1
|
Polin H, Wenighofer B, Polonyi N, Danzer M. Evaluation of the LightCycler ® PRO Instrument as a Platform for Rhesus D Typing. Biomedicines 2024; 12:1785. [PMID: 39200249 PMCID: PMC11352138 DOI: 10.3390/biomedicines12081785] [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: 06/23/2024] [Revised: 07/25/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Rapid and reliable Rhesus D typing is crucial for blood donation centers. In instances of massive blood transfusion or reduced antigen expression, DNA-based phenotype prediction becomes mandatory. Our molecular RHD typing approach involves an initial real-time PCR for the most common aberrant RHD types in our region, RHD*01W.1 (weak D type 1), RHD*01W.2 (weak D type 2), RHD*01W.3 (weak D type 3), and RHD*07.01 (DVII). For comprehensive coverage, Sanger sequencing of RHD coding regions is performed in the case of PCR target-negative results. We evaluated the specificity and accuracy of these methods using the recently launched LightCycler® PRO real-time platform. All findings demonstrated remarkable accuracy. Notably, the LightCycler® PRO instrument offers a distinct advantage in data interpretation and integration via the HL7 interface. This study underlines the importance of including advanced molecular techniques in blood typing protocols, especially in scenarios where conventional serological methods may be insufficient.
Collapse
Affiliation(s)
- Helene Polin
- Red Cross Transfusion Service of Upper Austria, Krankenhausstrasse 7, 4020 Linz, Austria
| | | | | | | |
Collapse
|
2
|
McGowan EC, Wu PC, Hellberg Å, Lopez GH, Hyland CA, Olsson ML. A Bioinformatically Initiated Approach to Evaluate GATA1 Regulatory Regions in Samples with Weak D, Del, or D- Phenotypes Despite Normal RHD Exons. Transfus Med Hemother 2024; 51:252-264. [PMID: 39021419 PMCID: PMC11250534 DOI: 10.1159/000538469] [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: 12/30/2023] [Accepted: 03/19/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction With over 360 blood group antigens in systems recognized, there are antigens, such as RhD, which demonstrate a quantitative reduction in antigen expression due to nucleotide variants in the non-coding region of the gene that result in aberrant splicing or a regulatory mechanism. This study aimed to evaluate bioinformatically predicted GATA1-binding regulatory motifs in the RHD gene for samples presenting with weak or apparently negative RhD antigen expression but showing normal RHD exons. Methods Publicly available open chromatin region data were overlayed with GATA1 motif candidates in RHD. Genomic DNA from weak D, Del or D- samples with normal RHD exons (n = 13) was used to confirm RHD zygosity by quantitative PCR. Then, RHD promoter, intron 1, and intron 2 regions were amplified for Sanger sequencing to detect potential disruptions in the GATA1 motif candidates. Electrophoretic mobility shift assay (EMSA) was performed to assess GATA1-binding. Luciferase assays were used to assess transcriptional activity. Results Bioinformatic analysis identified five of six GATA1 motif candidates in the promoter, intron 1 and intron 2 for investigation in the samples. Luciferase assays showed an enhancement in transcription for GATA1 motifs in intron 1 and for intron 2 only when the R 2 haplotype variant (rs675072G>A) was present. GATA1 motifs were intact in 12 of 13 samples. For one sample with a Del phenotype, a novel RHD c.1-110A>C variant disrupted the GATA1 motif in the promoter which was supported by a lack of a GATA1 supershift in the EMSA and 73% transcriptional activity in the luciferase assay. Two samples were D+/D- chimeras. Conclusion The bioinformatic predictions enabled the identification of a novel DEL allele, RHD c.1-110A>C, which disrupted the GATA1 motif in the proximal promoter. Although the majority of the samples investigated here remain unexplained, we provide GATA1 targets which may benefit future RHD regulatory investigations.
Collapse
Affiliation(s)
- Eunike C. McGowan
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Ping Chun Wu
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Åsa Hellberg
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Genghis H. Lopez
- Research and Development, Australian Red Cross Lifeblood, Brisbane, QLD, Australia
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Catherine A. Hyland
- Research and Development, Australian Red Cross Lifeblood, Brisbane, QLD, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Martin L. Olsson
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, Lund, Sweden
| |
Collapse
|
3
|
Flegel WA, Srivastava K. 40 years of researching the Del phenotype results in a change of transfusion practice. Transfusion 2024; 64:1187-1190. [PMID: 38899801 PMCID: PMC11251845 DOI: 10.1111/trf.17913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024]
Abstract
Anti-D cannot agglutinate red cells of any Del phenotype in routine serology. Many individuals with East Asian ancestry who type D-negative in serology harbor a Del phenotype. Almost all such individuals carry one distinct DEL variant, dubbed Asian-type DEL, known as RHD*01EL.01, RHD*DEL1, RHD:c.1227G>A, formerly known as RHD(K409K). Clinical evidence strongly suggests that Asian-type DEL individuals can safely be transfused with RhD-positive blood and do not need anti-D prophylaxis in pregnancy.
Collapse
Affiliation(s)
- Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
4
|
Schimanski B, Kräuchi R, Stettler J, Lejon Crottet S, Niederhauser C, Clausen FB, Fontana S, Hodel M, Amylidi-Mohr S, Raio L, Abbal C, Henny C. Fetal RHD Screening in RH1 Negative Pregnant Women: Experience in Switzerland. Biomedicines 2023; 11:2646. [PMID: 37893020 PMCID: PMC10604374 DOI: 10.3390/biomedicines11102646] [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: 08/29/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
RH1 incompatibility between mother and fetus can cause hemolytic disease of the fetus and newborn. In Switzerland, fetal RHD genotyping from maternal blood has been recommended from gestational age 18 onwards since the year 2020. This facilitates tailored administration of RH immunoglobulin (RHIG) only to RH1 negative women carrying a RH1 positive fetus. Data from 30 months of noninvasive fetal RHD screening is presented. Cell-free DNA was extracted from 7192 plasma samples using a commercial kit, followed by an in-house qPCR to detect RHD exons 5 and 7, in addition to an amplification control. Valid results were obtained from 7072 samples, with 4515 (64%) fetuses typed RHD positive and 2556 (36%) fetuses being RHD negative. A total of 120 samples led to inconclusive results due to the presence of maternal or fetal RHD variants (46%), followed by women being serologically RH1 positive (37%), and technical issues (17%). One sample was typed false positive, possibly due to contamination. No false negative results were observed. We show that unnecessary administration of RHIG can be avoided for more than one third of RH1 negative pregnant women in Switzerland. This reduces the risks of exposure to a blood-derived product and conserves this limited resource to women in actual need.
Collapse
Affiliation(s)
- Bernd Schimanski
- Interregional Blood Transfusion SRC Berne Ltd., 3008 Berne, Switzerland
| | - Rahel Kräuchi
- Interregional Blood Transfusion SRC Berne Ltd., 3008 Berne, Switzerland
| | - Jolanda Stettler
- Interregional Blood Transfusion SRC Berne Ltd., 3008 Berne, Switzerland
| | | | - Christoph Niederhauser
- Interregional Blood Transfusion SRC Berne Ltd., 3008 Berne, Switzerland
- Institute for Infectious Diseases, University of Berne,3010 Berne, Switzerland
| | - Frederik Banch Clausen
- Department of Clinical Immunology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Stefano Fontana
- Interregional Blood Transfusion SRC Berne Ltd., 3008 Berne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1005 Lausanne, Switzerland
| | - Markus Hodel
- Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland
| | - Sofia Amylidi-Mohr
- Department of Obstetrics and Gynecology, University Hospital of Berne—Inselspital, 3010 Berne, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology, University Hospital of Berne—Inselspital, 3010 Berne, Switzerland
| | - Claire Abbal
- Division of Hematology, Lausanne University Hospital—CHUV, 1011 Lausanne, Switzerland
| | - Christine Henny
- Interregional Blood Transfusion SRC Berne Ltd., 3008 Berne, Switzerland
| |
Collapse
|
5
|
Wen J, Jia S, Wang Z, Chen J, Liang Q, Wei L, Richard G, Fichou Y, Luo G, Ji Y. Molecular and serological analysis of the D variant in the Chinese population and identification of seven novel RHD alleles. Transfusion 2023; 63:402-414. [PMID: 36382965 DOI: 10.1111/trf.17186] [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: 08/09/2022] [Revised: 09/30/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The molecular basis of the D variant phenotype in the Chinese differs greatly from that of the Caucasian. Adapting a specific D typing strategy to the spectrum of prevalent RHD variant alleles is necessary. STUDY DESIGN AND METHODS Blood samples with ambiguous D phenotypes were collected in the Southern Chinese population. A special three-step typing strategy was applied. First, the common DVI type 3 was identified from epitope profiles of D antigen. Then, another common weak D type 15 (RHD*845A) was identified by epitope profiles of D antigen and Sanger sequencing of RHD exon 6. Finally, the remaining D variants were genotyped mainly by Sanger sequencing. For the novel RHD alleles in the coding region and exon-intron junction, in vitro transfection and minigene splicing assays were performed, respectively. The anti-D investigation was performed. RESULTS DVI type 3 (65/253, 25.7%) and weak D type 15 (62/253, 24.5%) were common Chinese D variants, and RHD*960A, DFR, RHD*weak D type 25, 72, and 136 were frequent variant RHD alleles. Besides, twenty-two sporadic and seven novel RHD alleles (RHD*188A; RHD*688C; RHD*782 T; RHD*1181C; RHD*165 T, 993A; RHD*148 + 3G > T and RHD*1227 + 5G > C) were identified. The deleterious effect of the novel RHD alleles on D antigen or mRNA expression was confirmed. Anti-D was detected in two DVI type 3 pregnant women. DISCUSSION The three-step typing strategy provides an effective approach for Chinese D variant typing. It can be anticipated that commercially available RHD genotyping kits have limitations for testing Chinese D variants, as some of the frequent variants are not interrogated.
Collapse
Affiliation(s)
- Jizhi Wen
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.,The Key Medical Laboratory of Guangzhou, Guangzhou, People's Republic of China
| | - Shuangshuang Jia
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.,The Key Medical Laboratory of Guangzhou, Guangzhou, People's Republic of China
| | - Zhen Wang
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.,The Key Medical Laboratory of Guangzhou, Guangzhou, People's Republic of China
| | - Jingwang Chen
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.,The Key Medical Laboratory of Guangzhou, Guangzhou, People's Republic of China
| | - Qianni Liang
- Department of Blood Transfusion, Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China
| | - Ling Wei
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.,The Key Medical Laboratory of Guangzhou, Guangzhou, People's Republic of China
| | | | - Yann Fichou
- Univ Brest, Inserm, EFS, UMR 1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Guangping Luo
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.,The Key Medical Laboratory of Guangzhou, Guangzhou, People's Republic of China
| | - Yanli Ji
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.,The Key Medical Laboratory of Guangzhou, Guangzhou, People's Republic of China
| |
Collapse
|
6
|
Yin Q, Ouchari M. Transfusion management of Africans with RHD variants in China. Transfus Clin Biol 2023; 30:287-293. [PMID: 36702201 DOI: 10.1016/j.tracli.2023.01.003] [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: 12/14/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
The presence of D variant among minorities could produce a higher rate of alloimmunization observed in patients from this group. This is partly due to the ethnic and racial specificity of RHD variants and the limited availability of Rh-matched blood donors. Approximately half a million African migrants in China carrying distinct Rh blood type composition have presented to the health care system with an imperative safety requirement of blood transfusion among 1.3 billion Chinese individuals. We depict the clinically significant RHD alleles among African migrants living in China and identify the genetic similarities and disparities to Chinese. We discussed practical strategies to manage the unique transfusion needs of African migrants in China.
Collapse
Affiliation(s)
- Qinan Yin
- School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, Henan, China
| | | |
Collapse
|
7
|
Morin PA, Perreault J, St-Louis M, Leiva-Torres GA, Robitaille N, Trépanier P. Weak D type 42: Antigen density and risk of alloimmunization in the province of Québec. Vox Sang 2022; 117:943-948. [PMID: 35297064 DOI: 10.1111/vox.13271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/14/2022] [Accepted: 03/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES A high proportion of suspected weak D patients referred to Héma-Québec were genotyped as weak D type 42 (368/2105, 17.5%). These patients are currently considered D with regard to RhD immunoprophylaxis in pregnancy and transfusion. The goal of this study was to retrospectively evaluate the risk of alloimmunization in weak D type 42 patients and to characterize their RhD surface molecule expression on red blood cells (RBCs) in comparison to other weak D types (1, 2 and 3). MATERIALS AND METHODS A retrospective analysis using the weak D type 42 patients' medical data to verify potential anti-D alloimmunization events was conducted. Quantitative analyses using flow cytometry were also performed on RBCs to quantify the cell surface density of the D antigen. RESULTS Data on 215 subjects with weak D type 42 were reviewed. None developed immune allo-anti-D; three had definite exposure to D+ red cells and 41 had possible exposure through pregnancy. Flow cytometry analysis showed that weak D types 1, 2, 3 and 42 had relative antigen densities of 2.7%, 2.2%, 8.1% and 3.6%, respectively, with R1R2 red cells referencing 100% density. The estimated antigen density range of weak D type 42 was 819-1104 sites per RBC. CONCLUSION Our retrospective alloimmunization data analysis and antigen density study establish a basis for the consideration of a weak D type 42 individual as D+. This consideration would allow for a targeted reduction of RhD immunoprophylaxis in pregnancy and the unjustified use of D- units for transfusion.
Collapse
Affiliation(s)
- Pierre-Aurèle Morin
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Josée Perreault
- Héma-Québec, Medical Affairs and Innovation, Québec City, Québec, Canada
| | - Maryse St-Louis
- Héma-Québec, Medical Affairs and Innovation, Québec City, Québec, Canada
| | | | | | - Patrick Trépanier
- Héma-Québec, Medical Affairs and Innovation, Québec City, Québec, Canada
| |
Collapse
|
8
|
Abstract
Red blood cell (RBC) transfusion is one of the most frequently performed clinical procedures and therapies to improve tissue oxygen delivery in hospitalized patients worldwide. Generally, the cross-match is the mandatory test in place to meet the clinical needs of RBC transfusion by examining donor-recipient compatibility with antigens and antibodies of blood groups. Blood groups are usually an individual's combination of antigens on the surface of RBCs, typically of the ABO blood group system and the RH blood group system. Accurate and reliable blood group typing is critical before blood transfusion. Serological testing is the routine method for blood group typing based on hemagglutination reactions with RBC antigens against specific antibodies. Nevertheless, emerging technologies for blood group testing may be alternative and supplemental approaches when serological methods cannot determine blood groups. Moreover, some new technologies, such as the evolving applications of blood group genotyping, can precisely identify variant antigens for clinical significance. Therefore, this review mainly presents a clinical overview and perspective of emerging technologies in blood group testing based on the literature. Collectively, this may highlight the most promising strategies and promote blood group typing development to ensure blood transfusion safety.
Collapse
Affiliation(s)
- Hong-Yang Li
- Department of Blood Transfusion, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Kai Guo
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Kai Guo
| |
Collapse
|
9
|
Uzuni A, Wlosinski L, Lopez-Plaza I. Updated Evaluation of RhD Status Among Women of Child-Bearing Age in Detroit, Michigan. Am J Clin Pathol 2021; 156:1000-1006. [PMID: 34050357 DOI: 10.1093/ajcp/aqab061] [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] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The Rh blood group system is one of the most important and immunogenic blood group systems after the ABO blood group system and, like other blood group antigens, it follows ethnic and racial trends. However, when it comes to D variants-partial D and weak D-most of the cohorts studied in the literature have been of European descent. This study aimed to discover the variant D trends in Detroit, Michigan, with an emphasis on Black communities. METHODS From 2016 to 2018, there were 102 patients (women of childbearing potential: < 50 years) at Henry Ford Hospital that had serologic D discrepant testing. These patients were sent out for molecular RHD determination. RESULTS In total, 12.7% of patients were characterized as RhD positive and 87.3% of patients were characterized as RhD variants (nominated as RhD negative at our institution). CONCLUSIONS Our predominantly Black cohort sheds light on the diversity of the RhD antigen. The majority of Blacks were classified as RhD variants (RhD negative nomination at our institution). Therefore, molecular testing for this patient population with serologic RhD discrepancies is paramount to properly manage their obstetric care.
Collapse
Affiliation(s)
- Ajna Uzuni
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Lindsey Wlosinski
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Ileana Lopez-Plaza
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|
10
|
Flegel WA. Proceed with care: the "uncommon" serologic weak D phenotypes. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2021; 19:272-276. [PMID: 34704554 PMCID: PMC8297679 DOI: 10.2450/2021.0147-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, United States of America
- Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
11
|
Leiva-Torres GA, Chevrier MC, Constanzo-Yanez J, Lewin A, Lavoie J, Laganière J, Baillargeon N, Trépanier P, Robitaille N. High prevalence of weak D type 42 in a large-scale RHD genotyping program in the province of Quebec (Canada). Transfusion 2021; 61:2727-2735. [PMID: 34121202 DOI: 10.1111/trf.16518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The determination of the RhD phenotype is crucial to avoid alloimmunization, especially in childbearing women. Following the 2015 recommendation from the Work Group on RHD Genotyping, a large-scale RHD genotyping program was implemented in the province of Quebec (Canada) and offered to women ≤45 years old with a serological weak D or discordant results. Since weak D type 42 was previously shown to be prevalent among French Canadians, genotyping for that variant was also performed. Our aim was to report the prevalence of the weak D alleles in the province of Quebec. STUDY DESIGN AND METHODS A retrospective study of 2105 women with serological weak D referred to Hema-Quebec's immunohematology reference laboratory (IRL) between June 2016 and May 2020 was conducted. Results from the serological tests performed by the referring hospital were compiled and RHD were genotyped. RESULTS Most patients presented at least one serological result ≤2+ before being referred to Hema-Quebec. Weak D type 42 was the most prevalent variant, representing 17.5% (368/2105) of all individuals tested. Only 15.3% (323/2105) of patients were weak D type 1, 3.3% (69/2105) were type 2, and 8.6% (180/2105) were type 3. Weak D type 42 is highly expressed in regions with low immigration rate and known for their founder effect. CONCLUSION Our RHD genotyping program allowed for a better management of weak D. The province of Quebec presents a unique RHD genotype distribution. We confirmed that weak D type 42 is associated with a founder effect found in Caucasian French Canadians.
Collapse
Affiliation(s)
| | | | | | - Antoine Lewin
- Medical Affairs and Innovation, Hema-Quebec, Quebec, Quebec, Canada
| | - Josée Lavoie
- Medical Affairs and Innovation, Hema-Quebec, Quebec, Quebec, Canada
| | - Josée Laganière
- Medical Affairs and Innovation, Hema-Quebec, Quebec, Quebec, Canada
| | - Nadia Baillargeon
- Immunohematology Reference Laboratory, Hema-Quebec, Montreal, Quebec, Canada
| | | | - Nancy Robitaille
- Immunohematology Reference Laboratory, Hema-Quebec, Montreal, Quebec, Canada
| |
Collapse
|
12
|
Flegel WA, Bodnar M, Clarke G, Hannon J, Lieberman L. What constitutes the most cautious approach for a pregnant person with weak D type 4.0? CMAJ 2021; 193:E916. [PMID: 34860699 PMCID: PMC8248459 DOI: 10.1503/cmaj.78986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Willy Albert Flegel
- Transfusion medicine specialist, chief of Laboratory Services section, NIH Clinical Center, National Institutes of Health, Bethesda, Md
| | - Melanie Bodnar
- Hematopathologist, transfusion medicine specialist, Canadian Blood Services, Edmonton, Alta
| | - Gwen Clarke
- Hematopathologist, transfusion medicine specialist, associate medical director of Donor and Clinical Services, Canadian Blood Services, Edmonton, Alta
| | - Judith Hannon
- Hematopathologist, transfusion medicine specialist, chair of Perinatal Advisory Council, Canadian Blood Services, Edmonton, Alta
| | - Lani Lieberman
- Pediatric hematologist, transfusion medicine specialist, chair of Canadian Obstetric and Pediatric Transfusion Network, University Health Network, Toronto, Ont
| |
Collapse
|
13
|
Molecular Characteristics of the Serological Weak D Phenotype in Koreans. Diagnostics (Basel) 2021; 11:diagnostics11060920. [PMID: 34063775 PMCID: PMC8223775 DOI: 10.3390/diagnostics11060920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022] Open
Abstract
Serological weak D is a reaction of 2+ or less to anti-D reagent and includes weak D and partial D phenotypes. Although identifying the RhD subtype is important for transfusion safety, serological tests are insufficient for defining the RhD subtype, and molecular tests are needed. To analyze the molecular characteristics of D variants in Koreans to facilitate the formulation of individualized transfusion strategies, molecular tests such as RhD genotyping using real-time polymerase chain reaction (PCR) and partial-D and/or weak-D sequence-specific amplification (SSP) were performed on 105 Korean Rare Blood Program (KRBP) patients exhibiting serological weak D. In total, 58 out of 68 serologically determined weak D KRBP patients were typed as having weak D or partial D phenotypes via RhD genotyping. In detail, eight (13.8%) were typed as partial DVa or DBS, nine (15.5%) as weak D type 15, and four others (6.8%) as partial DVI, partial DVII, weak D type 2, or weak D type 41 or 45, whereas the rest (n = 37, 63.8%) was typed as having either weak D or partial D. This suggests that serological weak D Koreans who require transfusion should be treated as D-negative.
Collapse
|
14
|
Yin Q, Srivastava K, Brust DG, Flegel WA. Transfusion support during childbirth for a woman with anti-U and the RHD*weak D type 4.0 allele. Immunohematology 2021; 37:1-4. [PMID: 33962485 DOI: 10.21307/immunohematology-2021-001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
D- red blood cells (RBCs), always in short supply, and Rh immune globulin (RhIG) are not needed for patient care if D+ RBCs can safely be transfused. According to a recent work group recommendation, patients with the RHD*weak D type 4.0 allele can be considered D+. We report an African American woman who presented for delivery at the end of the third trimester, at which time anti-U and a serologic weak D phenotype were recognized, requiring U-, D- RBC units. We obtained 3 U- RBC units, including 1 D- unit. Later, the RHD*weak D type 4.0 allele was determined by RHD genotyping, only 6 days before delivery. The patient had an uneventful vaginal delivery of a D+ baby. No transfusion was needed for mother or baby. In this case, a pregnant woman with the RHD*weak D type 4.0 allele can safely be managed as D+, relaxing the unnecessary D- restriction for the limited U- RBC supply. The procured U-, D- RBC unit was frozen with 14 days of shelf-life remaining. To conserve D- RBC units, not limited to U-, for patients with a definite need, we recommend molecular analysis of a serologic weak D phenotype before a transfusion becomes imminent. The best time to resolve a serologic weak D phenotype with RHD genotyping is early in a pregnancy. Immunohematology 2021;37:1-4 . D– red blood cells (RBCs), always in short supply, and Rh immune globulin (RhIG) are not needed for patient care if D+ RBCs can safely be transfused. According to a recent work group recommendation, patients with the RHD*weak D type 4.0 allele can be considered D+. We report an African American woman who presented for delivery at the end of the third trimester, at which time anti-U and a serologic weak D phenotype were recognized, requiring U–, D– RBC units. We obtained 3 U– RBC units, including 1 D– unit. Later, the RHD*weak D type 4.0 allele was determined by RHD genotyping, only 6 days before delivery. The patient had an uneventful vaginal delivery of a D+ baby. No transfusion was needed for mother or baby. In this case, a pregnant woman with the RHD*weak D type 4.0 allele can safely be managed as D+, relaxing the unnecessary D– restriction for the limited U– RBC supply. The procured U–, D– RBC unit was frozen with 14 days of shelf-life remaining. To conserve D– RBC units, not limited to U–, for patients with a definite need, we recommend molecular analysis of a serologic weak D phenotype before a transfusion becomes imminent. The best time to resolve a serologic weak D phenotype with RHD genotyping is early in a pregnancy. Immunohematology 2021;37:1–4 .
Collapse
Affiliation(s)
- Q Yin
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health , Bethesda, MD
| | - K Srivastava
- Laboratory Services Section, Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health , Bethesda, MD
| | - D G Brust
- Blood Banking and Transfusion Medicine, Department of Pathology, University of Texas Medical Branch , Galveston, TX
| | - W A Flegel
- Laboratory Services Section, Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health , 10 Center Drive, Bethesda, MD 20892
| |
Collapse
|
15
|
Floch A, Pirenne F, Barrault A, Chami B, Toly-Ndour C, Tournamille C, de Brevern AG. Insights into anti-D formation in carriers of RhD variants through studies of 3D intraprotein interactions. Transfusion 2021; 61:1286-1301. [PMID: 33586199 DOI: 10.1111/trf.16301] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/04/2020] [Accepted: 01/13/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Many RhD variants associated with anti-D formation (partial D) in carriers exposed to the conventional D antigen carry mutations affecting extracellular loop residues. Surprisingly, some carry mutations affecting transmembrane or intracellular domains, positions not thought likely to have a major impact on D epitopes. STUDY DESIGN AND METHODS A wild-type Rh trimer (RhD1 RhAG2 ) was modeled by comparative modeling with the human RhCG structure. Taking trimer conformation, residue accessibility, and position relative to the lipid bilayer into account, we redefine the domains of the RhD protein. We generated models for RhD variants carrying one or two amino acid substitutions associated with anti-D formation in published articles (25 variants) or abstracts (12 variants) and for RHD*weak D type 38. We determined the extracellular substitutions and compared the interactions of the variants with those of the standard RhD. RESULTS The findings of the three-dimensional (3D) analysis were correlated with anti-D formation for 76% of RhD variants: 15 substitutions associated with anti-D formation concerned extracellular residues, and structural differences in intraprotein interactions relative to standard RhD were observed in the others. We discuss the mechanisms by which D epitopes may be modified in variants in which the extracellular residues are identical to those of standard RhD and provide arguments for the benignity of p.T379M (RHD*DAU0) and p.G278D (RHD*weak D type 38) in transfusion medicine. CONCLUSION The study of RhD intraprotein interactions and the precise redefinition of residue accessibility provide insight into the mechanisms through which RhD point mutations may lead to anti-D formation in carriers.
Collapse
Affiliation(s)
- Aline Floch
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - France Pirenne
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Aurélie Barrault
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Btissam Chami
- Etablissement francais du sang Ile-de-France, Creteil, France
| | - Cécile Toly-Ndour
- Unité Fonctionnelle d'expertise en Immuno-Hémobiologie Périnatale, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Service de Médecine Fœtale, Pôle Périnatalité, Hôpital Trousseau, GH HUEP, APHP, Paris, France
| | - Christophe Tournamille
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Alexandre G de Brevern
- Laboratoire d'Excellence GR-Ex, Paris, France.,Université de Paris, Biologie Intégrée du Globule Rouge UMR_S1134, Inserm, Université de la Réunion, Université des Antilles, Paris, France.,Institut National de la Transfusion Sanguine (INTS), Paris, France
| |
Collapse
|
16
|
Vege S, Sprogøe U, Lomas-Francis C, Jakobsen MA, Antonsen B, Aeschlimann J, Yazer M, Westhoff CM. Impact of RHD genotyping on transfusion practice in Denmark and the United States and identification of novel RHD alleles. Transfusion 2020; 61:256-265. [PMID: 32975828 DOI: 10.1111/trf.16100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Reduced D antigen on red blood cells (RBCs) may be due to "partial" D phenotypes associated with loss of epitope(s) and risk for alloimmunization or "weak" D phenotypes that do not lack major epitopes with absence of clinical complications. Genotyping of samples with weak and discrepant D typing is recommended to guide transfusion and RhIG prophylaxis. The goal was to compare the impact of RHD genotyping on transfusion practice in two centers serving different populations. STUDY DESIGN AND METHODS Fifty-seven samples from Denmark and 353 from the United States with weak or discrepant D typing were genotyped. RBC typing was by multiple methods and reagents. DNA isolated from white blood cells was tested with RBC-Ready Gene D weak or CDE in Denmark or RHD BeadChip in the United States. RHD was sequenced for those unresolved. RESULTS Of Caucasian samples from Denmark, 90% (n = 51) had weak D types 1, 2, or 3; two had other weak D, two partial D, and two new alleles. In diverse ethnic U.S. samples, 44% (n = 155) had weak D types 1, 2, or 3 and 56% (n = 198) had other alleles: uncommon weak D (n = 13), weak 4.0 (n = 62), partial D (n = 107), no RHD (n = 9), and new alleles (n = 7). CONCLUSION Most samples with weak or variable D typing from Denmark had alleles without risk for anti-D. In U.S. samples, 48% could safely be treated as D+, 18% may require consideration if pregnancy possible, and 34% could potentially benefit from being treated as D-. Black and multiracial ethnicities were overrepresented relative to population.
Collapse
Affiliation(s)
- Sunitha Vege
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
| | - Ulrik Sprogøe
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Christine Lomas-Francis
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
| | - Marianne A Jakobsen
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Berit Antonsen
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Judith Aeschlimann
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
| | - Mark Yazer
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.,Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Connie M Westhoff
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
| |
Collapse
|
17
|
RHD genotyping of serological weak D phenotypes in the Iranian blood donors and patients. Transfus Apher Sci 2020; 59:102870. [PMID: 32660892 DOI: 10.1016/j.transci.2020.102870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/13/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most prevalent weak D types in the Caucasians molecularly defined weak D types 1, 2 or 3 and can be managed safely as RhD-positive, conserving limited supplies of RhD-negative RBCs. Therefore, identification of RHD alleles prevalence in each population could improve the policies related to accuracy of RhD typing. The aim of this study was to determine the frequency of RHD variant alleles among donors and patients for the first time in Iran. MATERIALS AND METHODS RHD genotyping was performed on 100 blood donor and patient samples with weak D phenotype. PCR-SSP and DNA sequencing were used to identify the RHD alleles. RESULTS Molecular analysis showed only 15 samples were RHD*weak D 1(n = 13) and RHD*weak D 3(n = 2), and no cases of RHD*weak D 2 were detected. RHD*weak 15 (n = 43) was determined as the most prevalent D variants in our population and the other weak D types follows: RHD*weak 4, 5, 80 and one case of each one: RHD*weak 8, 11, 14, 100 and 105. Partial D variants also was identified in 18 samples as follows: RHD*partial DLO, DBT1, DV2, DHK and DAU-1. CONCLUSION The results of this study highlight the specific pattern of RHD status in the Iranian population. The weak D types 15 was the most common weak D type in the Iranian population. However, the screening for weak D types 1, 2 and 3 with 15 % frequency is also necessary for accurate RhD typing and developing clinical strategy of blood transfusion in weak D patients.
Collapse
|
18
|
RHD and RHCE molecular analysis in weak D blood donors and in patients with Rh antibodies against their own corresponding Rh antigen. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 18:295-303. [PMID: 32697929 DOI: 10.2450/2020.0026-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Rh system is the largest and most polymorphic blood group system. The existence of a large number of RH alleles results in variant phenotypes that often complicate blood donor phenotyping and the distinction between auto- and allo-antibodies in recipients who have anti-Rh antibodies in the presence of their own corresponding Rh antigen. Knowledge of these variants is necessary in order to make blood transfusion safer. MATERIALS AND METHODS Samples from 48 blood donors with serological weak D and from 29 patients who had anti-Rh antibody in the presence of their own corresponding Rh antigen were evaluated molecularly for RHD and RHCE alleles using a blood-multiplex ligation-dependent probe amplification assay and Sanger sequencing. RESULTS Rh variants were found in 45 of the 48 blood donors: 24/45 (53%) were weak D, 2/45 (4%) partial D and 19/45 (42%) were weak and partial D. The remaining three donors (6%) did not show a mutation in the RHD allele. Among the 29 patients, 13/29 had anti-e, of whom 4/13 had genotypes that predicted a partial e antigen; 11/29 had anti-D, with 6/11 being identified as partial D; 2/29 had anti-c, of whom 1/2 was predicted to express partial c antigen; 4/29 who had anti-E and 4/29 who had anti-C did not show mutations in RHCE*C or RHCE*E. DISCUSSION It was possible to find individuals with clinically significant Rh phenotypes due to the weak reactivity of the D antigen, detected through serological tests in blood donors. In patients, when found with the anti-Rh antibody in the presence of the same Rh antigen, it is difficult to distinguish an auto-antibody from an allo-antibody by serological tests; in these cases, molecular methods (genotyping) can help us to determine whether there are changes in the RH alleles and to discover the nature of the antibody (allo or auto).
Collapse
|
19
|
Khetan D, Verma A, Chaudhary RK, Shukla JS. Molecular characterisation of RhD variants in North Indian blood donor population. Transfus Med 2020; 30:295-303. [PMID: 32488899 DOI: 10.1111/tme.12690] [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: 07/18/2019] [Revised: 01/01/2020] [Accepted: 05/10/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES A molecular analysis of serologically RhD variant samples was conducted to find the incidence of various D variants in our blood donor population. BACKGROUND Determining a blood donor's RhD phenotype and genotype is important as transfusion of units with a weak D or partial D phenotype can result in immunisation of the recipients. METHODS Samples with discrepant D and weak D phenotypes identified on testing with at least five different monoclonal anti-D antisera were considered serological RhD variant and subjected to molecular testing (Massarray kit, Agena Bioscience, San Diego) for variant RHD gene. RESULTS A total of 39 samples, including 19 RhD discrepant samples and 20 weak D samples, were identified as serological RhD variant from a total of 4386 samples. Thirteen (13/39) samples carried variants leading to weak D phenotype, and eight samples had variants leading to partial D categories. Seven samples (7) could not be characterised, whereas 11 samples were identified as Rh negative (RHD*01N.01) after molecular testing. Overall incidence of D variants in the study population was 0.48%. RHD*weak D type 1(5, 0.1%) and RHD*DFR1 (5, 1%) were the most common variants identified. CONCLUSIONS Few samples with weak reaction on serological testing were found to be partial D variant and vice versa. Donor centres should develop a protocol for genotyping of samples with aberrant results on serological testing for assessing the actual RhD status of an individual as results of serological testing may be misleading.
Collapse
Affiliation(s)
- Dheeraj Khetan
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anviti Verma
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajendra K Chaudhary
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Jai Shankar Shukla
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
20
|
Flegel WA, Denomme GA, Queenan JT, Johnson ST, Keller MA, Westhoff CM, Katz LM, Delaney M, Vassallo RR, Simon CD, Sandler SG. It's time to phase out "serologic weak D phenotype" and resolve D types with RHD genotyping including weak D type 4. Transfusion 2020; 60:855-859. [PMID: 32163599 DOI: 10.1111/trf.15741] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 01/21/2020] [Accepted: 02/15/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Willy A Flegel
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | - John T Queenan
- Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Margaret A Keller
- National Molecular Laboratory, American Red Cross Biomedical Services, Philadelphia, Pennsylvania, USA
| | - Connie M Westhoff
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprises, New York, New York, USA
| | - Louis M Katz
- Mississippi Valley Regional Blood Center, Davenport, Iowa, USA
| | | | | | - Clayton D Simon
- Defense Health Agency, Armed Services Blood Program Office, Falls Church, Virginia, USA
| | - S Gerald Sandler
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
21
|
Londero D, Monge J, Hellberg A. A multi-centre study on the performance of the molecular genotyping platform ID RHD XT for resolving serological weak RhD phenotype in routine clinical practice. Vox Sang 2020; 115:241-248. [PMID: 31912520 DOI: 10.1111/vox.12886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/17/2019] [Accepted: 12/17/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES There is concern regarding the lack of prevention of unnecessary transfusion of RhD negative red cells and unnecessary administration of Rh immunoglobulin (RhIG) to pregnant women. In this study, performance of ID RHD XT, a genotyping assay for identification of six RHD allelic variants and human platelet antigens HPA-1a/1b was assessed. MATERIALS AND METHODS Whole blood samples presenting weak, discrepant or inconclusive D phenotype results were genotyped with ID RHD XT and compared to reference molecular tests. Candidacy for RhIG prophylaxis was determined by analysing samples from pregnant women. Hands-on time to complete the procedures was measured. RESULTS Overall, 167 samples were tested (55 donors, 56 patients, 52 pregnant women and four newborns). Agreement between ID RHD XT and the reference method was 100% (51% weak D type 1, 2 or 3; 35·5% weak D Types 1, 2 or 3 not detected; 4% RHD deletion; 1% RHD*Pseudogene; 1% RHD*DIIIa-CE(3-7)-D; and 4% no amplification variant detected for RHD genotype; and 64% HPA-1a/a; 30% HPA-1a/b; and 3% HPA-1b/b for HPA-1 genotype). Call rate was 98·2%. ID RHD XT identified 40% of the pregnant women that would not have required RhIG prophylaxis. Overall hands-on time was 25-45 min to process a batch of 24 samples, and four hours for total assay time. CONCLUSION ID RHD XT yielded reproducible results for RHD typing in serologically weak D phenotype individuals. ID RHD XT was proven useful for the correct management of patients with RhD serological discrepancies and the rational use of RhIG in pregnancy.
Collapse
Affiliation(s)
- Donatella Londero
- Immunohematology Laboratory, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Jorge Monge
- Immunohematology Laboratory, Basque Centre for Blood Transfusion & Human Tissues, Galdakao, Spain.,Cell Therapy, Stem Cells and Tissues Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Asa Hellberg
- Nordic Reference Laboratory for Genomic Blood Group Typing, Lund University Hospital, Lund, Sweden
| |
Collapse
|
22
|
Bakry RM, Nasreldin E, Hassaballa AE, Mansour SM, Aboalia SA. Evaluation of molecular typing and serological methods in solving discrepant results of weak and partial D (Rh) in South Egypt. Asian J Transfus Sci 2019; 13:110-114. [PMID: 31896917 PMCID: PMC6910034 DOI: 10.4103/ajts.ajts_162_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/31/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Rh discrepancies produced by partial and weak D phenotypes are a problem during routine testing. Some blood units with weak and partial D expression may be missed by serology. Overcoming the limitations of serology can be achieved by molecular typing. Our objective was to evaluate currently used serologic methods with the molecular analysis in solving discrepant results of weak and partial D (Rh) in South Egypt. PATIENTS AND METHODS Fifty blood donor and patient samples with undetermined D phenotype were subjected to serology to define their phenotype using identification (ID)-Card "ID-partial RhD typing set" using six monoclonal anti-D panels, followed by molecular typing using polymerase chain reaction sequence-specific primer kit. RESULTS Molecular typing confirmed most of the serology results; two samples previously resolved as partial D Type 3 and DFR by serological methods were clarified by molecular techniques - one sample as weak Type 4 and the other sample as weak Type 3. Among the weak D alleles found in our study, Type 4 was the most common, with a frequency of 20%, followed by Type 3 (14%), Type 1 (8%), Type 2 (6%), and finally, Type 5 with a frequency of 3%. The most common types of partial D were partial D Type D5 (14%) and Type D3 (10%). CONCLUSION Our study identified D variants (weak D and partial D categories) of the antigen D and determined the frequency and composition of partial D and weak D alleles in our population. Molecular typing also confirmed most of the results obtained from serological methods.
Collapse
Affiliation(s)
- Rania M Bakry
- Department of Oncological Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Eman Nasreldin
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ashraf E Hassaballa
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Samar M Mansour
- Department of Oncological Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Sahar A Aboalia
- Department of Oncological Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| |
Collapse
|
23
|
Takeuchi-Baba C, Ito S, Kinjo R, Miyagi H, Yasuda H, Ogasawara K, Ohto H. Production of RBC autoantibody mimicking anti-D specificity following transfusion in a patient with weak D Type 15. Transfusion 2019; 59:1190-1195. [DOI: 10.1111/trf.15207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/19/2018] [Accepted: 12/03/2018] [Indexed: 12/24/2022]
Affiliation(s)
| | - Shoichi Ito
- Japanese Red Cross Tohoku Block Center; Sendai Japan
| | - Rie Kinjo
- Department of Clinical Laboratory; Tomishiro Central Hospital; Okinawa Japan
| | - Hitomi Miyagi
- Department of Clinical Laboratory; Tomishiro Central Hospital; Okinawa Japan
| | - Hiroyasu Yasuda
- Division of Medical Technology; Fukushima Prefectural Hygiene Institute; Fukushima Japan
| | | | - Hitoshi Ohto
- Department of Advanced Cancer Immunotherapy; Fukushima Medical University; Fukushima Japan
| |
Collapse
|
24
|
A proposal for a rational transfusion strategy in patients of European and North African descent with weak D type 4.0 and 4.1 phenotypes. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 17:89-90. [PMID: 31013249 DOI: 10.2450/2018.0059-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
25
|
Luo X, Keller MA, James I, Grant M, Liu S, Massey KS, Czulewicz A, Nance S, Li Y. Strategies to identify candidates for D variant genotyping. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 16:293-301. [PMID: 28488958 PMCID: PMC5919842 DOI: 10.2450/2017.0274-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/21/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND RhD variants have altered D epitopes and/or decreased antigen copies per red cell. Individuals carrying these variants may test antigen negative, weakly positive, or positive by serology, and may or may not be at risk of alloimmunisation after exposure. There have been recommendations to perform RHD genotyping of patients, pregnant women and females of childbearing potential with serological weak D phenotype, to guide prophylactic use of Rh immune globulin (RhIG), and better conserve D-negative blood products. The purpose of this study was to evaluate the performance of a set of empirical criteria to identify such patients. MATERIALS AND METHODS A two-method strategy of gel testing (GT) and tube testing (TT) was used for Rh typing of patients with no historical blood type in the present institution. A monoclonal-polyclonal blend anti-D was used for Rh typing by TT at immediate spin. Three empirical criteria were used to identify candidates for genotyping: C1: discrepancy between the two test methods and a GT reaction strength >2+ stronger than TT; C2: weak serological reaction, defined as reaction strength ≤2+ regardless of testing method if both GT and TT were performed or reaction strength ≤2+ if only GT was performed, or reaction strength ≤1+ if only TT was performed; C3: presence of anti-D in D-positive patients with no history of RhIG use in the preceding 3 months and in whom alloanti-D is suspected. RESULTS Overall, 50 patients, ranging from newly born to 93 years old, were identified. Genomic testing confirmed D variants in 49/50 cases with a positive predictive value of 98%. DISCUSSION This two-method strategy is a powerful screening tool for identifying candidates for RHD genotyping. This strategy meets the current requirements of two blood type determinations/two specimens in pre-transfusion testing while simultaneously identifying candidates for RHD genotyping with a minimal increase in work load and cost.
Collapse
Affiliation(s)
- Xunda Luo
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Temple University, Philadelphia, PA, United States of America
| | - Margaret A. Keller
- American Red Cross, Temple University, Philadelphia, PA, United States of America
| | - Ian James
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Temple University, Philadelphia, PA, United States of America
| | - Michelle Grant
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Temple University, Philadelphia, PA, United States of America
| | - Shiguang Liu
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Temple University, Philadelphia, PA, United States of America
| | - Kellie Simmons Massey
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Temple University, Philadelphia, PA, United States of America
| | - Andrew Czulewicz
- Department of Pathology, Jeanes Hospital, Temple University, Philadelphia, PA, United States of America
| | - Sandra Nance
- American Red Cross, Temple University, Philadelphia, PA, United States of America
- University of Pennsylvania, Department of Pathology and Laboratory Medicine, Division of Transfusion Medicine, Temple University, Philadelphia, PA, United States of America
| | - Yanhua Li
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| |
Collapse
|
26
|
Ouchari M, Srivastava K, Romdhane H, Jemni Yacoub S, Flegel WA. Transfusion strategy for weak D Type 4.0 based on RHD alleles and RH haplotypes in Tunisia. Transfusion 2017; 58:306-312. [PMID: 29193104 DOI: 10.1111/trf.14411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND With more than 460 RHD alleles, this gene is the most complex and polymorphic among all blood group systems. The Tunisian population has the largest known prevalence of weak D Type 4.0 alleles, occurring in one of 105 RH haplotypes. We aimed to establish a rationale for the transfusion strategy of weak D Type 4.0 in Tunisia. STUDY DESIGN AND METHODS Donors were randomly screened for the serologic weak D phenotype. The RHD coding sequence and parts of the introns were sequenced. To establish the RH haplotype, the RHCE gene was tested for characteristic single-nucleotide positions. RESULTS We determined all RHD alleles and the RH haplotypes coding for the serologic weak D phenotype among 13,431 Tunisian donations. A serologic weak D phenotype was found in 67 individuals (0.50%). Among them, 60 carried a weak D Type 4 allele: 53 weak D Type 4.0, six weak D Type 4.2.2 (DAR), and one weak D Type 4.1. An additional four donors had one variant allele each: DVII, weak D Type 1, weak D Type 3, and weak D type 100, while three donors showed a normal RHD sequence. The weak D Type 4.0 was most often linked to RHCE*ceVS.04.01, weak D Type 4.2.2 to RHCE*ceAR, and weak D Type 4.1 to RHCE*ceVS.02, while the other RHD alleles were linked to one of the common RHCE alleles. CONCLUSIONS Among the weak D phenotypes in Tunisia, no novel RHD allele was found and almost 90% were caused by alleles of the weak D Type 4 cluster, of which 88% represented the weak D Type 4.0 allele. Based on established RH haplotypes for variant RHD and RHCE alleles and the lack of adverse clinical reports, we recommend D+ transfusions for patients with weak D Type 4.0 in Tunisia.
Collapse
Affiliation(s)
- Mouna Ouchari
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | | | | | - Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
27
|
Sandler SG, Chen L, Flegel WA. Serological weak D phenotypes: a review and guidance for interpreting the RhD blood type using the RHD genotype. Br J Haematol 2017; 179:10-19. [PMID: 28508413 PMCID: PMC5612847 DOI: 10.1111/bjh.14757] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Approximately 0·2-1% of routine RhD blood typings result in a "serological weak D phenotype." For more than 50 years, serological weak D phenotypes have been managed by policies to protect RhD-negative women of child-bearing potential from exposure to weak D antigens. Typically, blood donors with a serological weak D phenotype have been managed as RhD-positive, in contrast to transfusion recipients and pregnant women, who have been managed as RhD-negative. Most serological weak D phenotypes in Caucasians express molecularly defined weak D types 1, 2 or 3 and can be managed safely as RhD-positive, eliminating unnecessary injections of Rh immune globulin and conserving limited supplies of RhD-negative RBCs. If laboratories in the UK, Ireland and other European countries validated the use of potent anti-D reagents to result in weak D types 1, 2 and 3 typing initially as RhD-positive, such laboratory results would not require further testing. When serological weak D phenotypes are detected, laboratories should complete RhD testing by determining RHD genotypes (internally or by referral). Individuals with a serological weak D phenotype should be managed as RhD-positive or RhD-negative, according to their RHD genotype.
Collapse
Affiliation(s)
- S. Gerald Sandler
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Leonard Chen
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Willy A. Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
28
|
Goy-Thollot I, Giger U, Boisvineau C, Perrin R, Guidetti M, Chaprier B, Barthélemy A, Pouzot-Nevoret C, Canard B. Pre- and Post-Transfusion Alloimmunization in Dogs Characterized by 2 Antiglobulin-Enhanced Cross-match Tests. J Vet Intern Med 2017; 31:1420-1429. [PMID: 28804957 PMCID: PMC5598901 DOI: 10.1111/jvim.14801] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/16/2017] [Accepted: 06/12/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND When dogs are transfused, blood compatibility testing varies widely but may include dog erythrocyte antigen (DEA) 1 typing and rarely cross-matching. OBJECTIVES Prospective study to examine naturally occurring alloantibodies against red blood cells (RBCs) and alloimmunization by transfusion using 2 antiglobulin-enhanced cross-match tests. ANIMALS Eighty client-owned anemic, 72 donor, and 7 control dogs. METHODS All dogs were typed for DEA 1 and some also for DEA 4 and DEA 7. Major cross-match tests with canine antiglobulin-enhanced immunochromatographic strip and gel columns were performed 26-129 days post-transfusion (median, 39 days); some dogs had an additional early evaluation 11-22 days post-transfusion (median, 16 days). Plasma from alloimmunized recipients was cross-matched against RBCs from 34 donor and control dogs. RESULTS The 2 cross-match methods gave entirely concordant results. All 126 pretransfusion cross-match results for the 80 anemic recipients were compatible, but 54 dogs died or were lost to follow up. Among the 26 recipients with follow-up, 1 dog accidently received DEA 1-mismatched blood and became cross-match-incompatible post-transfusion. Eleven of the 25 DEA 1-matched recipients (44%) became incompatible against other RBC antigens. No naturally occurring anti-DEA 7 alloantibodies were detected in DEA 7- dogs. CONCLUSIONS AND CLINICAL IMPORTANCE The antiglobulin-enhanced immunochromatographic strip cross-match and laboratory gel column techniques identified no naturally occurring alloantibodies against RBC antigens, but a high degree of post-transfusion alloimmunization in dogs. Cross-matching is warranted in any dog that has been previously transfused independent of initial DEA 1 typing and cross-matching results before the first transfusion event.
Collapse
Affiliation(s)
- I Goy-Thollot
- SIAMU, VetAgro Sup, University of Lyon, APCSe, Marcy l'Etoile, France
| | - U Giger
- Section of Medical Genetics (PennGen), University of Pennsylvania, Philadelphia, PA
| | - C Boisvineau
- SIAMU, VetAgro Sup, University of Lyon, APCSe, Marcy l'Etoile, France
| | - R Perrin
- SIAMU, VetAgro Sup, University of Lyon, APCSe, Marcy l'Etoile, France
| | | | | | - A Barthélemy
- SIAMU, VetAgro Sup, University of Lyon, APCSe, Marcy l'Etoile, France
| | - C Pouzot-Nevoret
- SIAMU, VetAgro Sup, University of Lyon, APCSe, Marcy l'Etoile, France
| | - B Canard
- Dianov Laboratories, Limonest, France
| |
Collapse
|
29
|
Bub CB, Aravechia MG, Costa TH, Kutner JM, Castilho L. RHD alleles among pregnant women with serologic discrepant weak D phenotypes from a multiethnic population and risk of alloimmunization. J Clin Lab Anal 2017; 32. [PMID: 28374955 DOI: 10.1002/jcla.22221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 02/23/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A considerable number of RHD alleles responsible for weak and partial D phenotypes have been identified. Serologic determination of these phenotypes is often doubtful and makes genetic analysis of RHD gene highly desirable in transfusion recipients and pregnant women. We analyzed the RHD gene in a cohort of pregnant women with doubtful D phenotypes. METHODS RHD genotyping was performed on 104 cases with D typing discrepancies or with history of serologic weak D phenotype. Laboratory-developed DNA tests, RHD BeadChip (Bioarray Solutions, Immucor), and sequencing were used to identify the RHD alleles. RESULTS Molecular analyses showed 23 of 104 (22%) pregnant women were RHD*weak D types 1, 2, or 3 and not at risk for anti-D. Fifty-one (49%) were RHD*weak partial 4.0, 6 RHD*weak D type 38 (6%), 1 RHD*weak D type 45 (1%), 1 RHD*weak D type 67 (1%), and potentially at risk for being alloimmunized and making anti-D. Partial D was identified in 22 of 104 (21%) patients and definitively at risk for anti-D. DISCUSSION Appropriate classification of RhD phenotypes is recommended for correct indication of RhIG in pregnant women. However, the serologic distinction between RhD-negative and RhD-positive phenotypes is a difficult task in the case of D variants due to the variations in serologic testing. Our results show a great variability in RHD variant alleles in pregnant women from this population of high admixture. According to these results, 78% of these obstetric patients are at risk for anti-D and candidates for RhIG.
Collapse
Affiliation(s)
- Carolina Bonet Bub
- Hemotherapy and Cellular Therapy Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Maria Giselda Aravechia
- Hemotherapy and Cellular Therapy Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Thiago Henrique Costa
- Hemotherapy and Cellular Therapy Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - José Mauro Kutner
- Hemotherapy and Cellular Therapy Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Lilian Castilho
- Hemotherapy and Cellular Therapy Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,Hemocentro Unicamp, Campinas, Brazil
| |
Collapse
|
30
|
McGowan EC, Lopez GH, Knauth CM, Liew YW, Condon JA, Ramadi L, Parsons K, Turner EM, Flower RL, Hyland CA. Diverse and novelRHDvariants in Australian blood donors with a weak D phenotype: implication for transfusion management. Vox Sang 2017; 112:279-287. [DOI: 10.1111/vox.12488] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 12/13/2022]
Affiliation(s)
- E. C. McGowan
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - G. H. Lopez
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - C. M. Knauth
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
- School of Biomedical Sciences; Faculty of Health; Queensland University of Technology; Brisbane QLD Australia
| | - Y.-W. Liew
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - J. A. Condon
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; West Melbourne Vic. Australia
| | - L. Ramadi
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; West Melbourne Vic. Australia
| | - K. Parsons
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; Alexandria NSW Australia
| | - E. M. Turner
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - R. L. Flower
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - C. A. Hyland
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| |
Collapse
|
31
|
Lukacevic Krstic J, Dajak S, Bingulac-Popovic J, Dogic V, Mratinovic-Mikulandra J. Anti-D Antibodies in Pregnant D Variant Antigen Carriers Initially Typed as RhD. Transfus Med Hemother 2016; 43:419-424. [PMID: 27994529 DOI: 10.1159/000446816] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/22/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND To evaluate the incidence, the consequences, and the prevention strategy of anti-D alloimmunizations of D variant carriers in the obstetric population of Split-Dalmatia County, Croatia. METHODS RhD immunization events were evaluated retrospectively for the period between 1993 and 2012. Women were tested for RhD antigen and irregular antibodies. Those with anti-D antibody who were not serologically D- were genotyped for RHD. They were evaluated for their obstetric and transfusion history and their titer of anti-D. The neonates were evaluated for RhD status, direct antiglobulin test (DAT), hemoglobin and bilirubin levels, transfusion therapy as well as phototherapy and outcome. RESULTS Out of 104,884 live births 102,982 women were tested for RhD antigen. Anti-D immunization occurred in 184 women which accounts for 0.9% of individuals at risk of anti-D formation. 181 cases occurred in women serologically typed as D-. Three women were partial D carriers (DVa n = 2, DNB n = 1), initially typed RhD+, and recognized as D variant carriers after the immunization occurred. Anti-D titer varied from 1:1 to 1:16. Six children were RhD+, four had positive DAT, and two underwent phototherapy. CONCLUSION Anti-D immunization occurred in pregnant partial D carriers (DVa, DNB). RhD+ children had serologic markers of hemolytic disease of the fetus and newborn (HDFN), with no cases of severe HDFN.
Collapse
Affiliation(s)
- Jelena Lukacevic Krstic
- Department of Transfusion Medicine, Split University Hospital Center, Split, Croatia, Zagreb, Croatia
| | - Slavica Dajak
- Department of Transfusion Medicine, Split University Hospital Center, Split, Croatia, Zagreb, Croatia
| | | | - Vesna Dogic
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | | |
Collapse
|
32
|
Clarke G, Hannon J, Berardi P, Barr G, Cote J, Fallis R, Alport T, Lane D, Petraszko T, Ochoa G, Goldman M. Resolving variable maternal D typing using serology and genotyping in selected prenatal patients. Transfusion 2016; 56:2980-2985. [DOI: 10.1111/trf.13798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 11/28/2022]
|
33
|
Yazer MH, Brunker PA, Bakdash S, Tobian AA, Triulzi DJ, Earnest V, Harris S, Delaney M. Low incidence of D alloimmunization among patients with a serologic weak D phenotype after D+ transfusion. Transfusion 2016; 56:2502-2509. [DOI: 10.1111/trf.13725] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Mark H. Yazer
- Department of Pathology; University of Pittsburgh; Pittsburgh Pennsylvania
- The Institute for Transfusion Medicine; Pittsburgh Pennsylvania
| | | | - Suzanne Bakdash
- Department of Clinical Pathology; The Cleveland Clinic; Cleveland Ohio
| | | | - Darrell J. Triulzi
- Department of Pathology; University of Pittsburgh; Pittsburgh Pennsylvania
- The Institute for Transfusion Medicine; Pittsburgh Pennsylvania
| | | | | | - Meghan Delaney
- Department of Laboratory Medicine; University of Washington
- Bloodworks NW; Seattle Washington
| |
Collapse
|
34
|
Clinically relevant RHD-CE genotypes in patients with sickle cell disease and in African Brazilian donors. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 14:449-54. [PMID: 27177398 DOI: 10.2450/2016.0275-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/14/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND As a consequence of the homology and opposite orientation of RHD and RHCE, numerous gene rearrangements have occurred in Africans and resulted in altered RH alleles that predict partial antigens, contributing to the high rate of Rh alloimmunisation among patients with sickle cell disease (SCD). In this study, we characterised variant RH alleles encoding partial antigens and/or lacking high prevalence antigens in patients with SCD and in African Brazilian donors, in order to support antigen-matched blood for transfusion. MATERIAL AND METHODS RH genotypes were determined in 168 DNA samples from SCD patients and 280 DNA samples from African Brazilian donors. Laboratory developed tests, RHD BeadChip(TM), RHCE BeadChip(TM), cloning and sequencing were used to determine RHD-CE genotypes among patients and African Brazilian blood donors. RESULTS The distributions of RHD and RHCE alleles in donors and patients were similar. We found RHCE variant alleles inherited with altered RHD alleles in 25 out of 168 patients (15%) and in 22 out of 280 (7.8%) African Brazilian donors. The RHD and RHCE allele combinations found in the population studied were: RHD*DAR with RHCE*ceAR; RHD*weak D type 4.2.2 with RHCE*ceAR, RHD*weak D type 4.0 with RHCE*ceVS.01 and RHCE*ceVS.02; RHD*DIIIa with RHCE*ceVS.02. Thirteen patients and six donors had RHD-CE genotypes with homozygous or compound heterozygous alleles predicting partial antigens and/or lacking high prevalence antigens. Eleven patients were alloimmunised to Rh antigens. For six patients with RHD-CE genotypes predicting partial antigens, no donors with similar genotypes were found. DISCUSSION Knowledge of the distribution and prevalence of RH alleles in patients with SCD and donors of African origin may be important for implementing a programme for RH genotype matching in SCD patients with RH variant alleles and clinically significant Rh antibodies.
Collapse
|
35
|
Campos FCA, Mota MA, Aravechia MG, Torres KB, Bub CB, Kutner JM, Castilho L. Variant RHD Types in Brazilians With Discrepancies in RhD Typing. J Clin Lab Anal 2016; 30:845-848. [PMID: 27076392 DOI: 10.1002/jcla.21946] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/14/2015] [Accepted: 01/13/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The knowledge of D variants in patients and donors is important because anti-D alloimmunization can occur in some but not all individuals who express a variant RHD allele. Serologic distinction of RhD discrepancies is not always straightforward, which makes molecular analysis highly desirable. METHODS A group of 223 subjects, 129 patients, and 94 blood donors was identified and analyzed on the basis of a D typing discrepancy. The D antigen expression was evaluated by tube and gel hemagglutination with four anti-D reagents. PCR-single specific primer (SSP), multiplex PCR, RHD BeadChip (Immucor), or sequencing were used for molecular analysis. RESULTS In total, 168/223 (75%) weak D and 55/223 (25%) partial D variants were identified. Hemagglutination results varied in methods and anti-D reagents used in this process. There was no standard serologic reactivity identified, which could predict what type of D variant would be identified. Among weak D samples, types 1-3 were the most common, while DAR and DVI were most prevalent among partial D samples. CONCLUSION Our results show that discrepancies found in the serologic typing should be investigated by molecular methods in order to determine the D variant involved and also to distinguish between weak D and partial D. The knowledge of the distribution of weak D types and partial D among populations is important for D- patients and pregnant women management.
Collapse
Affiliation(s)
| | - Mariza Aparecida Mota
- Departamento de Hemoterapia e Terapia Celular, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Maria Giselda Aravechia
- Departamento de Hemoterapia e Terapia Celular, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Kelyan Bertani Torres
- Departamento de Hemoterapia e Terapia Celular, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Carolina Bonet Bub
- Departamento de Hemoterapia e Terapia Celular, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
| | - José Mauro Kutner
- Departamento de Hemoterapia e Terapia Celular, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Lilian Castilho
- Departamento de Hemoterapia e Terapia Celular, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Hemocentro Unicamp, Campinas, SP, Brazil
| |
Collapse
|
36
|
Papasavva T, Martin P, Legler TJ, Liasides M, Anastasiou G, Christofides A, Christodoulou T, Demetriou S, Kerimis P, Kontos C, Leontiades G, Papapetrou D, Patroclos T, Phylaktou M, Zottis N, Karitzie E, Pavlou E, Kountouris P, Veldhuisen B, van der Schoot E, Kleanthous M. Prevalence of RhD status and clinical application of non-invasive prenatal determination of fetal RHD in maternal plasma: a 5 year experience in Cyprus. BMC Res Notes 2016; 9:198. [PMID: 27036548 PMCID: PMC4818414 DOI: 10.1186/s13104-016-2002-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 03/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After the discovery that cell-free fetal DNA (cffDNA) is circulating in the maternal plasma of pregnant women, non-invasive prenatal diagnosis for fetal RhD in maternal plasma in RhD negative women at risk for haemolytic disease of the newborn (HDN) was clinically established and used by many laboratories. The objectives of this study are: (a) to assess the feasibility and report our experiences of the routine implementation of fetal RHD genotyping by analysis of cffDNA extracted from maternal plasma of RhD negative women at risk of HDN, and (b) to estimate the RhD phenotype frequencies, the RHD genotype frequencies and the RhD zygosity in the Cypriot population. METHODS cffDNA was extracted from maternal plasma of 73 RhD negative pregnant women. Real-Time Multiplex-PCR was used to amplify regions of RHD gene in exons 4, 5 and 10. RhD phenotypes were determined on 445 random samples using conventional agglutination slide test. RESULTS The fetus was predicted to be positive in 53 cases and negative in 18 cases. Two of cases were identified as D-variants, weak D type-1 and 11. The frequency of RhD negative homozygosity in the Cypriot population was estimated to be 7.2%, while the frequencies of RHD hemizygosity and RhD positive homozygosity was calculated to be 39.2 and 53.6%, respectively. CONCLUSION Fetal RHD genotyping can be accurately determined using cffDNA from maternal plasma. The implementation of the test has eliminated all use of unnecessary anti-D and reduced the total use of anti-D by 25.3% while achieving appropriate management of the RhD negative pregnancies.
Collapse
Affiliation(s)
- Thessalia Papasavva
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and Genetics, 6 Internanional Airport Ave, Agios Dometios, 1683, Nicosia, Cyprus.
| | - Pete Martin
- International Blood Group Reference Laboratory, Bristol Institute for Transfusion Sciences, NHS Blood and Transport, North Bristol Park, Filton, Bristol, BS34 7QG, UK
| | - Tobias J Legler
- Department of Transfusion Medicine, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Marios Liasides
- Zoodochou Pigis Clinic, 9 Antisthenous, Kapsalos, 3086, Limassol, Cyprus
| | - George Anastasiou
- Mother and Child Medical Center, 9-11 Penelopis Delta Str., 1076, Nicosia, Cyprus
| | | | - Tasos Christodoulou
- Apollonion Private Hospital, Lefkotheou 20, Strovolos, 2054, Nicosia, Cyprus
| | - Sotos Demetriou
- European Woman's Clinic, Vyzantiou 26, Strovolos, 2064, Nicosia, Cyprus
| | - Prokopis Kerimis
- Ygia Polyclinic Private Hospital, 21, Nafpliou str., 3305, Limassol, Cyprus
| | - Charis Kontos
- Iasis Hospital, 8 Voriou Ipirou str., 8069, Paphos, Cyprus
| | | | - Demetris Papapetrou
- Mother and Child Medical Center, 9-11 Penelopis Delta Str., 1076, Nicosia, Cyprus
| | | | - Marios Phylaktou
- Apollonion Private Hospital, Lefkotheou 20, Strovolos, 2054, Nicosia, Cyprus
| | - Nikos Zottis
- Ledra Obstetrics Gynecology Clinic, 19 Pindarou, Ayios Antonios, 1060, Nicosia, Cyprus
| | - Eleni Karitzie
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and Genetics, 6 Internanional Airport Ave, Agios Dometios, 1683, Nicosia, Cyprus
| | - Eleni Pavlou
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and Genetics, 6 Internanional Airport Ave, Agios Dometios, 1683, Nicosia, Cyprus
| | - Petros Kountouris
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and Genetics, 6 Internanional Airport Ave, Agios Dometios, 1683, Nicosia, Cyprus
| | | | | | - Marina Kleanthous
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and Genetics, 6 Internanional Airport Ave, Agios Dometios, 1683, Nicosia, Cyprus
| |
Collapse
|
37
|
Abstract
The clinical importance of blood group antigens relates to their ability to evoke immune antibodies that are capable of causing hemolysis. The most important antigens for safe transfusion are ABO and D (Rh), and typing for these antigens is routinely performed for patients awaiting transfusion, prenatal patients, and blood donors. Typing for other blood group antigens, typically of the Kell, Duffy, Kidd, and MNS blood groups, is sometimes necessary, for patients who have, or are likely to develop antibodies to these antigens. The most commonly used typing method is serological typing, based on hemagglutination reactions against specific antisera. This method is generally reliable and practical for routine use, but it has certain drawbacks. In recent years, molecular typing has emerged as an alternative or supplemental typing method. It is based on detecting the polymorphisms and mutations that control the expression of blood group antigens, and using this information to predict the probable antigen type. Molecular typing methods are useful when traditional serological typing methods cannot be used, as when a patient has been transfused and the sample is contaminated with red blood cells from the transfused blood component. Moreover, molecular typing methods can precisely identify clinically significant variant antigens that cannot be distinguished by serological typing; this capability has been exploited for the resolution of typing discrepancies and shows promise for the improved transfusion management of patients with sickle cell anemia. Despite its advantages, molecular typing has certain limitations, and it should be used in conjunction with serological methods.
Collapse
|
38
|
Abstract
AbstractHemolytic disease of the fetus and newborn (HDFN) affects 3/100 000 to 80/100 000 patients per year. It is due to maternal blood group antibodies that cause fetal red cell destruction and in some cases, marrow suppression. This process leads to fetal anemia, and in severe cases can progress to edema, ascites, heart failure, and death. Infants affected with HDFN can have hyperbilirubinemia in the acute phase and hyporegenerative anemia for weeks to months after birth. The diagnosis and management of pregnant women with HDFN is based on laboratory and radiographic monitoring. Fetuses with marked anemia may require intervention with intrauterine transfusion. HDFN due to RhD can be prevented by RhIg administration. Prevention for other causal blood group specificities is less studied.
Collapse
|
39
|
Recommendations for the prevention and treatment of haemolytic disease of the foetus and newborn. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:109-34. [PMID: 25633877 DOI: 10.2450/2014.0119-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
40
|
A model for integrating molecular-based testing in transfusion services. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 14:566-572. [PMID: 26509823 DOI: 10.2450/2015.0070-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/22/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Molecular-based laboratory tests can predict blood group antigens and supplement serological methods, adding a unique technology to assist in resolving discrepant or incomplete blood group typing or antibody identification. Hospital transfusion services have options for integrating molecular-based methods in their routine operations. We describe here the model of a hospital-reference laboratory partnership. MATERIALS AND METHODS Blood samples for compatibility testing were obtained from patients in a 609-bed hospital serving an urban multiethnic and multiracial population. When results of blood group phenotyping by serological methods were inconclusive, samples were referred for molecular-based testing. The reference laboratory used several methods for genotyping, including polymerase chain reaction followed by restriction enzyme-linked polymorphism analysis, sequence-specific primer polymerase chain reaction and array-based approaches. Human erythrocyte antigen, RHCE and RHD single nucleotide polymorphism arrays were integrated into the laboratory as they became commercially available. RESULTS The hospital-reference laboratory model made it possible to integrate blood group genotyping promptly by current technology without the expense of new laboratory equipment or adding personnel with technical expertise. We describe ten cases that illustrate the categories of serological problems that were resolved by molecular methods. DISCUSSION In-hospital molecular testing for transfusion services has logistical advantages, but is financially impractical for most hospitals. Our model demonstrates the advantages of a hospital-reference laboratory partnership. In conclusion, hospital transfusion services can integrate molecular-based testing in their routine services without delay by establishing a partnership with a molecular blood group reference laboratory. The hospital reference-laboratory model promotes genomic medicine without the expense of new equipment and skilled personnel, while supporting the economy of centralised large-scale laboratory operations.
Collapse
|
41
|
|
42
|
Wang M, Wang BL, Xu W, Fan DD, Peng ML, Pan J, Yao P, Jiang GM, Wan XJ. Anti-D alloimmunisation in pregnant women with DEL phenotype in China. Transfus Med 2015; 25:163-9. [PMID: 26033335 DOI: 10.1111/tme.12211] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 04/02/2015] [Accepted: 05/03/2015] [Indexed: 01/28/2023]
Affiliation(s)
- M. Wang
- The Department of Blood Transfusion; Affiliated Provincial Hospital of Anhui Medical University; Hefei Anhui China
- The Department of Laboratory Medicine; Affiliated Provincial Hospital of Anhui Medical University; Hefei Anhui China
| | - B. L. Wang
- The Department of Laboratory Medicine; Affiliated Provincial Hospital of Anhui Medical University; Hefei Anhui China
| | - W. Xu
- The Department of Blood Transfusion; The First Affiliated Hospital of Anhui Medical University; Hefei Anhui China
| | - D. D. Fan
- The Department of Epidemiology & Biostatistics, School of Public Health; Anhui Medical University; Hefei Anhui China
| | - M. L. Peng
- The Department of Epidemiology & Biostatistics, School of Public Health; Anhui Medical University; Hefei Anhui China
| | - J. Pan
- The Department of Blood Transfusion; Affiliated Provincial Hospital of Anhui Medical University; Hefei Anhui China
| | - P. Yao
- The Department of Laboratory Medicine; Affiliated Provincial Hospital of Anhui Medical University; Hefei Anhui China
| | - G. M. Jiang
- The Department of Blood Transfusion; Affiliated Provincial Hospital of Anhui Medical University; Hefei Anhui China
| | - X. J. Wan
- The Department of Blood Transfusion; Affiliated Provincial Hospital of Anhui Medical University; Hefei Anhui China
| |
Collapse
|
43
|
Sandler SG, Flegel WA, Westhoff CM, Denomme GA, Delaney M, Keller MA, Johnson ST, Katz L, Queenan JT, Vassallo RR, Simon CD. It's time to phase in RHD genotyping for patients with a serologic weak D phenotype. College of American Pathologists Transfusion Medicine Resource Committee Work Group. Transfusion 2015; 55:680-9. [PMID: 25438646 PMCID: PMC4357540 DOI: 10.1111/trf.12941] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 11/29/2022]
Affiliation(s)
- S Gerald Sandler
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Haspel RL, Westhoff CM. How do I manage Rh typing in obstetric patients? Transfusion 2015; 55:470-4. [DOI: 10.1111/trf.12995] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Richard L. Haspel
- Department of Pathology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston Massachusetts
| | | |
Collapse
|
45
|
Molecular immunohaematology round table discussions at the AABB Annual Meeting, Denver 2013. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 13:514-20. [PMID: 25545874 DOI: 10.2450/2014.0213-14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/20/2014] [Indexed: 11/21/2022]
|
46
|
Sassi A, Ouchari M, Houissa B, Romdhane H, Abdelkefi S, Chakroun T, Jemni Yacoub S. RHD genotyping and its implication in transfusion practice. Transfus Apher Sci 2014; 51:59-63. [PMID: 25457010 DOI: 10.1016/j.transci.2014.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/07/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The limitations of serology can be overcome by molecular typing. In order to evaluate the contribution of RH systematic genotyping and its implication in transfusion practice, a genotyping of D- blood donors was initiated. METHODS Blood samples were collected from 400 unrelated D- individuals. All samples were tested by RHD exon 10 PCR. In order to clarify the molecular mechanisms of RHD gene carrier, we applied molecular tools using different techniques: PCR-multiplex, and PCR-SSPs. RESULTS Among 400 D- subjects tested, 390 had RHD gene deletion; and 10 had RHD exon 10 of which seven were associated with the presence of the C or E antigens. Among D- carriers, we observed in five cases the presence of RHD-CE-Ds hybrid, in four cases the presence of pseudogene RHD ψ and in one case the presence of weak D type 4. CONCLUSION Since the majority of aberrant alleles were associated with C or E antigens and the preliminary infrastructure for molecular diagnostic were absent in all Tunisia territory, we recommend to reinforce transfusion practice to consider D- donors but C+/E+ antigens as D+ donors and the application of RHD molecular typing only to solve serologic problems.
Collapse
Affiliation(s)
- Awatef Sassi
- Centre Régional de Transfusion Sanguine, Hôpital Farhat Hached Sousse, Tunis, Tunisia
| | - Mouna Ouchari
- Centre Régional de Transfusion Sanguine, Hôpital Farhat Hached Sousse, Tunis, Tunisia
| | - Batoul Houissa
- Centre Régional de Transfusion Sanguine, Hôpital Farhat Hached Sousse, Tunis, Tunisia
| | - Houda Romdhane
- Centre Régional de Transfusion Sanguine, Hôpital Farhat Hached Sousse, Tunis, Tunisia
| | - Saida Abdelkefi
- Centre Régional de Transfusion Sanguine, Hôpital Farhat Hached Sousse, Tunis, Tunisia
| | - Taher Chakroun
- Centre Régional de Transfusion Sanguine, Hôpital Farhat Hached Sousse, Tunis, Tunisia
| | - Saloua Jemni Yacoub
- Centre Régional de Transfusion Sanguine, Hôpital Farhat Hached Sousse, Tunis, Tunisia.
| |
Collapse
|
47
|
RHD positive among C/E+ and D-negative blood donors in Tunisia. Transfus Clin Biol 2014; 21:320-3. [PMID: 25458985 DOI: 10.1016/j.tracli.2014.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 10/03/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE OF THE STUDY The aim of this study was to investigate RHD alleles among Tunisian blood donors with D-negative phenotype and positive for C and/or E antigen. PATIENTS AND METHODS A total of 100 D-negative and C/E+ samples were analyzed by RHD genotyping using an initial test for RHD exon 10. In case of a positive reaction, further molecular investigations including real time quantitative PCR, allele specific PCR and nucleotide sequencing were done to elucidate the RHD involved mechanisms. RESULTS Seventy-five percent of the studied samples lacked the RHD gene. Twenty-three percent carried the hybrid RHD-CE-D alleles (16 RHD-CE(3-7)-D, 5 RHD-CE(4-7)-D, 1 RHD-CE(4-8)-D, 1 RHD-CE(3-8)-D) and 2% were weak D (1 weak D type 1 and 1 weak D type 5). CONCLUSION Our study proved the high frequency of RHD gene among serologically D-negative samples, positive for C and/or E antigen. Thus achieving systematically RHCE phenotyping in all transfusion centers on the Tunisian territory and considering blood donated from D-negative C/E+ persons as D-positive will be recommended to reduce anti-D allo-immunization.
Collapse
|
48
|
Van Sandt VS, Gassner C, Emonds MP, Legler TJ, Mahieu S, Körmöczi GF. RHDvariants in Flanders, Belgium. Transfusion 2014; 55:1411-7. [DOI: 10.1111/trf.12947] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/22/2014] [Accepted: 10/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Vicky S.T. Van Sandt
- Histocompatibility and Immunogenetic Laboratory; Red Cross Flanders; Mechelen Belgium
| | - Christoph Gassner
- Blood Transfusion Service Zürich; Swiss Red Cross; Schlieren Switzerland
| | - Marie-Paule Emonds
- Histocompatibility and Immunogenetic Laboratory; Red Cross Flanders; Mechelen Belgium
| | - Tobias J. Legler
- Department of Transfusion Medicine; University of Göttingen; Göttingen Germany
| | - Sarah Mahieu
- Histocompatibility and Immunogenetic Laboratory; Red Cross Flanders; Mechelen Belgium
- ZNA Stuivenberg; Antwerp Belgium
| | - Günther F. Körmöczi
- Department of Blood Group Serology and Transfusion Medicine; Medical University of Vienna; Vienna Austria
| |
Collapse
|
49
|
Serologic findings of RhD alleles in Egyptians and their clinical implications. Transfus Apher Sci 2014; 51:184-7. [PMID: 25219636 DOI: 10.1016/j.transci.2014.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 08/19/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Serologic discrepancies caused by various reactivity of D variants can only be resolved by the use of RhD genotyping. However, this strategy cannot be applied routinely due to the cost and feasibility. It has been documented that D variants are demonstrated among individuals with positivity for at least C or E antigens. It is considered to be affordable for some countries to test D negative donors who are C or E positive for D variants. It was proposed that an algorithm could be found based on distinct serologic features that matches the Egyptian genetic frequency data, and correctly assigns donors and patients, using the least possible expenses. MATERIALS AND METHODS Samples with the most prevalent weak D and partial D were investigated for their RhCE phenotype. Routine D typing by immediate spin (IS) tube method was performed in parallel with an automated gel test, and the reactivity results of D variants with both techniques were compared. RESULTS Among 31 D variants, only 5 were C or E positive (16.1 %). R0r phenotype was associated with the remaining 26 samples (83.9%) and constituted weak D types 4.2 (38.5%), and 4.0/4.1 (11.5%), partial DIII (34.6%), and partial DV (15.4%). Gel reacted strongly with partial DIII and DV. Ten samples with DIII and DV typed as D positive with IS. All weak D were positive by indirect antiglobulin test (IAT), while all partial D were positive by gel and IAT. CONCLUSION Guidelines for RhD workup should be adjusted to match population data. Detection of D variants among C or E positive donors may not be an optimal strategy for Egyptians. Serology cannot discriminate weak D from partial D, but may provide a clue about the probable D variant to be tested molecularly with the appropriate kit. Reagent selection is important to correctly assign donors and patients with the DIII and DV types.
Collapse
|
50
|
Affiliation(s)
- Willy A Flegel
- From the Laboratory Services Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland (Drs Flegel and Tholpady); and the Department of Pathology, Virginia Commonwealth University Health System, Richmond, Virginia (Dr Roseff)
| | | | | |
Collapse
|