research, University of Twente, Enschede, The Netherlands.,Department of Stochastic Operations Research, University of Twente, Enschede, The Netherlands
| | - Henk Schonewille
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
| | - Mart P Janssen
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
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7
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Yin Q, Flegel WA. DEL in China: the D antigen among serologic RhD-negative individuals. J Transl Med 2021; 19:439. [PMID: 34670559 PMCID: PMC8527646 DOI: 10.1186/s12967-021-03116-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/21/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Providing RhD-negative red cell transfusions is a challenge in East Asia, represented by China, Korea, and Japan, where the frequency of RhD-negative is the lowest in the world. FINDINGS Among 56 ethnic groups in China, the RhD-negative frequency in Han, the prevalent ethnicity, is 0.5% or less, similar to most other ethnic groups. The Uyghur ethnic group has the highest reported RhD-negative frequency of up to 4.7%, as compared to 13.9% in the US. However, an estimated 7.15 million RhD-negative people live in China. The RhD-negative phenotype typically results from a loss of the entire RHD gene, causing the lack of the RhD protein and D antigen. The DEL phenotype carries a low amount of the D antigen and types as RhD-negative in routine serology. The DEL prevalence in RhD-negative individuals averages 23.3% in the Han, 17% in the Hui and 2.4% in the Uyghur ethnicities. The Asian type DEL, also known as RHD*DEL1 and RHD:c.1227G > A allele, is by far the most prevalent among the 13 DEL alleles observed in China. CONCLUSION The purpose of this review is to summarize the data on DEL and to provide a basis for practical strategy decisions in managing patients and donors with DEL alleles in East Asia using molecular assays.
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Affiliation(s)
- Qinan Yin
- Laboratory Services Section, Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
- Henan University of Science and Technology, Luoyang, Henan, China
| | - Willy Albert Flegel
- Laboratory Services Section, Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.
- Huazhong University of Science and Technology, Wuhan, Hubei, China.
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8
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Al-Riyami AZ, Al Hinai D, Al-Rawahi M, Al-Hosni S, Al-Zadjali S, Al-Marhoobi A, Al-Khabori M, Al-Riyami H, Denomme GA. Molecular blood group screening in Omani blood donors. Vox Sang 2021; 117:424-430. [PMID: 34647328 DOI: 10.1111/vox.13204] [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: 06/18/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Blood group genotyping has been used in different populations. This study aims at evaluating the genotypes of common blood group antigens in the Omani blood donors and to assess the concordance rate with obtained phenotypes. MATERIAL AND METHODS Blood samples from 180 Omani donors were evaluated. Samples were typed by serological methods for the five blood group systems MNS, RH (RHD/RHCE), KEL, FY and JK. Samples were genotyped using RBC-FluoGene vERYfy eXtend kit (inno-train©). Predicted phenotypic variants for 70 red blood cell antigens among the MNS, RH (RHD/RHCE), KEL, FY, JK, DO, LU, YT, DI, VEL, CO and KN blood group systems were assessed. RESULTS Simultaneous phenotype and genotype results were available in 130 subjects. Concordance rate was >95% in all blood group systems with exception of Fy(b+) (87%). Homozygous GATA-1 mutation leading to erythroid silencing FY*02N.01 (resulting in the Fy(b-)ES phenotype) was detected in 81/112 (72%) of genotyped samples. In addition, discrepant Fyb phenotype/genotype result was obtained in 14/112 samples; 13 of which has a heterozygous GATA-1 mutation and one sample with a wild GATA genotype. D and partial e c.733C>G variants expressing the V+VS+ phenotype were found in 22/121 (18.2%) and 14/120 (11.7%) of the samples, respectively. Di(a-b+), Js(a-b+), Yt(a+b-) and Kn(a+b-) genotype frequencies were 99.4%, 95.8%, 91.9% and 97.7%, respectively. CONCLUSION In conclusion, we report a high frequency of FY*02N.01 allele due to homozygous c.-67T>C GATA-1 single-nucleotide variation. This is the first study reporting the detailed distribution of common and rare red cell genotypes in Omani blood donors.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Dina Al Hinai
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al-Rawahi
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Saif Al-Hosni
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Ali Al-Marhoobi
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Murtadha Al-Khabori
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Hamad Al-Riyami
- Department of Genetics, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Gregory A Denomme
- Diagnostic Laboratories, Versiti Blood Center of Wisconsin, Milwaukee, Wisconsin, USA
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9
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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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10
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Allen ES, Cohn CS, Bakhtary S, Dunbar NM, Gniadek T, Hopkins CK, Jacobson J, Lokhandwala PM, Metcalf RA, Murphy C, Prochaska MT, Raval JS, Shan H, Storch EK, Pagano MB. Current advances in transfusion medicine 2020: A critical review of selected topics by the AABB Clinical Transfusion Medicine Committee. Transfusion 2021; 61:2756-2767. [PMID: 34423446 DOI: 10.1111/trf.16625] [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: 04/02/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The AABB Clinical Transfusion Medicine Committee (CTMC) compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine (TM), which has been made available as a manuscript published in Transfusion since 2018. METHODS CTMC committee members reviewed original manuscripts including TM-related topics published electronically (ahead) or in print from December 2019 to December 2020. The selection of topics and manuscripts was discussed at committee meetings and chosen based on relevance and originality. Next, committee members worked in pairs to create a synopsis of each topic, which was then reviewed by two additional committee members. The first and senior authors of this manuscript assembled the final manuscript. Although this synopsis is extensive, it is not exhaustive, and some papers may have been excluded or missed. RESULTS The following topics are included: COVID-19 effects on the blood supply and regulatory landscape, COVID convalescent plasma, adult transfusion practices, whole blood, molecular immunohematology, pediatric TM, cellular therapy, and apheresis medicine. CONCLUSIONS This synopsis provides easy access to relevant topics and may be useful as an educational tool.
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Affiliation(s)
- Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sara Bakhtary
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Thomas Gniadek
- Department of Pathology, NorthShore University Health System, Chicago, Illinois, USA
| | | | - Jessica Jacobson
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, USA
| | - Parvez M Lokhandwala
- American Red Cross, Biomedical Services, Baltimore, Maryland, USA.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ryan A Metcalf
- Clinical Pathology Division, Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Colin Murphy
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Micah T Prochaska
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Hua Shan
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Emily K Storch
- Office of Blood Research and Review, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Monica B Pagano
- Transfusion Medicine Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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11
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Savinkina AA, Haass KA, Sapiano MRP, Henry RA, Berger JJ, Basavaraju SV, Jones JM. Transfusion-associated adverse events and implementation of blood safety measures - findings from the 2017 National Blood Collection and Utilization Survey. Transfusion 2021; 60 Suppl 2:S10-S16. [PMID: 32134123 DOI: 10.1111/trf.15654] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Serious transfusion-associated adverse events are rare in the United States. To enhance blood safety, various measures have been developed. With use of data from the 2017 National Blood Collection and Utilization Survey (NBCUS), we describe the rate of transfusion-associated adverse events and the implementation of specific blood safety measures. STUDY DESIGN AND METHODS Data from the 2017 NBCUS were used with comparison to already published estimates from 2015. Survey weighting and imputation were used to obtain national estimates of transfusion-associated adverse events, and the number of units treated with pathogen reduction technology (PRT), screened for Babesia, and leukoreduced. RESULTS The rate of transfusion-associated adverse events requiring any diagnostic or therapeutic interventions was stable (275 reactions per 100,000 transfusions in 2015 and 282 reactions per 100,000 transfusions in 2017). In 2017 among US blood collection centers, 16 of 141 (11.3%) reported screening units for Babesia and 28 of 144 (19.4%) reported PRT implementation; 138 of 2279 (6.1%) hospitals reported transfusing PRT-treated platelets. In 2017, 134 of 2336 (5.7%) hospitals reported performing secondary bacterial testing of platelets (50,922 culture-based and 63,220 rapid immunoassay tests); in 2015, 71 of 1877 (3.8%) hospitals performed secondary testing (87,155 culture-based and 21,779 rapid immunoassay tests). Nearly all whole blood/red blood cell units and platelet units were leukoreduced. CONCLUSIONS Besides leukoreduction, implementation of most blood safety measures reported in this study remains low. Nationally, hospitals might be shifting from culture-based secondary bacterial testing to rapid immunoassays.
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Affiliation(s)
- Alexandra A Savinkina
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Kathryn A Haass
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mathew R P Sapiano
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard A Henry
- Office of HIV/AIDS and Infectious Disease Policy, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Washington, District of Columbia
| | - James J Berger
- Office of HIV/AIDS and Infectious Disease Policy, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Washington, District of Columbia
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jefferson M Jones
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Yang MH, Chen JW, Wei ST, Hou SM, Chen YJ. The efficacy of ethnic specific blood groups genotyping for routine donor investigation and rare donor identification in Taiwan. Vox Sang 2021; 117:99-108. [PMID: 34159602 DOI: 10.1111/vox.13133] [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: 07/22/2020] [Revised: 04/16/2021] [Accepted: 05/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Large-scale single nucleotide variation (SNV)-based blood group genotyping assays have been made available for over a decade. Due to differences in ethnic groups, there is much diversity in clinically important blood group antigens and genetic variants. Here, we developed a robust matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF)-based blood group genotyping method on MassARRAY system. STUDY DESIGN AND METHODS A total of 1428 donors were enrolled into three groups: (a) reagent red cell donors; (b) rare donor or common antigen-negative donors; and (c) group O, R1 R1 /R2 R2 donors. Forty-two SNVs were designed for determining nine blood groups, with X/Y chromosome in two multiplex reactions, on MassARRAY 96-well format system. Further targeted sequence analyses were performed by Sanger sequencing. RESULTS WHO reference reagent (NIBSC code: 11/214) was tested for concordance with the provided genotype results. Among the donors, concordance rate was over 99%. Alleles of important phenotypes such as Mi(a+), Di(a+), and Asian-type DEL and alleles of rare blood groups such as Fy(a-), Jk(a-b-) and s- were screened. Three types of discrepancies were found. Serologically, the 'N' antigen was expressed on genetically MM with GYP*Mur red blood cells and caused genuine discrepancies (9.5%). Genetically, allele dropout (ADO) was caused by rare SNV in the primer for Ss genotype (2.1%) and partial insertion of RHD genes (0.9%) led to difficulties in predicting phenotypes. CONCLUSION Hemo panel module and MassARRAY System in 96-well format showed good performance in terms of large-scale blood group genotyping and phenotype predictions. Implementation of this method is effective for routine blood group genotype screening of donors.
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Affiliation(s)
- Meng-Hua Yang
- Head Office, Taiwan Blood Services Foundation, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jen-Wei Chen
- Head Office, Taiwan Blood Services Foundation, Taipei, Taiwan
| | - Sheng-Tang Wei
- Head Office, Taiwan Blood Services Foundation, Taipei, Taiwan
| | - Sheng-Mou Hou
- Head Office, Taiwan Blood Services Foundation, Taipei, Taiwan.,Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Yann-Jang Chen
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Life Sciences and Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan.,Department of Pediatrics, Taipei Veteran General Hospital, Taipei, Taiwan.,Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
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13
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Pre-analytic depletion of medicinal anti-CD38 antibody from patient plasma for immunohematology testing. Blood 2021; 138:814-817. [PMID: 34086874 PMCID: PMC8414259 DOI: 10.1182/blood.2021011396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/24/2021] [Indexed: 12/17/2022] Open
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14
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Trépanier P, Chevrier MC, Constanzo Yanez J, Baillargeon N, St-Pierre C, Perreault J. Adapting to supply-and-demand emerging trends for antigen-negative red blood cell units. Transfusion 2021; 61:1489-1494. [PMID: 33515215 DOI: 10.1111/trf.16285] [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: 06/12/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND A global downtrend in blood usage has been observed by many countries, while the demand for antigen-negative red blood cell (RBC) units used in antigen-matched transfusions keeps increasing. The declining number of units collected exposes blood providers to a rapidly evolving supply challenge. METHODS This study was conducted retrospectively with use of internal data analysis to weigh Québec's situation regarding global and antigen-negative RBC demand, to measure the effects of community-directed recruitment and blood drives, and to evaluate the benefits of mass-scale RBC genotyping. RESULTS Our findings confirm a global RBC usage downtrend of over 20% total in the past 10 years with a steady antigen-negative usage and highlight the most requested negative antigen combinations. Our data also show our +39.5% progress regarding the number of Black donors recruited for antigen matching of patients with sickle cell disease in the past 3 years, as well as a constantly growing number of just-in-time blood collection for complex orders. Finally, our data summarize the efficiency of our mass-scale RBC genotyping efforts. CONCLUSION Altogether, this study confirms the demand trends for regular and antigen-negative RBC units in Québec and the efficient effects of our recruitment and typing strategies.
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Affiliation(s)
- Patrick Trépanier
- Héma-Québec, Medical Affairs and Innovation, Québec City, Québec, Canada
| | | | | | | | - Christine St-Pierre
- Héma-Québec, Customer Experience and Business Intelligence, St-Laurent, Québec, Canada
| | - Josée Perreault
- Héma-Québec, Medical Affairs and Innovation, Québec City, Québec, Canada
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15
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Srivastava K, Albasri J, Alsuhaibani OM, Aljasem HA, Bueno MU, Antonacci T, Branch DR, Denomme GA, Flegel WA. SCAR: The high-prevalence antigen 013.008 in the Scianna blood group system. Transfusion 2021; 61:246-254. [PMID: 33098316 PMCID: PMC9067365 DOI: 10.1111/trf.16152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/31/2020] [Accepted: 09/24/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Scianna (SC) blood group system comprises seven antigens. They reside on the erythroblast membrane-associated glycoprotein (ERMAP). The ERMAP and RHCE genes are juxtaposed to each other on chromosome 1. We report a novel SC antigen. STUDY DESIGN AND METHODS Blood samples came from a patient and his two sisters in Saudi Arabia. To investigate the antibody specificity we used the column agglutination technique and soluble recombinant ERMAP protein. The significance of anti-SCAR was evaluated by the transfusion history and a monocyte monolayer assay. We determined the genomic sequence of ERMAP and RHCE genes. RESULTS The patient's serum showed an antibody of titer 8 against a high-prevalence antigen. The soluble recombinant ERMAP protein inhibited the antibody. The propositus genotyped homozygous for an ERMAP:c.424C>G variant, for which his sisters were heterozygous. The c.424C>G variant occurred in the SC*01 allele in one haplotype with the RHCE*03 (RHCE*cE) allele. No signs of hemolysis occurred following an incompatible blood transfusion. The monocyte monolayer assay was negative. CONCLUSIONS We characterized a high-prevalence antigen, with the proposed name "SCAR," which is the eighth antigen of the Scianna blood group system (proposed designation 013.008). Individuals homozygous for ERMAP:p.(Gln142Glu) protein variant can produce anti-SCAR. Although we did not observe any sign of hemolysis at this time, the anti-SCAR prompted a change of the treatment regimen. A review of the known reports indicated that all SC alloantibodies of sufficient titer should be considered capable of causing hemolysis.
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Affiliation(s)
- Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Jasem Albasri
- Blood Bank Laboratory, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Omar M. Alsuhaibani
- Blood Bank Laboratory, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hassan A. Aljasem
- Blood Bank Laboratory, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Marina U. Bueno
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Tania Antonacci
- Versiti Blood Research Institute and Diagnostic Laboratories, Versiti, Milwaukee, Wisconsin
| | - Donald R. Branch
- Department of Medicine, University of Toronto, and Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada
| | - Gregory A. Denomme
- Versiti Blood Research Institute and Diagnostic Laboratories, Versiti, Milwaukee, Wisconsin
| | - Willy A. Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
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16
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Shah A, Oczkowski S, Aubron C, Vlaar AP, Dionne JC. Transfusion in critical care: Past, present and future. Transfus Med 2020; 30:418-432. [PMID: 33207388 DOI: 10.1111/tme.12738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/27/2020] [Indexed: 01/28/2023]
Abstract
Anaemia and coagulopathy are common in critically ill patients and are associated with poor outcomes, including increased risk of mortality, myocardial infarction, failure to be liberated from mechanical ventilation and poor physical recovery. Transfusion of blood and blood products remains the corner stone of anaemia and coagulopathy treatment in critical care. However, determining when the benefits of transfusion outweigh the risks of anaemia may be challenging in some critically ill patients. Therefore, the European Society of Intensive Care Medicine prioritised the development of a clinical practice guideline to address anaemia and coagulopathy in non-bleeding critically ill patients. The aims of this article are to: (1) review the evolution of transfusion practice in critical care and the direction for future developments in this important area of transfusion medicine and (2) to provide a brief synopsis of the guideline development process and recommendations in a format designed for busy clinicians and blood bank staff. These clinical practice guidelines provide recommendations to clinicians on how best to manage non-bleeding critically ill patients at the bedside. More research is needed on alternative transfusion targets, use of transfusions in special populations (e.g., acute neurological injury, acute coronary syndromes), use of anaemia prevention strategies and point-of-care interventions to guide transfusion strategies.
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Affiliation(s)
- Akshay Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Adult Intensive Care Unit, John Radcliffe Hospital, Oxford, UK
| | - Simon Oczkowski
- Department of Medicine, McMaster University, Hamilton, Canada.,Guidelines in Intensive Care, Development and Evaluation (GUIDE) Group, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Cecile Aubron
- Department of Intensive Care Medicine, Centre Hospitalier Regional et Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
| | - Alexander P Vlaar
- Department of Intensive Care Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Joanna C Dionne
- Department of Medicine, McMaster University, Hamilton, Canada.,Guidelines in Intensive Care, Development and Evaluation (GUIDE) Group, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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17
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Shih AW, Yan MTS, Elahie AL, Barty RL, Liu Y, Berardi P, Azzam M, Siddiqui R, Parvizian MK, Mcdougall T, Heddle NM, Al-Habsi KS, Goldman M, Cote J, Athale U, Verhovsek MM. Utilising red cell antigen genotyping and serological phenotyping in sickle cell disease patients to risk-stratify patients for alloimmunisation risk. Transfus Med 2020; 30:263-274. [PMID: 32432400 DOI: 10.1111/tme.12685] [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: 02/01/2020] [Revised: 03/23/2020] [Accepted: 04/25/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Alloimmunisation and haemolytic transfusion reactions (HTRs) can occur in patients with sickle cell disease (SCD) despite providing phenotype-matched red blood cell (RBC) transfusions. Variant RBC antigen gene alleles/polymorphisms can lead to discrepancies in serological phenotyping. We evaluated differences between RBC antigen genotyping and phenotyping methods and retrospectively assessed if partial antigen expression may lead to increased risk of alloimmunisation and HTRs in SCD patients at a tertiary centre in Canada. METHODS RBC antigen phenotyping and genotyping were performed by a reference laboratory on consenting SCD patients. Patient demographic, clinical and transfusion-related data were obtained from a local transfusion registry and chart review after research ethics board approval. RESULTS A total of 106 SCD patients were enrolled, and 91% (n = 96) showed additional clinically relevant genotyping information when compared to serological phenotyping alone. FY*02N.01 (FY*B GATA-1) (n = 95; 90%) and RH variant alleles (n = 52, 49%; majority accompanied by FY*02N.01) were common, the latter with putative partial antigen expression in 25 patients. Variability in genotype-phenotype antigen prediction occurred mostly in the Rh system, notably with the e antigen (kappa: 0.17). Fifteen (14.2%) patients had a history of alloimmunisation, with five having HTR documented; no differences in clinical outcomes were found in patients with partial antigen expression. Genotype/extended-phenotype matching strategies may have prevented alloimmunisation events. CONCLUSION We show a high frequency of variant alleles/polymorphisms in the SCD population, where genotyping may complement serological phenotyping. Genotyping SCD patients before transfusion may prevent alloimmunisation and HTRs, and knowledge of the FY*02N.01 variant allele increases feasibility of finding compatible blood.
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Affiliation(s)
- Andrew W Shih
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew T S Yan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Medical Services and Hospital Relations, Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Allahna L Elahie
- Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca L Barty
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Yang Liu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Philip Berardi
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Mona Azzam
- Department of Pediatrics, Suez Canal University, Ismailia, Egypt
| | - Reda Siddiqui
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael K Parvizian
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Tara Mcdougall
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nancy M Heddle
- Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Centre for Innovation, Canadian Blood Services, Hamilton, Ontario, Canada
| | - Khalid S Al-Habsi
- Department of Blood Banks Services, Directorate General of Specialized Medical Care, Ministry of Health, Muscat, Oman
| | - Mindy Goldman
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Jacqueline Cote
- National Immunohematology Reference Laboratory, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Uma Athale
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Madeleine M Verhovsek
- Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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18
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Knier M, Schanen M, Piefer C, Bensing KM, Marchan M, Anani WQ, Denomme GA. How to use a cloud-based search engine of a centralized donor database to identify historical antigen-negative units in hospital inventories. Transfusion 2020; 60:414-416. [PMID: 31903613 DOI: 10.1111/trf.15641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/12/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Madeline Knier
- Immunohematology Reference Laboratory, Versiti, Milwaukee, Wisconsin
| | - Michael Schanen
- Immunohematology Reference Laboratory, Versiti, Milwaukee, Wisconsin
| | - Cindy Piefer
- Immunohematology Reference Laboratory, Versiti, Milwaukee, Wisconsin
| | | | - Marisela Marchan
- Immunohematology Reference Laboratory, Versiti, Milwaukee, Wisconsin
| | - Waseem Q Anani
- Diagnostic Laboratories, Versiti, Milwaukee, Wisconsin.,Immunohematology Reference Laboratory, Versiti, Milwaukee, Wisconsin.,Medical Sciences Institute, Versiti, Milwaukee, Wisconsin
| | - Gregory A Denomme
- Diagnostic Laboratories, Versiti, Milwaukee, Wisconsin.,Immunohematology Reference Laboratory, Versiti, Milwaukee, Wisconsin.,Versiti Blood Research Institute, Wauwatosa, Wisconsin
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19
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Denomme GA, Reinders S, Bensing KM, Piefer C, Schanen M, Curnes J, Treml A, Gottschall JL, Anani WQ. Use of a cloud‐based search engine of a centralized donor database to identify historical antigen‐negative units in hospital inventories. Transfusion 2020; 60:417-423. [DOI: 10.1111/trf.15638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/12/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Gregory A. Denomme
- Diagnostic Laboratories Wauwatosa Wisconsin
- Immunohematology Reference Laboratory Wauwatosa Wisconsin
- Versiti Blood Research Institute Wauwatosa Wisconsin
| | | | | | - Cindy Piefer
- Immunohematology Reference Laboratory Wauwatosa Wisconsin
| | - Michael Schanen
- Immunohematology Reference Laboratory Wauwatosa Wisconsin
- Transfusion Services Wauwatosa Wisconsin
| | | | - Angela Treml
- Medical Sciences Institute, Versiti, Milwaukee Wauwatosa Wisconsin
| | - Jerome L. Gottschall
- Immunohematology Reference Laboratory Wauwatosa Wisconsin
- Medical Sciences Institute, Versiti, Milwaukee Wauwatosa Wisconsin
| | - Waseem Q. Anani
- Immunohematology Reference Laboratory Wauwatosa Wisconsin
- Medical Sciences Institute, Versiti, Milwaukee Wauwatosa Wisconsin
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20
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Panch SR, Savani BN, Stroncek DF. Transfusion Support in Patients with Hematologic Disease: New and Novel Transfusion Modalities. Semin Hematol 2019; 56:227-228. [PMID: 31836027 DOI: 10.1053/j.seminhematol.2019.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Fürst D, Tsamadou C, Neuchel C, Schrezenmeier H, Mytilineos J, Weinstock C. Next-Generation Sequencing Technologies in Blood Group Typing. Transfus Med Hemother 2019; 47:4-13. [PMID: 32110189 DOI: 10.1159/000504765] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/07/2019] [Indexed: 12/14/2022] Open
Abstract
Sequencing of the human genome has led to the definition of the genes for most of the relevant blood group systems, and the polymorphisms responsible for most of the clinically relevant blood group antigens are characterized. Molecular blood group typing is used in situations where erythrocytes are not available or where serological testing was inconclusive or not possible due to the lack of antisera. Also, molecular testing may be more cost-effective in certain situations. Molecular typing approaches are mostly based on either PCR with specific primers, DNA hybridization, or DNA sequencing. Particularly the transition of sequencing techniques from Sanger-based sequencing to next-generation sequencing (NGS) technologies has led to exciting new possibilities in blood group genotyping. We describe briefly the currently available NGS platforms and their specifications, depict the genetic background of blood group polymorphisms, and discuss applications for NGS approaches in immunohematology. As an example, we delineate a protocol for large-scale donor blood group screening established and in use at our institution. Furthermore, we discuss technical challenges and limitations as well as the prospect for future developments, including long-read sequencing technologies.
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Affiliation(s)
- Daniel Fürst
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg/Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Chrysanthi Tsamadou
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg/Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Christine Neuchel
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg/Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Hubert Schrezenmeier
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg/Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Joannis Mytilineos
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg/Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Christof Weinstock
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg/Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
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22
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Carter JH, Flegel WA. Red Cell Transfusions in the Genomics Era. Semin Hematol 2019; 56:236-240. [PMID: 31836029 DOI: 10.1053/j.seminhematol.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 11/11/2022]
Abstract
Red cell genotyping has become widely available and now contributes to support transfusion of patients with hematologic diseases. This technology has facilitated the immunohematologic approach to antibody prevention, detection and identification. Donors, particularly rare donors, are most efficiently screened and identified by red cell genotyping. In transfused patients with challenging serologic reactivity, antibodies are more reliably identified when molecular typing information is available. Red cell genotyping of both donors and patients augments the selection of blood components. This technology, serving at the core of a real-time database inventory, is resulting in blood supply efficiencies. However, there is limited published evidence on the extent to which red cell genotyping has translated into improved clinical outcomes. Red cell alloimmunized patients may benefit the most in enhanced safety. For patients with antibodies to high-prevalence antigens, other than Rh, blood centers realized supply-chain efficiencies in the past decade. Prospective clinical trials and cost-effectiveness studies would contribute to further clarifying the optimal role of molecular testing in providing transfusion support for patients with hematologic diseases.
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Affiliation(s)
- Jamal H Carter
- Division of Clinical Pathology/Laboratory Medicine, Department of Pathology, Montefiore Medical Center, Bronx, NY
| | - Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD.
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23
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Abstract
PURPOSE OF REVIEW To summarize recent advances in red blood cell (RBC) blood group genotyping, with an emphasis on advances in the use of NGS next generation sequencing (NGS) to detect clinically relevant blood group gene variation. RECENT FINDINGS Genetic information is useful in predicting RBC blood group antigen expression in several clinical contexts, particularly, for patients at high-risk for allosensitization, such as multiple transfused patients. Blood group antigen expression is directed by DNA variants affecting multiply genes. With over 300 known antigens, NGS offers the attractive prospect of comprehensive blood group genotyping. Recent studies from several groups show that NGS reliably detects blood group gene single nucleotide variants (SNVs) with good correlation with other genetic methods and serology. Additionally, new custom NGS methods accurately detect complex DNA variants, including hybrid RH alleles. Thus, recent work shows that NGS detects known and novel blood group gene variants in patients, solves challenging clinical cases, and detects relevant blood group variation in donors. SUMMARY New work shows that NGS is particularly robust in identifying SNVs in blood group genes, whereas custom genomic tools can be used to identify known and novel complex structural variants, including in the RH system.
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24
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Santos LD, Bub CB, Aravechia MG, Bastos EP, Kutner JM, Castilho L. The rare holley antibody associated with a severe hemolytic transfusion reaction: the importance of this antibody identification to find a compatible blood unit. EINSTEIN-SAO PAULO 2019; 18:eRC4582. [PMID: 31531557 PMCID: PMC6905162 DOI: 10.31744/einstein_journal/2020rc4582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 01/30/2019] [Indexed: 11/05/2022] Open
Abstract
The correct identification of erythrocyte antibodies is fundamental for the searching for compatible blood and haemolytic transfusion reactions prevention. Antibodies against antigens of high prevalence are difficult to identify because of the rarity of their occurrence and unavailability of negative red cells for confirmation. We report a case of 46-years-old woman, diagnosed with hemoglobinopathy, and who had symptomatic fall in hemoglobin levels (5.3g/dL) after blood transfusion suggestive of transfusion reaction. The patient's blood type was O RhD-positive. Irregular antibody screening was positive and demonstrated a panreaction against all erythrocytes tested, but this result was not reactive with dithiothreitol. Using negative red cells for antigens of high prevalence of our inventory we could identify in the serum of the same erythrocytes an anti-Holley antibody associated with anti-E. Molecular analysis confirmed that the patient was negative for E and Holley antigens. The crossmath with compatible units confirmed the results. Holley is a high prevalence antigen of the Dombrock blood system whose negative phenotype is extremely rare in all populations and is associated with hemolytic transfusion reactions. This is an antibody that is difficult to identify because laboratories need to have experience in solving complex cases, and have available a large stock of rare sera and erythrocytes, as well other tools such as enzymes, thiol reagents and molecular tests. The correct identification of a rare antibody is initial and mandatory for searching of compatible donors, and to guarantee a satisfactory transfusional support.
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25
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Complete RHD next-generation sequencing: establishment of reference RHD alleles. Blood Adv 2019; 2:2713-2723. [PMID: 30337299 DOI: 10.1182/bloodadvances.2018017871] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 09/13/2018] [Indexed: 12/14/2022] Open
Abstract
The Rh blood group system (ISBT004) is the second most important blood group after ABO and is the most polymorphic one, with 55 antigens encoded by 2 genes, RHD and RHCE This research uses next-generation sequencing (NGS) to sequence the complete RHD gene by amplifying the whole gene using overlapping long-range polymerase chain reaction (LR-PCR) amplicons. The aim was to study different RHD alleles present in the population to establish reference RHD allele sequences by using the analysis of intronic single-nucleotide polymorphisms (SNPs) and their correlation to a specific Rh haplotype. Genomic DNA samples (n = 69) from blood donors of different serologically predicted genotypes including R1R1 (DCe/DCe), R2R2 (DcE/DcE), R1R2 (DCe/DcE), R2RZ (DcE/DCE), R1r (DCe/dce), R2r (DcE/dce), and R0r (Dce/dce) were sequenced and data were then mapped to the human genome reference sequence hg38. We focused on the analysis of hemizygous samples, as these by definition will only have a single copy of RHD For the 69 samples sequenced, different exonic SNPs were detected that correlate with known variants. Multiple intronic SNPs were found in all samples: 21 intronic SNPs were present in all samples indicating their specificity to the RHD*DAU0 (RHD*10.00) haplotype which the hg38 reference sequence encodes. Twenty-three intronic SNPs were found to be R2 haplotype specific, and 15 were linked to R1, R0, and RZ haplotypes. In conclusion, intronic SNPs may represent a novel diagnostic approach to investigate known and novel variants of the RHD and RHCE genes, while being a useful approach to establish reference RHD allele sequences.
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26
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Abstract
Red blood cell (RBC) antigen phenotyping is an essential component of transfusion compatibility testing. Serology has been the gold standard method, but its low throughput and risk of diagnostic interference in certain situations limits its applicability. Genotyping is useful for phenotyping in these cases, providing a high-throughput and reliable alternative to serology. Genotyping is indicated in several hematology and oncology patient populations. Because genotyping requires a complex testing environment and bears an additional risk of genotype-phenotype discrepancy, its use is currently limited, but it serves as a useful adjunct and may eventually supplant serology as a new gold standard.
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Affiliation(s)
- Ronald Jackups
- Department of Pathology & Immunology, Washington University School of Medicine, 660 South Euclid Avenue #8118, St Louis, MO 63110, USA.
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27
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Affiliation(s)
- Sandhya R Panch
- From the Department of Transfusion Medicine, Warren G. Magnuson Clinical Center, National Institutes of Health Clinical Center, Bethesda, MD
| | - Celina Montemayor-Garcia
- From the Department of Transfusion Medicine, Warren G. Magnuson Clinical Center, National Institutes of Health Clinical Center, Bethesda, MD
| | - Harvey G Klein
- From the Department of Transfusion Medicine, Warren G. Magnuson Clinical Center, National Institutes of Health Clinical Center, Bethesda, MD
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28
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Denomme GA, Anani WQ. Mass‐scale red cell genotyping of blood donors: from data visualization to historical antigen labeling and donor recruitment. Transfusion 2019; 59:2768-2770. [DOI: 10.1111/trf.15419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/06/2019] [Accepted: 06/03/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Gregory A. Denomme
- Diagnostic LaboratoriesVersiti Wisconsin Milwaukee Wisconsin
- Blood Research InstituteVersiti Wisconsin Wauwatosa Wisconsin
| | - Waseem Q. Anani
- Diagnostic LaboratoriesVersiti Wisconsin Milwaukee Wisconsin
- Blood Research InstituteVersiti Wisconsin Wauwatosa Wisconsin
- Department of PathologyMedical College of Wisconsin Milwaukee Wisconsin
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29
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Hyland CA, Roulis EV, Schoeman EM. Developments beyond blood group serology in the genomics era. Br J Haematol 2019; 184:897-911. [PMID: 30706459 DOI: 10.1111/bjh.15747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Blood group serology and single nucleotide polymorphism-based genotyping platforms are accurate but do not provide a comprehensive cover for all 36 blood group systems and do not cover the antigen diversity observed among population groups. This review examines the extent to which genomics is shaping blood group serology. Resources for genomics include the Human Reference Genome Sequence assembly; curated blood group tables listing variants; public databases providing information on genetic variants from world-wide studies; and massively parallel sequencing technologies. Blood group genomic studies span the spectrum, from bioinformatic data mining of huge data sets containing whole genome and whole exome information to laboratory investigations utilising targeted sequencing approaches. Blood group predictions based on genome sequencing and genomic studies are proving accurate, and have shown utility in both research and reference settings. Overall, studies confirm the potential for blood group genomics to reshape donor and patient transfusion management strategies to provide more compatible blood transfusions.
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Affiliation(s)
- Catherine A Hyland
- Clinical Services and Research, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Eileen V Roulis
- Clinical Services and Research, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Elizna M Schoeman
- Clinical Services and Research, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
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30
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RH genotype matching for transfusion support in sickle cell disease. Blood 2018; 132:1198-1207. [DOI: 10.1182/blood-2018-05-851360] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/05/2018] [Indexed: 11/20/2022] Open
Abstract
Key PointsRH genotyping of red cells may improve matching of patients and donors and reduce Rh alloimmunization. RH genotype matching may improve use of an African American blood donor inventory.
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31
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Wagner FF, Doescher A, Bittner R, Müller TH. Extended Donor Typing by Pooled Capillary Electrophoresis: Impact in a Routine Setting. Transfus Med Hemother 2018; 45:225-237. [PMID: 30283272 DOI: 10.1159/000490155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/11/2018] [Indexed: 01/15/2023] Open
Abstract
Background PCR with sequence-specific priming using allele-specific fluorescent primers and analysis on a capillary sequencer is a standard technique for DNA typing. We aimed to adapt this method for donor typing in a medium-throughput setting. Methods Using the Extract-N-Amp PCR system, we devised a set of eight multiplex allele-specific PCR with fluorescent primers for Fya/Fyb, Jka/Jkb, M/N, and S/s. The alleles of a gene were discriminated by the fluorescent color; donor and polymorphism investigated were encoded by product length. Time, cost, and routine performance were collated. Discrepant samples were investigated by sequencing. The association of new alleles with the phenotype was evaluated by a step-wise statistical analysis. Results On validation using 312 samples, for 1.1% of antigens (in 5.4% of samples) no prediction was obtained. 99.96% of predictions were correct. Consumable cost per donor were below EUR 2.00. In routine use, 92.2% of samples were successfully predicted. Discrepancies were most frequently due to technical reasons. A total of 11 previously unknown alleles were detected in the Kell, Lutheran, and Colton blood group systems. In 2017, more than 20% of the RBC units prepared by our institution were from donors with predicted antigen status. A steady supply of Yt(a-), Co(a-) and Lu(b-) RBC units was ensured. Conclusions Pooled capillary electrophoresis offers a suitable alternative to other methods for extended donor DNA typing. Establishing a large cohort of typed donors improved transfusion support for patients.
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Affiliation(s)
- Franz F Wagner
- DRK Blutspendedienst NSTOB, Institute Springe, Springe, Germany
| | - Andrea Doescher
- DRK Blutspendedienst NSTOB, Institute Oldenburg, Oldenburg, Germany
| | - Rita Bittner
- DRK Blutspendedienst NSTOB, Institute Springe, Springe, Germany
| | - Thomas H Müller
- DRK Blutspendedienst NSTOB, Institute Springe, Springe, Germany
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32
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Gassner C, Wagner FF. Optimized Antigen Matching - Chances and Challenges in Molecular Times. Transfus Med Hemother 2018; 45:216-217. [PMID: 30283269 PMCID: PMC6158590 DOI: 10.1159/000491583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Christoph Gassner
- Blood Transfusion Service Zürich, Swiss Red Cross (SRC), Department of Molecular Diagnostics & Research (MOC), Schlieren, Switzerland; DRK Blutspendedienst NSTOB, Institute Springe, Springe, Germany
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33
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Immunohaematological complications in patients with sickle cell disease after haemopoietic progenitor cell transplantation: a prospective, single-centre, observational study. LANCET HAEMATOLOGY 2018; 4:e553-e561. [PMID: 29100558 DOI: 10.1016/s2352-3026(17)30196-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/09/2017] [Accepted: 09/14/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Haemopoietic progenitor cell (HPC) transplantation can cure sickle cell disease. Non-myeloablative conditioning typically results in donor-derived erythrocytes and stable mixed chimerism of recipient-derived and donor-derived leucocytes. Exposure to donor antigens from the HPC graft and new red cell antibodies induced by transfusion can lead to immunohaematological complications. We assessed the incidence of such complications among HPC transplant recipients with sickle cell disease. METHODS The study population was all patients with sickle cell disease enrolled before March 31, 2015, in the three clinical trials of non-myeloablative HPC transplantation at the National Institutes of Health. We assessed formation of new red cell antibodies after transplantation and red cell incompatibility between donors and recipients. FINDINGS 61 patients were enrolled, 42 were HLA matched and 19 were haploidentical. Nine (15%) had immunohaematological complications. Before HPC transplantation, three patients had antibodies incompatible with their donors. After HPC transplantation, new red cell antibodies were seen in six patients (11 alloantibodies and two autoantibodies), among whom three developed antibodies incompatible with donor or recipient red cells and three developed compatible antibodies. The clinical course of complications was highly variable, from no severe effects attributable to antibodies, to sustained reticulocytopenia, to near-fatal haemolysis. We found no significant correlation between immunohaematological complications and graft failure, graft rejection, or death. INTERPRETATION Clinical effects ranged from seemingly not clinically important to potentially fatal. In patients with sickle cell disease, donor and recipient red cell phenotypes should be carefully assessed before transplantation to minimise and manage the risk of immunohaematological complications. FUNDING Intramural Research Program and National Institutes of Health.
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34
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Gomez-Martinez J, Silvy M, Chiaroni J, Fournier-Wirth C, Roubinet F, Bailly P, Brès JC. Multiplex Lateral Flow Assay for Rapid Visual Blood Group Genotyping. Anal Chem 2018; 90:7502-7509. [PMID: 29842785 DOI: 10.1021/acs.analchem.8b01078] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Conventional blood group phenotyping by hemagglutination assays, carried out pretransfusion, is unsuitable in certain clinical situations. Molecular typing offers an alternative method, allowing the deduction of blood group phenotype from genotype. However, current methods require a long turnaround time and are not performed on-site, limiting their application in emergency situations. Here, we report the development of a novel, rapid multiplex molecular method to identify seven alleles in three clinically relevant blood group systems (Kidd, Duffy, and MNS). Our test, using a dry-reagent allele-specific lateral flow biosensor, does not require DNA extraction and allows easy visual determination of blood group genotype. Multiplex linear-after-the-exponential (LATE)-PCR and lateral flow parameters were optimized with a total processing time of 1 h from receiving the blood sample. Our assay had a 100% concordance rate between the deduced and the standard serological phenotype in a sample from 108 blood donors, showing the accuracy of the test. Owing to its simple handling, the assay can be operated by nonskilled health-care professionals. The proposed assay offers the potential for the development of other relevant single nucleotide polymorphism (SNP) panels for immunohematology and new applications, such as for infectious diseases, in the near future.
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Affiliation(s)
- Julien Gomez-Martinez
- Etablissement Français du Sang Occitanie , F-34184 Montpellier , France.,Pathogenesis and Control of Chronic Infections , University of Montpellier, INSERM, EFS , F-34184 Montpellier , France
| | - Monique Silvy
- Etablissement Français du Sang PACA Corse , Biologie des Groupes Sanguins , F-13385 Marseille , France.,University of Aix Marseille, CNRS, EFS, ADES , F-13385 Marseille , France
| | - Jacques Chiaroni
- Etablissement Français du Sang PACA Corse , Biologie des Groupes Sanguins , F-13385 Marseille , France.,University of Aix Marseille, CNRS, EFS, ADES , F-13385 Marseille , France
| | - Chantal Fournier-Wirth
- Etablissement Français du Sang Occitanie , F-34184 Montpellier , France.,Pathogenesis and Control of Chronic Infections , University of Montpellier, INSERM, EFS , F-34184 Montpellier , France
| | - Francis Roubinet
- Etablissement Français du Sang Occitanie , F-34184 Montpellier , France
| | - Pascal Bailly
- Etablissement Français du Sang PACA Corse , Biologie des Groupes Sanguins , F-13385 Marseille , France.,University of Aix Marseille, CNRS, EFS, ADES , F-13385 Marseille , France
| | - Jean-Charles Brès
- Etablissement Français du Sang Occitanie , F-34184 Montpellier , France.,Pathogenesis and Control of Chronic Infections , University of Montpellier, INSERM, EFS , F-34184 Montpellier , France
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35
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Shin KH, Lee HJ, Park KH, Hye BM, Chang CL, Kim HH. Extended Red Blood Cell Genotyping to Investigate Immunohematology Problems. Ann Lab Med 2018; 38:387-388. [PMID: 29611394 PMCID: PMC5895873 DOI: 10.3343/alm.2018.38.4.387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/08/2017] [Accepted: 01/15/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kyung Hwa Shin
- Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun Ji Lee
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kyung Hee Park
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Bae Mi Hye
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Chulhun L Chang
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung Hoi Kim
- Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
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36
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Molecular immunohaematology round table discussions at the AABB Annual Meeting, Orlando 2016. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018. [PMID: 29517973 DOI: 10.2450/2018.0260-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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37
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Singhal D, Kutyna MM, Chhetri R, Wee LYA, Hague S, Nath L, Nath SV, Sinha R, Wickham N, Lewis ID, Ross DM, Bardy PG, To LB, Reynolds J, Wood EM, Roxby DJ, Hiwase DK. Red cell alloimmunization is associated with development of autoantibodies and increased red cell transfusion requirements in myelodysplastic syndrome. Haematologica 2017; 102:2021-2029. [PMID: 28983058 PMCID: PMC5709101 DOI: 10.3324/haematol.2017.175752] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/27/2017] [Indexed: 11/09/2022] Open
Abstract
Up to 90% of patients with a myelodysplastic syndrome require red blood cell transfusion; nevertheless, comprehensive data on red cell alloimmunization in such patients are limited. This study evaluates the incidence and clinical impact of red cell alloimmunization in a large cohort of patients with myelodysplastic syndrome registered in the statewide South Australian-MDS registry. The median age of the 817 patients studied was 73 years, and 66% were male. The cumulative incidence of alloimmunization was 11%. Disease-modifying therapy was associated with a lower risk of alloimmunization while alloimmunization was significantly higher in patients with a revised International Prognostic Scoring System classification of Very Low, Low or Intermediate risk compared to those with a High or Very High risk (P=0.03). Alloantibodies were most commonly directed against antigens in the Rh (54%) and Kell (24%) systems. Multiple alloantibodies were present in 49% of alloimmunized patients. Although 73% of alloimmunized patients developed alloantibodies during the period in which they received their first 20 red cell units, the total number of units transfused was significantly higher in alloimmunized patients than in non-alloimmunized patients (90±100 versus 30±52; P<0.0001). In individual patients, red cell transfusion intensity increased significantly following alloimmunization (2.8±1.3 versus 4.1±2.0; P<0.0001). A significantly higher proportion of alloimmunized patients than non-alloimmunized patients had detectable autoantibodies (65% versus 18%; P<0.0001) and the majority of autoantibodies were detected within a short period of alloimmunization. In conclusion, this study characterizes alloimmunization in a large cohort of patients with myelodysplastic syndrome and demonstrates a signficant increase in red cell transfusion requirements following alloimmunization, most probably due to development of additional alloantibodies and autoantibodies, resulting in subclinical/clinical hemolysis. Strategies to mitigate alloimmunization risk are critical for optimizing red cell transfusion support.
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Affiliation(s)
- Deepak Singhal
- Cancer Centre, Royal Adelaide Hospital, Adelaide, Australia.,Haematology Department, SA Pathology, Adelaide, Australia.,School of Medicine, University of Adelaide, Australia
| | | | | | - Li Yan A Wee
- Haematology Department, SA Pathology, Adelaide, Australia
| | - Sophia Hague
- Transfusion Medicine, SA Pathology, Adelaide, Australia
| | - Lakshmi Nath
- Haematology, Clinpath Laboratories, Adelaide, Australia
| | - Shriram V Nath
- Haematology, Clinpath Laboratories, Adelaide, Australia.,Adelaide Haematology Centre, Ashford Specialist Centre, Adelaide, Australia
| | - Romi Sinha
- Blood, Organ and Tissue Programs, Public Health & Clinical Systems, Department of Health, Adelaide, Australia
| | - Nicholas Wickham
- Adelaide Cancer Centre, Ashford Specialist Centre, Adelaide, Australia
| | - Ian D Lewis
- Cancer Centre, Royal Adelaide Hospital, Adelaide, Australia.,Haematology Department, SA Pathology, Adelaide, Australia.,School of Medicine, University of Adelaide, Australia
| | - David M Ross
- Cancer Centre, Royal Adelaide Hospital, Adelaide, Australia.,Haematology Department, SA Pathology, Adelaide, Australia.,School of Medicine, University of Adelaide, Australia.,Haematology & Genetic Pathology, Flinders University, Bedford Park, Australia.,Cancer Research, Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Peter G Bardy
- Cancer Centre, Royal Adelaide Hospital, Adelaide, Australia.,Haematology Department, SA Pathology, Adelaide, Australia.,School of Medicine, University of Adelaide, Australia
| | - Luen Bik To
- Cancer Centre, Royal Adelaide Hospital, Adelaide, Australia.,Haematology Department, SA Pathology, Adelaide, Australia.,School of Medicine, University of Adelaide, Australia
| | - John Reynolds
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Erica M Wood
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - David J Roxby
- Transfusion Medicine, SA Pathology, Adelaide, Australia.,Haematology & Genetic Pathology, Flinders University, Bedford Park, Australia
| | - Devendra K Hiwase
- Cancer Centre, Royal Adelaide Hospital, Adelaide, Australia .,Haematology Department, SA Pathology, Adelaide, Australia.,School of Medicine, University of Adelaide, Australia.,Cancer Research, Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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38
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Denomme GA, Anani WQ, Avent ND, Bein G, Briggs LB, Lapadat RC, Montemayor C, Rios M, St-Louis M, Uhl L, Wendel S, Flegel WA. Red cell genotyping precision medicine: a conference summary. Ther Adv Hematol 2017; 8:277-291. [PMID: 29051799 DOI: 10.1177/2040620717729128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This review summarizes the salient points of the symposium 'Red Cell Genotyping 2015: Precision Medicine' held on 10 September 2015 in the Masur Auditorium of the National Institutes of Health. The specific aims of this 6th annual symposium were to: (1) discuss how advances in molecular immunohematology are changing patient care; (2) exemplify patient care strategies by case reports (clinical vignettes); (3) review the basic molecular studies and their current implications in clinical practice; (4) identify red cell genotyping strategies to prevent alloimmunization; and (5) compare and contrast future options of red cell genotyping in precision transfusion medicine. This symposium summary captured the state of the art of red cell genotyping and its contribution to the practice of precision medicine.
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Affiliation(s)
- Gregory A Denomme
- Diagnostic Laboratories, BloodCenter of Wisconsin, 638 N 18th Street, PO Box 2178, Milwaukee, WI 53201-2178, USA
| | - Waseem Q Anani
- Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
| | | | | | - Lynne B Briggs
- Information Services Versiti/BloodCenter of Wisconsin, Milwaukee, WI, USA
| | - Razvan C Lapadat
- Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
| | - Celina Montemayor
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Maria Rios
- Office of Blood Research and Review, CBER/FDA, Rockville, MD, USA
| | | | - Lynne Uhl
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | | | - Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
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39
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Ji YL, Luo H, Wen JZ, Haer-Wigman L, Veldhuisen B, Wei L, Wang Z, Ligthart P, Lodén-van Straaten M, Fu YS, van der Schoot CE, Luo GP. RHDgenotype and zygosity analysis in the Chinese Southern Han D+, D− and D variant donors using the multiplex ligation-dependent probe amplification assay. Vox Sang 2017; 112:660-670. [DOI: 10.1111/vox.12554] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/14/2017] [Accepted: 06/23/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Y. L. Ji
- Guangzhou Blood Center; Institute of Clinical Blood Transfusion; Guangzhou China
- Sanquin Research and Landsteiner Laboratory; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - H. Luo
- Guangzhou Blood Center; Institute of Clinical Blood Transfusion; Guangzhou China
| | - J. Z. Wen
- Guangzhou Blood Center; Institute of Clinical Blood Transfusion; Guangzhou China
| | - L. Haer-Wigman
- Sanquin Research and Landsteiner Laboratory; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - B. Veldhuisen
- Sanquin Research and Landsteiner Laboratory; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
- The Department of Immunohematology Diagnostics; Sanquin Diagnostic Services; Amsterdam The Netherlands
| | - L. Wei
- Guangzhou Blood Center; Institute of Clinical Blood Transfusion; Guangzhou China
| | - Z. Wang
- Guangzhou Blood Center; Institute of Clinical Blood Transfusion; Guangzhou China
| | - P. Ligthart
- The Department of Immunohematology Diagnostics; Sanquin Diagnostic Services; Amsterdam The Netherlands
| | | | - Y. S. Fu
- Guangzhou Blood Center; Institute of Clinical Blood Transfusion; Guangzhou China
| | - C. E. van der Schoot
- Sanquin Research and Landsteiner Laboratory; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - G. P. Luo
- Guangzhou Blood Center; Institute of Clinical Blood Transfusion; Guangzhou China
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40
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Anani WQ, Duffer K, Kaufman RM, Denomme GA. How do I work up pretransfusion samples containing anti-CD38? Transfusion 2017; 57:1337-1342. [PMID: 28474469 DOI: 10.1111/trf.14144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 12/12/2022]
Abstract
Anti-CD38 is used to treat relapsed or treatment-refractory multiple myeloma. CD38 monoclonal antibodies, however, can interfere with routine blood bank serologic tests. Agglutination is observed at the indirect phase of testing as the drug binds to red blood cells (RBCs). Resolving the testing interference causes delays issuing RBC units to patients with anemia. A number of devised methods to eliminate or bypass the effects of anti-CD38 on serologic tests are in use but no panacea exists. The limitations of each method require each testing site tailor an approach to best fit their needs. We present perspectives and testing practices from a hospital transfusion medicine service and an Immunohematology Reference Laboratory managing pretransfusion samples with anti-CD38.
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Affiliation(s)
- Waseem Q Anani
- Diagnostic Laboratories, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kathleen Duffer
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard M Kaufman
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Gregory A Denomme
- Diagnostic Laboratories, Medical College of Wisconsin, Milwaukee, Wisconsin.,Blood Research Institute, BloodCenter of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
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41
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Anani WQ, Marchan MG, Bensing KM, Schanen M, Piefer C, Gottschall JL, Denomme GA. Practical approaches and costs for provisioning safe transfusions during anti-CD38 therapy. Transfusion 2017; 57:1470-1479. [PMID: 28150308 DOI: 10.1111/trf.14021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/21/2016] [Accepted: 12/16/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anti-CD38 therapy causes interference with both the direct and the indirect antiglobulin tests. We describe the experience from an Immunohematology Reference Laboratory and model cost options for providing safe transfusions. STUDY DESIGN AND METHODS Phenotyping, genotyping, and antibody identification orders were retrospectively reviewed in the setting of anti-CD38 therapy. The data were used to model the added cost of transfusion support. Four approaches were evaluated: 1) thiol-treated reagent red blood cells (RRCs) in antibody investigations with K- red blood cell (RBC) transfusions, 2) patient phenotyping or 3) genotyping with antigen-matched RBC transfusions, and 4) a combination of interval thiol-treated RRC antibody investigations with genotype antigen-matched RBC transfusions. RESULTS Sixty-two patients were identified as receiving anti-CD38 therapy. Thiol-treated RRC antibody investigations (28/62 patients) were favored over genotyping (23/62) and combination testing (11/62). Patient phenotyping failed to detect useful antigen information on eight patients: seven Fyb silencing mutations and one partial e. A thiol-treated RRC antibody investigation was the least expensive testing method for the first transfusion, but four- and five-antigen-matched RBC transfusions were equal in cost within five and 21 transfusion events, respectively. CONCLUSION Genotyping provided a more accurate antigen status than phenotyping patient RBCs. Patients requiring long-term transfusion support benefit from antigen matching when matching less than four antigens. Ultimately, the decision to genotype or use thiol-treated RRC antibody investigations will vary for each hospital blood bank.
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Affiliation(s)
- Waseem Q Anani
- Diagnostic Laboratories.,Blood Research Institute, BloodCenter of Wisconsin
| | | | | | | | | | - Jerome L Gottschall
- Diagnostic Laboratories.,Blood Research Institute, BloodCenter of Wisconsin.,Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gregory A Denomme
- Diagnostic Laboratories.,Blood Research Institute, BloodCenter of Wisconsin
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42
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Ji Y, Wen J, Veldhuisen B, Haer-Wigman L, Wang Z, Lodén-van Straaten M, Wei L, Luo G, Fu Y, van der Schoot CE. Validation of the multiplex ligation-dependent probe amplification assay and its application on the distribution study of the major alleles of 17 blood group systems in Chinese donors from Guangzhou. Transfusion 2016; 57:423-432. [DOI: 10.1111/trf.13940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/26/2016] [Accepted: 10/02/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Yanli Ji
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center; Guangzhou People's Republic of China
- Sanquin Research and Landsteiner Laboratory; Academic Medical Center, University of Amsterdam; Amsterdam The Netherlands
| | - Jizhi Wen
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center; Guangzhou People's Republic of China
| | - Barbera Veldhuisen
- Sanquin Research and Landsteiner Laboratory; Academic Medical Center, University of Amsterdam; Amsterdam The Netherlands
| | - Lonneke Haer-Wigman
- Sanquin Research and Landsteiner Laboratory; Academic Medical Center, University of Amsterdam; Amsterdam The Netherlands
| | - Zhen Wang
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center; Guangzhou People's Republic of China
| | | | - Ling Wei
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center; Guangzhou People's Republic of China
| | - Guangping Luo
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center; Guangzhou People's Republic of China
| | - Yongshui Fu
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center; Guangzhou People's Republic of China
| | - C. Ellen van der Schoot
- Sanquin Research and Landsteiner Laboratory; Academic Medical Center, University of Amsterdam; Amsterdam The Netherlands
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43
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Performance evaluation study of ID CORE XT, a high throughput blood group genotyping platform. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 16:193-199. [PMID: 27893355 DOI: 10.2450/2016.0146-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/05/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Traditionally, red blood cell antigens have been identified using serological methods, but recent advances in molecular biology have made the implementation of methods for genetic testing of most blood group antigens possible. The goal of this study was to validate the performance of the ID CORE XT blood group typing assay. MATERIALS AND METHODS One thousand independent samples from donors, patients and neonates were collected from three research institutes in Spain and the Netherlands. DNA was extracted from EDTA-anticoagulated blood. The data were processed with the ID CORE XT to obtain the genotypes and the predicted blood group phenotypes, and results were compared to those obtained with well-established serological and molecular methods. All 1,000 samples were typed for major blood group antigens (C, c, E, e, K) and 371-830 samples were typed for other antigens depending on the rarity and availability of serology comparators. RESULTS The incorrect call rate was 0%. Four "no calls" (rate: 0.014%) were resolved after repetition. The sensitivity of ID CORE XT for all phenotypes was 100% regarding serology. There was one discrepancy in E- antigen and 33 discrepancies in Fyb- antigen. After bidirectional sequencing, all discrepancies were resolved in favour of ID CORE XT (100% specificity). ID CORE XT detected infrequent antigens of Caucasians in the sample as well as rare allelic variants. DISCUSSION In this evaluation performed in an extensive sample following the European Directive, the ID CORE XT blood genotyping assay performed as a reliable and accurate method for correctly predicting the genotype and phenotype of clinically relevant blood group antigens.
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44
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Srivastava K, Polin H, Sheldon SL, Wagner FF, Grabmer C, Gabriel C, Denomme GA, Flegel WA. The DAU cluster: a comparative analysis of 18 RHD alleles, some forming partial D antigens. Transfusion 2016; 56:2520-2531. [PMID: 27480171 PMCID: PMC5499517 DOI: 10.1111/trf.13739] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND The Rh system is the most complex and polymorphic blood group system in humans with more than 460 alleles known for the RHD gene. The DAU cluster of RHD alleles is characterized by the single-nucleotide change producing the p.Thr379Met amino acid substitution. It is called the DAU-0 allele and has been postulated to be the primordial allele, from which all other alleles of the DAU cluster have eventually evolved. STUDY DESIGN AND METHODS For two novel DAU alleles, the nucleotide sequences of all 10 exons as well as adjacent intronic regions, including the 5' and 3' untranslated regions (UTR), were determined for the RHD and RHCE genes. A phylogenetic tree for all DAU alleles was established using the neighbor-joining method with Pan troglodytes as root. Standard hemagglutination and flow cytometry tests were performed. RESULTS We characterized two DAU alleles, DAU-11 and DAU-5.1, closely related to DAU-3 and DAU-5, respectively. A phylogenetic analysis of the 18 known DAU alleles indicated point mutations and interallelic recombination contributing to diversification of the DAU cluster. CONCLUSIONS The DAU alleles encode a group of RhD protein variants, some forming partial D antigens known to permit anti-D in carriers; all are expected to cause anti-D alloimmunization in recipients of red blood cell transfusions. The DAU alleles evolved through genomic point mutations and recombination. These results suggest that the cluster of DAU alleles represent a clade, which is concordant with our previous postulate that they derived from the primordial DAU-0 allele.
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Affiliation(s)
- Kshitij Srivastava
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Helene Polin
- Red Cross Transfusion Service of Upper Austria, Linz, Austria
| | - Sherry Lynne Sheldon
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | | | - Christoph Grabmer
- Department of Blood Group Serology and Transfusion Medicine, SALK-Paracelsus Medical University, Salzburg, Austria
| | - Christian Gabriel
- Red Cross Transfusion Service of Upper Austria, Linz, Austria
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | | | - Willy Albert Flegel
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland.
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Fasano RM, Chou ST. Red Blood Cell Antigen Genotyping for Sickle Cell Disease, Thalassemia, and Other Transfusion Complications. Transfus Med Rev 2016; 30:197-201. [DOI: 10.1016/j.tmrv.2016.05.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 01/19/2023]
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46
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Molecular immunohaematology round table discussions at the AABB Annual Meeting, Anaheim 2015. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 14:557-565. [PMID: 27483480 DOI: 10.2450/2016.0063-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/17/2016] [Indexed: 12/16/2022]
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47
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Fichou Y, Mariez M, Le Maréchal C, Férec C. The experience of extended blood group genotyping by next-generation sequencing (NGS): investigation of patients with sickle-cell disease. Vox Sang 2016; 111:418-424. [PMID: 27442304 DOI: 10.1111/vox.12432] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/04/2016] [Accepted: 06/06/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients suffering from haemoglobinopathies may be treated by red blood cell (RBC) transfusion on a regular basis and then exposed to multiple antigens with a recurrent, potential risk of alloimmunization routinely prevented by extended RBC antigen cross-matching. While time-consuming and labour-intensive serological analyses are the gold standard for RBC typing, genotyping by current high-throughput molecular tools, including next-generation sequencing (NGS), appears to offer a potent alternative. STUDY DESIGN AND METHODS The potential of extended blood group genotyping (EBGG) by NGS of 17 genes involved in 14 blood group systems was evaluated in a cohort of 48 patients with sickle-cell disease. Sample preparation and sequencing were simplified and automated for future routine implementation. RESULTS Sequencing data were obtained for all DNA samples with two different sequencing machines. Prediction of phenotypes could be made in 12 blood group systems and partially in two other blood group systems (Rh and MNS). Importantly, predicted phenotypes in the MNS (S/s), Duffy, Kidd and Kell systems matched well with serological data (98·9%), when available. Unreferenced alleles in the ACHE and ART4 genes, respectively, involved in the Yt and Dombrock blood groups, were identified, then contributing to extend the current knowledge of blood group molecular genetics. CONCLUSIONS Overall, we consider that our strategy for NGS-based EBGG, assisted by a simple method for genotyping exons 1 and 2 of the pairs of homologous genes (i.e. RHD/RHCE and GYPA/GYPB), as well as the future support of potent bioinformatics tools, may be implemented for routine diagnosis in specific populations.
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Affiliation(s)
- Y Fichou
- Etablissement Français du Sang (EFS) - Région Bretagne, Brest, France.,Institut National de la Santé et de la Recherche Médicale (Inserm), UMR1078, Brest, France
| | - M Mariez
- Etablissement Français du Sang (EFS) - Région Bretagne, Brest, France.,Institut National de la Santé et de la Recherche Médicale (Inserm), UMR1078, Brest, France
| | - C Le Maréchal
- Etablissement Français du Sang (EFS) - Région Bretagne, Brest, France.,Institut National de la Santé et de la Recherche Médicale (Inserm), UMR1078, Brest, France.,Laboratoire de Génétique Moléculaire et d'Histocompatibilité, Centre Hospitalier Régional Universitaire (CHRU), Hôpital Morvan, Brest, France.,Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale (UBO), Brest, France
| | - C Férec
- Etablissement Français du Sang (EFS) - Région Bretagne, Brest, France.,Institut National de la Santé et de la Recherche Médicale (Inserm), UMR1078, Brest, France.,Laboratoire de Génétique Moléculaire et d'Histocompatibilité, Centre Hospitalier Régional Universitaire (CHRU), Hôpital Morvan, Brest, France.,Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale (UBO), Brest, France
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Nydegger U, Lung T, Risch L, Risch M, Medina Escobar P, Bodmer T. Inflammation Thread Runs across Medical Laboratory Specialities. Mediators Inflamm 2016; 2016:4121837. [PMID: 27493451 PMCID: PMC4963559 DOI: 10.1155/2016/4121837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/31/2016] [Indexed: 12/16/2022] Open
Abstract
We work on the assumption that four major specialities or sectors of medical laboratory assays, comprising clinical chemistry, haematology, immunology, and microbiology, embraced by genome sequencing techniques, are routinely in use. Medical laboratory markers for inflammation serve as model: they are allotted to most fields of medical lab assays including genomics. Incessant coding of assays aligns each of them in the long lists of big data. As exemplified with the complement gene family, containing C2, C3, C8A, C8B, CFH, CFI, and ITGB2, heritability patterns/risk factors associated with diseases with genetic glitch of complement components are unfolding. The C4 component serum levels depend on sufficient vitamin D whilst low vitamin D is inversely related to IgG1, IgA, and C3 linking vitamin sufficiency to innate immunity. Whole genome sequencing of microbial organisms may distinguish virulent from nonvirulent and antibiotic resistant from nonresistant varieties of the same species and thus can be listed in personal big data banks including microbiological pathology; the big data warehouse continues to grow.
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Affiliation(s)
- Urs Nydegger
- Labormedizinisches Zentrum Dr. Risch and Kantonsspital Graubünden, 7000 Chur, Switzerland
| | - Thomas Lung
- Labormedizinisches Zentrum Dr. Risch and Kantonsspital Graubünden, 7000 Chur, Switzerland
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr. Risch and Kantonsspital Graubünden, 7000 Chur, Switzerland
| | - Martin Risch
- Labormedizinisches Zentrum Dr. Risch and Kantonsspital Graubünden, 7000 Chur, Switzerland
| | - Pedro Medina Escobar
- Labormedizinisches Zentrum Dr. Risch and Kantonsspital Graubünden, 7000 Chur, Switzerland
| | - Thomas Bodmer
- Labormedizinisches Zentrum Dr. Risch and Kantonsspital Graubünden, 7000 Chur, Switzerland
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49
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Red cell alloimmunisation: incidence and prevention. LANCET HAEMATOLOGY 2016; 3:e260-1. [PMID: 27264033 DOI: 10.1016/s2352-3026(16)30043-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/05/2016] [Indexed: 11/20/2022]
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50
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Blood group polymorphisms in Brazil. Rev Bras Hematol Hemoter 2016; 38:182-3. [PMID: 27521851 PMCID: PMC4997893 DOI: 10.1016/j.bjhh.2016.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 04/27/2016] [Indexed: 11/22/2022] Open
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