1
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Shao LN, Xia YX, Li CX, Yang YC, Zhou SH. Identification of a novel DEL allele with c.411G>C on the RHD*01EL.01 allele background. Transfusion 2024; 64:E26-E27. [PMID: 38655626 DOI: 10.1111/trf.17853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Affiliation(s)
| | - Yue-Xin Xia
- Dalian Blood Center, Dalian, Liaoning, China
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2
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Arnoni CP, Vendrame TA, Silva FS, Silva NM, Cortez A, Latini F, Castilho L. Serologic profiling of D variants in donor routine: unveiling the impact on false-negative results and alloimmunization. Immunohematology 2024; 40:47-53. [PMID: 38910444 DOI: 10.2478/immunohematology-2024-007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
The high number of D variants can lead to the unnecessary use of Rh immune globulin, overuse of D- RBC units, and anti-D allommunization. D variant prevalence varies among ethnic groups, and knowledge of the main variants present in a specific population, their behavior in serologic tests, and their impact on clinical practice is crucial to define the best serologic tests for routine use. The present study aimed to explore the serologic profile of D variants and to determine which variants are most associated with false-negative D typing results and alloimmunization. Donor samples were selected in two study periods. During the first period, D typing was performed on a semi-automated instrument in microplates, and weak D tests were conducted in tube or gel tests. In the second period, D typing was carried out using an automated instrument with microplates, and weak D tests were performed in solid phase. Samples from patients typed as D+ with anti-D were also selected. All samples were characterized by molecular testing. A total of 37 RHD variants were identified. Discrepancies and atypical reactivity without anti-D formation were observed in 83.4 percent of the samples, discrepant D typing results between donations were seen in 12.3 percent, and D+ patients with anti-D comprised 4.3 percent. DAR1.2 was the most prevalent variant. Weak D type 38 was responsible for 75 percent of discrepant samples, followed by weak D type 11, predominantly detected by solid phase. Among the D variants related to alloimmunization, DIVa was the most prevalent, which was not recognized by serologic testing; the same was true for DIIIc. The results highlight the importance of selecting tests for donor screening capable of detecting weak D types 38 and 11, especially in populations where these variants are more prevalent. In pre-transfusion testing, it is crucial that D typing reagents demonstrate weak reactivity with DAR variants; having a serologic strategy to recognize DIVa and DIIIc is also valuable.
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Affiliation(s)
- Carine P Arnoni
- 1Colsan-Associação Beneficente de Coleta de Sangue, São Paulo, SP, Brazil
| | - Tatiane A Vendrame
- 1Colsan-Associação Beneficente de Coleta de Sangue, São Paulo, SP, Brazil
| | - Flavia S Silva
- 1Colsan-Associação Beneficente de Coleta de Sangue, São Paulo, SP, Brazil
| | - Nayara M Silva
- 1Colsan-Associação Beneficente de Coleta de Sangue, São Paulo, SP, Brazil
| | - Afonso Cortez
- 1Colsan-Associação Beneficente de Coleta de Sangue, São Paulo, SP, Brazil
| | - Flavia Latini
- 1Colsan-Associação Beneficente de Coleta de Sangue, São Paulo, SP, Brazil
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3
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Clausen FB. Antenatal RHD screening to guide antenatal anti-D immunoprophylaxis in non-immunized D- pregnant women. Immunohematology 2024; 40:15-27. [PMID: 38739027 DOI: 10.2478/immunohematology-2024-004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
In pregnancy, D- pregnant women may be at risk of becoming immunized against D when carrying a D+ fetus, which may eventually lead to hemolytic disease of the fetus and newborn. Administrating antenatal and postnatal anti-D immunoglobulin prophylaxis decreases the risk of immunization substantially. Noninvasive fetal RHD genotyping, based on testing cell-free DNA extracted from maternal plasma, offers a reliable tool to predict the fetal RhD phenotype during pregnancy. Used as a screening program, antenatal RHD screening can guide the administration of antenatal prophylaxis in non-immunized D- pregnant women so that unnecessary prophylaxis is avoided in those women who carry a D- fetus. In Europe, antenatal RHD screening programs have been running since 2009, demonstrating high test accuracies and program feasibility. In this review, an overview is provided of current state-of-the-art antenatal RHD screening, which includes discussions on the rationale for its implementation, methodology, detection strategies, and test performance. The performance of antenatal RHD screening in a routine setting is characterized by high accuracy, with a high diagnostic sensitivity of ≥99.9 percent. The result of using antenatal RHD screening is that 97-99 percent of the women who carry a D- fetus avoid unnecessary prophylaxis. As such, this activity contributes to avoiding unnecessary treatment and saves valuable anti-D immunoglobulin, which has a shortage worldwide. The main challenges for a reliable noninvasive fetal RHD genotyping assay are low cell-free DNA levels, the genetics of the Rh blood group system, and choosing an appropriate detection strategy for an admixed population. In many parts of the world, however, the main challenge is to improve the basic care for D- pregnant women.
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Affiliation(s)
- Frederik B Clausen
- Laboratory of Blood Genetics, Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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4
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Yin Q. DEL variants: review of molecular mechanisms, clinical consequences and molecular testing strategy. Funct Integr Genomics 2023; 23:318. [PMID: 37840046 DOI: 10.1007/s10142-023-01249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
Patients with DEL phenotype, a D variant with a low number of D antigens per red blood cell, are routinely typed as RhD-negative in serology testing and are detectable only by adsorption and elution techniques or molecular methods. DEL is of clinical importance worldwide, as indicated by its genotype-phenotype discrepancies among different populations and its potential to cause anti-D alloimmunization when DEL phenotype individuals are inadvertently managed as RhD-negative. This narrative review summarized the DEL alleles causing DEL phenotype and the underlying mechanisms. The clinical consequences and current molecular testing approach were discussed to manage the transfusion needs of patients and donors with DEL phenotype.
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Affiliation(s)
- Qinan Yin
- Henan Engineering Research Center of Digital Pathology and Artificial Intelligence Diagnosis, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
- Precision Medicine Laboratory, School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China.
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5
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Uzunel M, Tiblad E, Mörtberg A, Wikman A. Single-exon approach to non-invasive fetal RHD screening in early pregnancy: An update after 10 years' experience. Vox Sang 2022; 117:1296-1301. [PMID: 36102142 PMCID: PMC9826394 DOI: 10.1111/vox.13348] [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: 05/12/2022] [Revised: 06/29/2022] [Accepted: 08/05/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Anti-D prophylaxis, administered to RhD-negative women, has significantly reduced the incidence of RhD immunization. Non-invasive fetal RHD screening has been used in Stockholm for more than 10 years to identify women who will benefit from prophylaxis. The method is based on a single-exon approach and is used in early pregnancy. The aim of this study was to update the performance of the method. MATERIALS AND METHODS The single exon assay from Devyser AB is a multiplex kit detecting both exon 4 of the RHD gene and the housekeeping gene GAPDH. Cell-free DNA was extracted from 1 ml of plasma from EDTA blood taken during early pregnancy, weeks 10-12. The genetic RHD results were compared with serological typing of newborns for a determination of sensitivity and specificity. RESULTS In total, 4337 pregnancies were included in the study; 44 samples (1%) were inconclusive either due to maternal RHD gene variants (n = 34) or technical reasons (n = 10). Of the remaining 4293 pregnancies, a total number of nine discrepant results were found. False positive results (n = 7) were mainly (n = 4) due to RHD gene variants in the child. False-negative results were found in two cases, of which one was caused by a technical error. None of the false-negative cases was due to RHD gene variants. Overall, the sensitivity of the method was 99.93% and specificity 99.56%. CONCLUSION The single-exon assay used in this study is correlated with high sensitivity and specificity.
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Affiliation(s)
- Mehmet Uzunel
- Division of Therapeutic Immunology and Transfusion Medicine, Karolinska InstitutetSolnaSweden
| | - Eleonor Tiblad
- Department of Women's Health, Division of ObstetricsKarolinska University HospitalStockholmSweden,Clinical Epidemiology Division, Department of Medicine SolnaKarolinska InstitutetSolnaSweden
| | - Anette Mörtberg
- The Department of Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
| | - Agneta Wikman
- The Department of Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
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6
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DUFOUR P, GERARD C, CHANTRAINE F, Jean‐Marc MINON. Investigation of discrepancies obtained during fifteen years of non‐invasive fetal
RHD
genotyping in apparent serologic RhD‐negative pregnant women. Prenat Diagn 2022; 42:1262-1272. [DOI: 10.1002/pd.6219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/06/2022] [Accepted: 07/26/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Patrice DUFOUR
- Department of Laboratory Medicine Immunohaematology and transfusion medicine division Centre Hospitalier Régional de la Citadelle Liège Belgium
| | - Christiane GERARD
- Blood Transfusion Service University of Liège (ULiège), CHU Liège Belgium
| | - Frédéric CHANTRAINE
- Department of Obstetrics and Gynecology Centre Hospitalier Universitaire de Liège CHR Citadelle Liège Belgium
| | - MINON Jean‐Marc
- Department of Laboratory Medicine Immunohaematology and transfusion medicine division Centre Hospitalier Régional de la Citadelle Liège Belgium
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7
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Ye L, Li M, Yang Q, Zhu Z. RHD alleles contributing to serologically weak D phenotypes in China: A single-centre study over 10 years. Vox Sang 2022; 117:949-957. [PMID: 35510963 DOI: 10.1111/vox.13275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/14/2022] [Accepted: 03/11/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES In cases of serologically weak D phenotypes, RHD genotyping may identify discrepant serotyping results and protect the patient against allogeneic immunization. This study aimed to conduct a comprehensive analysis of weak D alleles in China. MATERIALS AND METHODS We collected samples carrying weak D antigen during a 10-year period from 2005 to 2014. The intensity and epitopes of D were analysed serologically. Genomic DNA was extracted and used for RHD sequencing and heterozygote analysis. In particular, an in vitro expression method for functional verification of the rare and novel in-frame deletion mutation was developed and then combined with homologous modelling results for analysis. RESULTS We studied a total of 283 weak D samples from volunteer blood donors and identified 45 RHD alleles among them, 11 of which were reported for the first time. Ten (3.5%) samples surprisingly carried DEL allelic variants and as many as 40 (14.1%) carried the wild-type RHD genotype. Combination of the results of functional experiments and in silico analysis suggested that the rare in-frame deletion mutation may reduce the expression of D antigen by affecting the RhD protein structure. CONCLUSIONS This study provides an enhanced overview of the distribution characteristics of RHD alleles in Chinese subjects with serologically weak D. An in vitro method to predict the biological significance of variant RHD alleles was also provided. We found inconsistent genotyping and phenotypic results in some samples, indicating the existence of additional regulatory mechanisms.
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Affiliation(s)
- Luyi Ye
- Immunohematology Lab, Shanghai Institute of Blood Transfusion, Shanghai Blood Centre, Shanghai, China
| | - Minghao Li
- Immunohematology Lab, Shanghai Institute of Blood Transfusion, Shanghai Blood Centre, Shanghai, China
| | - Qixiu Yang
- Immunohematology Lab, Shanghai Institute of Blood Transfusion, Shanghai Blood Centre, Shanghai, China
| | - Ziyan Zhu
- Immunohematology Lab, Shanghai Institute of Blood Transfusion, Shanghai Blood Centre, Shanghai, China
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8
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Raud L, Le Tertre M, Vigneron L, Ka C, Richard G, Callebaut I, Chen JM, Férec C, Le Gac G, Fichou Y. Missense RHD single nucleotide variants induce weakened D antigen expression by altering splicing and/or protein expression. Transfusion 2021; 61:2468-2476. [PMID: 34110623 DOI: 10.1111/trf.16538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/09/2021] [Accepted: 04/28/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although D variant phenotype is known to be due to genetic defects, including rare missense single nucleotide variants (SNVs), within the RHD gene, few studies have addressed the molecular and cellular mechanisms driving this altered expression. We and others showed previously that splicing is commonly disrupted by SNVs in constitutive splice sites and their vicinity. We thus sought to investigate whether rare missense SNVs located in "deep" exonic regions could also impair this mechanism. STUDY DESIGN AND METHODS Forty-six missense SNVs reported within exons 6 and 7 were first selected from the Human RhesusBase. Their respective effect on splicing was assessed by using an in vitro assay. An RhD-negative cell model was further generated by using the CRISPR-Cas9 approach. RhD-mutated proteins were overexpressed in the newly created model, and cell membrane expression of the D antigen was measured by flow cytometry. RESULTS Minigene splicing assay showed that 14 of 46 (30.4%) missense SNVs alter splicing. Very interestingly, further investigation of two missense SNVs, which both affect codon 338 and confer a weak D phenotype, showed various mechanisms: c.1012C>G (p.Leu338Val) disrupts splicing only, while c.1013T>C (p.Leu338Pro) alters only the protein structure, in agreement with in silico prediction tools and 3D protein structure visualization. CONCLUSION Our functional data set suggests that missense SNVs damage quantitatively D antigen expression by, at least, two different mechanisms (splicing alteration and protein destabilization) that may act independently. These data thereby contribute to extend the current knowledge of the molecular mechanisms governing weakened D expression.
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Affiliation(s)
- Loann Raud
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Marlène Le Tertre
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France.,Service de Génétique Médicale, CHRU Brest, Brest, France
| | | | - Chandran Ka
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France.,Service de Génétique Médicale, CHRU Brest, Brest, France
| | - Gaëlle Richard
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Isabelle Callebaut
- Sorbonne Université, Muséum National d'Histoire Naturelle, UMR CNRS 7590, Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie (IMPMC), Paris, France
| | - Jian-Min Chen
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Claude Férec
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France.,Service de Génétique Médicale, CHRU Brest, Brest, France
| | - Gérald Le Gac
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France.,Service de Génétique Médicale, CHRU Brest, Brest, France
| | - Yann Fichou
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
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9
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Next-generation sequencing of 35 RHD variants in 16 253 serologically D- pregnant women in the Finnish population. Blood Adv 2021; 4:4994-5001. [PMID: 33057632 DOI: 10.1182/bloodadvances.2020001569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022] Open
Abstract
Fetal RHD screening for targeted routine antenatal anti-D prophylaxis has been implemented in many countries, including Finland, since the 2010s. Comprehensive knowledge of the RHD polymorphism in the population is essential for the performance and safety of the anti-D prophylaxis program. During the first 3 years of the national screening program in Finland, over 16 000 samples from RhD- women were screened for fetal RHD; among them, 79 samples (0.5%) containing a maternal variant allele were detected. Of the detected maternal variants, 35 cases remained inconclusive using the traditional genotyping methods and required further analysis by next-generation sequencing (NGS) of the whole RHD gene to uncover the variant allele. In addition to the 13 RHD variants that have been previously reported in different populations, 8 novel variants were also detected, indicating that there is more variation of RHD in the RhD- Finnish population than has been previously known. Three of the novel alleles were identified in multiple samples; thus, they are likely specific to the original Finnish population. National screening has thus provided new information about the diversity of RHD variants in the Finnish population. The results show that NGS is a powerful method for genotyping the highly polymorphic RHD gene compared with traditional methods that rely on the detection of specific nucleotides by polymerase chain reaction amplification.
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10
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Xie H, Yang X, Zhu S, Lin H, Chen F. A serologic weakly reactive RhD is caused by a novel RHD (c.722C>A, p.Thr241Asn) allele. Transfusion 2021; 61:E31-E33. [PMID: 33720432 DOI: 10.1111/trf.16345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Haihua Xie
- Department of Clinical Laboratory, Fujian Provincial Jinshan Hospital, Fuzhou, China
| | - Xiaojun Yang
- Department of Transfusion Medicine, Clinical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Shengting Zhu
- Department of Transfusion Medicine, Clinical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Haibin Lin
- Department of Clinical Laboratory, Fujian Provincial Jinshan Hospital, Fuzhou, China
| | - Fawen Chen
- Department of Clinical Laboratory, Fujian Provincial Jinshan Hospital, Fuzhou, China.,Department of Transfusion Medicine, Clinical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
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11
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Floch A, Pirenne F, Barrault A, Chami B, Toly-Ndour C, Tournamille C, de Brevern AG. Insights into anti-D formation in carriers of RhD variants through studies of 3D intraprotein interactions. Transfusion 2021; 61:1286-1301. [PMID: 33586199 DOI: 10.1111/trf.16301] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/04/2020] [Accepted: 01/13/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Many RhD variants associated with anti-D formation (partial D) in carriers exposed to the conventional D antigen carry mutations affecting extracellular loop residues. Surprisingly, some carry mutations affecting transmembrane or intracellular domains, positions not thought likely to have a major impact on D epitopes. STUDY DESIGN AND METHODS A wild-type Rh trimer (RhD1 RhAG2 ) was modeled by comparative modeling with the human RhCG structure. Taking trimer conformation, residue accessibility, and position relative to the lipid bilayer into account, we redefine the domains of the RhD protein. We generated models for RhD variants carrying one or two amino acid substitutions associated with anti-D formation in published articles (25 variants) or abstracts (12 variants) and for RHD*weak D type 38. We determined the extracellular substitutions and compared the interactions of the variants with those of the standard RhD. RESULTS The findings of the three-dimensional (3D) analysis were correlated with anti-D formation for 76% of RhD variants: 15 substitutions associated with anti-D formation concerned extracellular residues, and structural differences in intraprotein interactions relative to standard RhD were observed in the others. We discuss the mechanisms by which D epitopes may be modified in variants in which the extracellular residues are identical to those of standard RhD and provide arguments for the benignity of p.T379M (RHD*DAU0) and p.G278D (RHD*weak D type 38) in transfusion medicine. CONCLUSION The study of RhD intraprotein interactions and the precise redefinition of residue accessibility provide insight into the mechanisms through which RhD point mutations may lead to anti-D formation in carriers.
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Affiliation(s)
- Aline Floch
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - France Pirenne
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Aurélie Barrault
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Btissam Chami
- Etablissement francais du sang Ile-de-France, Creteil, France
| | - Cécile Toly-Ndour
- Unité Fonctionnelle d'expertise en Immuno-Hémobiologie Périnatale, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Service de Médecine Fœtale, Pôle Périnatalité, Hôpital Trousseau, GH HUEP, APHP, Paris, France
| | - Christophe Tournamille
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Alexandre G de Brevern
- Laboratoire d'Excellence GR-Ex, Paris, France.,Université de Paris, Biologie Intégrée du Globule Rouge UMR_S1134, Inserm, Université de la Réunion, Université des Antilles, Paris, France.,Institut National de la Transfusion Sanguine (INTS), Paris, France
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12
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Matteocci A, Monge-Ruiz J, Stef M, Apraiz I, Herrera-Del-Val L, Mancuso T, Fennell K, Lopez M, Larizgoitia-Martin Y, Nespoli G, Rubia-Tejero M, Collaretti A, Pierelli L, Ochoa-Garay G. Two new RHD alleles with deletions spanning multiple exons. Transfusion 2020; 61:682-686. [PMID: 33241598 DOI: 10.1111/trf.16199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/29/2020] [Accepted: 10/11/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The most common large-deletion RHD allele (RHD*01N.01) includes the entire coding sequence, intervening regions and untranslated regions. The rest of large-deletion RHD alleles reported to-date consist of single-exon deletions, such as RHD*01N.67 which includes exon 1. MATERIALS AND METHODS Samples from two donors with RhD-negative serology yielded unclear or inconclusive results when subject to confirmatory testing on RHD genotyping arrays. To determine their RHD genotypes, genomic DNA was analyzed with a combination of allele-specific PCR, long-range PCR, Sanger sequencing, and next-generation sequencing assays. RESULTS Allele-specific PCR failed to detect products for RHD exons 1 to 3 in one sample and RHD exons 1 to 5 in the other. A quantitative next-generation sequencing assay confirmed deletion of exons 1 to 3 and 1 to 5 respectively, and detected the absence of an RHD gene in trans in both samples. Long-range PCR and Sanger sequencing enabled identification of the breakpoints for both alleles. Both deletions start within the 5' Rhesus box (upstream of the identity region for the 1-to-3 deletion, downstream of it for the 1-to-5 deletion), and end within introns. CONCLUSIONS Resolution of unclear or inconclusive results from targeted genotyping arrays often leads to the discovery of new alleles. The 5' Rhesus box may be a hot spot for genetic recombination events, such as the large deletions described in this report.
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Affiliation(s)
| | - Jorge Monge-Ruiz
- Osakidetza, Basque Center for Blood Transfusion and Human Tissues, Galdakao, Spain.,Biocruces Bizkaia Health Research Institute, Cell Therapy, Stem Cells and Tissues Group, Barakaldo, Spain
| | - Marianne Stef
- Grifols Immunohematology Center, San Marcos, Texas, USA
| | | | - Lara Herrera-Del-Val
- Osakidetza, Basque Center for Blood Transfusion and Human Tissues, Galdakao, Spain.,Biocruces Bizkaia Health Research Institute, Cell Therapy, Stem Cells and Tissues Group, Barakaldo, Spain
| | | | - Katie Fennell
- Grifols Immunohematology Center, San Marcos, Texas, USA
| | | | | | - Guido Nespoli
- Transfusion Medicine Unit, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Angela Collaretti
- Transfusion Medicine Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Luca Pierelli
- Transfusion Medicine Unit, San Camillo Forlanini Hospital, Rome, Italy.,Department of Experimental Medicine, Sapienza University, Rome, Italy
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13
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Flegel WA, Srivastava K. Frameshift variations in the RHD coding sequence: Molecular mechanisms permitting protein expression. Transfusion 2020; 60:2737-2744. [PMID: 33037655 DOI: 10.1111/trf.16123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/08/2020] [Accepted: 07/17/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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14
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Zhang X, Li G, Zhou Z, Shao C, Huang X, Li L, Li X, Liu Y, Fan H, Li J. Molecular and computational analysis of 45 samples with a serologic weak D phenotype detected among 132,479 blood donors in northeast China. J Transl Med 2019; 17:393. [PMID: 31775789 PMCID: PMC6880393 DOI: 10.1186/s12967-019-02134-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 11/09/2019] [Indexed: 02/07/2023] Open
Abstract
Background RH1 is one of the most clinically important blood group antigens in the field of transfusion and in the prevention of fetal incompatibility. The molecular analysis and characterization of serologic weak D phenotypes is essential to ensuring transfusion safety. Methods Blood samples from a northeastern Chinese population were randomly screened for a serologic weak D phenotype. The nucleotide sequences of all 10 exons, adjacent flanking intronic regions, and partial 5′ and 3′ untranslated regions (UTRs) were detected for RHD genes. Predicted deleterious structural changes in missense mutations of serologicl weak D phenotypes were analyzed using SIFT, PROVEAN and PolyPhen2 software. The protein structure of serologic weak D phenotypes was predicted using Swiss-PdbViewer 4.0.1. Results A serologic weak D phenotype was found in 45 individuals (0.03%) among 132,479 blood donors. Seventeen distinct RHD mutation alleles were detected, with 11 weak D, four partial D and two DEL alleles. Further analyses resulted in the identification of two novel alleles (RHD weak D 1102A and 399C). The prediction of a three-dimensional structure showed that the protein conformation was disrupted in 16 serologic weak D phenotypes. Conclusions Two novel and 15 rare RHD alleles were identified. Weak D type 15, DVI Type 3, and RHD1227A were the most prevalent D variant alleles in a northeastern Chinese population. Although the frequencies of the D variant alleles presented herein were low, their phenotypic and genotypic descriptions add to the repertoire of reported RHD alleles. Bioinformatics analysis on RhD protein can give us more interpretation of missense variants of RHD gene.
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Affiliation(s)
- Xu Zhang
- Institute of Transfusion Medicine, Liaoning Blood Center, Shenyang, Liaoning, China.,Key Laboratory of Blood Safety Research of Liaoning Province, Shenyang, Liaoning, China
| | - Guiji Li
- Department of Hematology, The Forth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhuren Zhou
- Institute of Transfusion Medicine, Liaoning Blood Center, Shenyang, Liaoning, China.,Key Laboratory of Blood Safety Research of Liaoning Province, Shenyang, Liaoning, China
| | - Chaopeng Shao
- Department of Transfusion, the Second People's Hospital of Shenzhen, Shenzhen, China
| | - Xuying Huang
- Institute of Transfusion Medicine, Liaoning Blood Center, Shenyang, Liaoning, China.,Key Laboratory of Blood Safety Research of Liaoning Province, Shenyang, Liaoning, China
| | - Lichun Li
- Institute of Transfusion Medicine, Liaoning Blood Center, Shenyang, Liaoning, China.,Key Laboratory of Blood Safety Research of Liaoning Province, Shenyang, Liaoning, China
| | - Xiaofeng Li
- Institute of Transfusion Medicine, Liaoning Blood Center, Shenyang, Liaoning, China.,Key Laboratory of Blood Safety Research of Liaoning Province, Shenyang, Liaoning, China
| | - Ying Liu
- Institute of Transfusion Medicine, Harbin Blood Center, Harbin, Heilongjiang, China
| | - Hua Fan
- Department of Hematology, The Forth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Jianping Li
- Institute of Transfusion Medicine, Liaoning Blood Center, Shenyang, Liaoning, China. .,Key Laboratory of Blood Safety Research of Liaoning Province, Shenyang, Liaoning, China. .,Institute of Transfusion Medicine, Harbin Blood Center, Harbin, Heilongjiang, China. .,Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China.
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15
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de Paula Vendrame TA, Prisco Arnoni C, Guilhem Muniz J, de Medeiros Person R, Pereira Cortez AJ, Roche Moreira Latini F, Castilho L. Characterization of RHD alleles present in serologically RHD-negative donors determined by a sensitive microplate technique. Vox Sang 2019; 114:869-875. [PMID: 31587310 DOI: 10.1111/vox.12851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/15/2019] [Accepted: 09/08/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Weak D phenotypes with very low antigen densities and DEL phenotype may not be detected in RhD typing routine and could be typed as D-negative, leading to D alloimmunization of D-negative recipients. The present study aimed to investigate the presence of RHD-positive genotypes in blood donors typed as D-negative by an automated system using the solid-phase methodology as a confirmatory test. METHODS Two screenings were performed in different selected donor populations. For the first screening, we selected 1403 blood donor samples typed as D-negative regardless of the CE status, and in the second screening, we selected 517 donor samples typed as D-negative C+ and/or E+. RhD typing was performed by microplate in an automated equipment (Neo-Immucor®), and the confirmatory test was performed by solid-phase technique using Capture R® technology. A multiplex PCR specific to RHD and RHDψ was performed in a pool of 6 DNA samples. Sequencing of RHD exons was performed in all RHD-positive samples, and a specific PCR was used to identify the D-CE(4-7)-D hybrid gene. RESULTS AND CONCLUSION No weak D type was found in either screening populations. Additionally, 353 (18·4%) D-negative samples presented previously reported non-functional RHD genes, 2 samples had a DEL allele, and 6 samples demonstrated new alleles, including one novel DEL allele. Our study identified six new RHD alleles and showed that the inclusion of a confirmatory test using serological methodology with high sensitivity can reduce the frequency of weak D samples typed as D-negative.
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16
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Takahashi K, Migita O, Sasaki A, Nasu M, Kawashima A, Sekizawa A, Sato T, Ito Y, Sago H, Okamoto A, Nakabayashi K, Hata K. Amplicon Sequencing-Based Noninvasive Fetal Genotyping for RHD-Positive D Antigen-Negative Alleles. Clin Chem 2019; 65:1307-1316. [PMID: 31488553 DOI: 10.1373/clinchem.2019.307074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/22/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND To avoid hemolytic disease of the fetus and newborn resulting from maternal alloantibodies against fetal Rh antigens, anti-D immunoglobulin is routinely administered to RhD-negative pregnant women in Japan. Fetal RHD genotyping using cell-free DNA may prevent unnecessary antibody administration; however, current PCR-based methods, which detect RHD deletion, do not address the higher rates of RHD-positive D antigen-negative alleles in nonwhite populations without additional inspections. METHODS We developed an amplicon-sequencing method that could estimate the type of paternally inherited fetal RHD allele from 4 major RHD alleles in the Japanese population: the D antigen-positive allele (RHD*01, 92.9%) and 3 D antigen-negative alleles (RHD*01N.01, 6.6%; RHD*01EL.01, 0.3%; RHD*01N.04, 0.1%) using cell-free DNA obtained from the blood plasma of pregnant women. RESULTS The method correctly determined the fetal RhD type even when RhD-negative pregnant women possessed an RHD-positive D antigen-negative allele: RHD*01EL.01 or RHD*01N.04. CONCLUSIONS This method is a reliable noninvasive fetal RHD genotyping method for Japanese and other East Asian populations. The genotyping principle of amplifying 2 different regions using the same primer pair and distinguishing them by their sequence difference during the subsequent mapping procedure is also theoretically applicable to RHD-positive D antigen-negative alleles prevalent in Africans. Therefore, this method offers an opportunity to consider targeted administration of anti-D immunoglobulin to RhD-negative pregnant women in East Asian and African countries and to increase the specificity of the fetal RHD genotyping implemented nationwide in several European countries.
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Affiliation(s)
- Ken Takahashi
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan.,Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan.,Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Ohsuke Migita
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan; .,Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Aiko Sasaki
- Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Michiko Nasu
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiro Kawashima
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Taisuke Sato
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan.,Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Ito
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan.,Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiko Nakabayashi
- Laboratory of Developmental Genomics, National Research Institute for Child Health and Development, Tokyo, Japan.
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan;
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17
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Wen J, Verhagen OJ, Jia S, Liang Q, Wang Z, Wei L, Luo H, Luo G, Vidarsson G, Akker E, Ji Y, Schoot CE. A variant RhAG protein encoded by theRHAG*572Aallele causes serological weak D expression while maintaining normal RhCE phenotypes. Transfusion 2018; 59:405-411. [DOI: 10.1111/trf.14969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 08/01/2018] [Accepted: 08/17/2018] [Indexed: 01/30/2023]
Affiliation(s)
- Jizhi Wen
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center Guangzhou People's Republic of China
| | - Onno J.H.M. Verhagen
- Sanquin Research and Landsteiner Laboratory, Academic Medical CentreUniversity of Amsterdam Amsterdam The Netherlands
| | - Shuangshuang Jia
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center Guangzhou People's Republic of China
| | - Qianni Liang
- Department of Blood TransfusionGuangdong No. 2 Provincial People's Hospital Guangzhou People's Republic of China
| | - Zhen Wang
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center Guangzhou People's Republic of China
| | - Ling Wei
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center Guangzhou People's Republic of China
| | - Hong Luo
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center Guangzhou People's Republic of China
| | - Guangping Luo
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center Guangzhou People's Republic of China
| | - Gestur Vidarsson
- Sanquin Research and Landsteiner Laboratory, Academic Medical CentreUniversity of Amsterdam Amsterdam The Netherlands
| | - Emile Akker
- Sanquin Research and Landsteiner Laboratory, Academic Medical CentreUniversity of Amsterdam Amsterdam The Netherlands
| | - Yanli Ji
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center Guangzhou People's Republic of China
| | - C. Ellen Schoot
- Sanquin Research and Landsteiner Laboratory, Academic Medical CentreUniversity of Amsterdam Amsterdam The Netherlands
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18
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Clausen FB. Lessons learned from the implementation of non-invasive fetalRHDscreening. Expert Rev Mol Diagn 2018; 18:423-431. [DOI: 10.1080/14737159.2018.1461562] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Frederik Banch Clausen
- Laboratory of Blood Genetics, Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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19
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Kulkarni SS, Gogri H, Parchure D, Mishra G, Ghosh K, Rajadhyaksha S, Madkaikar M, Férec C, Fichou Y. RHD-Positive Alleles among D- C/E+ Individuals from India. Transfus Med Hemother 2018; 45:173-177. [PMID: 29928172 DOI: 10.1159/000479239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/05/2017] [Indexed: 01/06/2023] Open
Abstract
Background Molecular bases of blood group systems, including Rh blood group, have been poorly studied in the Indian population so far, while specificities of Europeans, East Asians and Africans have been well known for years. In order to gain insights into the molecular bases of this population, we sought to characterize the RHD allele in D- Indian donors expressing C and/or E antigen(s). Methods RHD gene was analyzed in 171 serologically D-, C/E+ samples by standard molecular methods such as quantitative, multiplex PCR of short fluorescent fragments (QMPSF) and direct sequencing when necessary. Results RHD whole gene deletion at the homozygous state was found to be the most common genotype associated with D- phenotype (118/171, 69.0%). Nonfunctional, negative hybrid genes with reported molecular backgrounds were observed in approximately one-third of the samples, while only four samples carry single-nucleotide variations, including one novel nonsense (RHD(Y243X)), one novel frameshift (RHD(c.701delG)), and two missense (RHD(T148R) and RHD(T148R, T195M)) alleles. Conclusion Overall we report for the first time the molecular bases of D antigen negativity in the D-, C/E+ Indian population, which appears to be qualitatively similar to other populations, but with a population-specific, quantitative distribution of D-- alleles.
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Affiliation(s)
- Swati S Kulkarni
- National Institute of Immunohematology, Indian Council of Medical Research (NIIH-ICMR), Mumbai, India
| | - Harita Gogri
- National Institute of Immunohematology, Indian Council of Medical Research (NIIH-ICMR), Mumbai, India
| | - Disha Parchure
- National Institute of Immunohematology, Indian Council of Medical Research (NIIH-ICMR), Mumbai, India
| | - Garima Mishra
- National Institute of Immunohematology, Indian Council of Medical Research (NIIH-ICMR), Mumbai, India
| | - Kanjaksha Ghosh
- National Institute of Immunohematology, Indian Council of Medical Research (NIIH-ICMR), Mumbai, India
| | - Sunil Rajadhyaksha
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, India
| | - Manisha Madkaikar
- National Institute of Immunohematology, Indian Council of Medical Research (NIIH-ICMR), Mumbai, India
| | - Claude Férec
- Institut National de la Santé et de la Recherche Médicale (Inserm), UMR1078, Brest, France.,Etablissement français du sang Bretagne, Brest, France.,Laboratoire de Génétique Moléculaire et d'Histocompatibilité, Centre Hospitalier Régional Universitaire (CHRU), Hôpital Morvan, Brest, France.,Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale (UBO), Brest, France
| | - Yann Fichou
- Institut National de la Santé et de la Recherche Médicale (Inserm), UMR1078, Brest, France.,Etablissement français du sang Bretagne, Brest, France
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20
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Hyland CA, Millard GM, O'Brien H, Schoeman EM, Lopez GH, McGowan EC, Tremellen A, Puddephatt R, Gaerty K, Flower RL, Hyett JA, Gardener GJ. Non-invasive fetal RHD genotyping for RhD negative women stratified into RHD gene deletion or variant groups: comparative accuracy using two blood collection tube types. Pathology 2017; 49:757-764. [PMID: 29096879 DOI: 10.1016/j.pathol.2017.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/17/2017] [Accepted: 08/27/2017] [Indexed: 12/19/2022]
Abstract
Non-invasive fetal RHD genotyping in Australia to reduce anti-D usage will need to accommodate both prolonged sample transport times and a diverse population demographic harbouring a range of RHD blood group gene variants. We compared RHD genotyping accuracy using two blood sample collection tube types for RhD negative women stratified into deleted RHD gene haplotype and RHD gene variant cohorts. Maternal blood samples were collected into EDTA and cell-free (cf)DNA stabilising (BCT) tubes from two sites, one interstate. Automated DNA extraction and polymerase chain reaction (PCR) were used to amplify RHD exons 5 and 10 and CCR5. Automated analysis flagged maternal RHD variants, which were classified by genotyping. Time between sample collection and processing ranged from 2.9 to 187.5 hours. cfDNA levels increased with time for EDTA (range 0.03-138 ng/μL) but not BCT samples (0.01-3.24 ng/μL). For the 'deleted' cohort (n=647) all fetal RHD genotyping outcomes were concordant, excepting for one unexplained false negative EDTA sample. Matched against cord RhD serology, negative predictive values using BCT and EDTA tubes were 100% and 99.6%, respectively. Positive predictive values were 99.7% for both types. Overall 37.2% of subjects carried an RhD negative baby. The 'variant' cohort (n=15) included one novel RHD and eight hybrid or African pseudogene variants. Review for fetal RHD specific signals, based on one exon, showed three EDTA samples discordant to BCT, attributed to high maternal cfDNA levels arising from prolonged transport times. For the deleted haplotype cohort, fetal RHD genotyping accuracy was comparable for samples collected in EDTA and BCT tubes despite higher cfDNA levels in the EDTA tubes. Capacity to predict fetal RHD genotype for maternal carriers of hybrid or pseudogene RHD variants requires stringent control of cfDNA levels. We conclude that fetal RHD genotyping is feasible in the Australian environment to avoid unnecessary anti-D immunoglobulin prophylaxis.
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Affiliation(s)
- Catherine A Hyland
- Clinical Services and Research, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, QLD, Australia.
| | - Glenda M Millard
- Clinical Services and Research, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, QLD, Australia
| | - Helen O'Brien
- Clinical Services and Research, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, QLD, Australia
| | - Elizna M Schoeman
- Clinical Services and Research, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, QLD, Australia
| | - Genghis H Lopez
- Clinical Services and Research, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, QLD, Australia
| | - Eunike C McGowan
- Clinical Services and Research, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, QLD, Australia
| | - Anne Tremellen
- Mater Research Institute, University of Queensland, South Brisbane, Qld, Australia
| | - Rachel Puddephatt
- High Risk Obstetrics, RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia
| | - Kirsten Gaerty
- The Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Qld, Australia
| | - Robert L Flower
- Clinical Services and Research, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, QLD, Australia
| | - Jonathan A Hyett
- High Risk Obstetrics, RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia; Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, Central Clinical School, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Glenn J Gardener
- Mater Research Institute, University of Queensland, South Brisbane, Qld, Australia; The Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Qld, Australia
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21
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22
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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.
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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
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23
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Lopez GH, McGowan EC, Condon JA, Schoeman EM, Millard GM, O'Brien H, Roulis EV, Ochoa-Garay G, Liew YW, Flower RL, Hyland CA. Genotyping by sequencing defines independent novel RHD variants for an antenatal patient and a blood donor. Transfusion 2017; 57:2281-2283. [PMID: 28714065 DOI: 10.1111/trf.14250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/01/2017] [Accepted: 06/04/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Genghis H Lopez
- Clinical Services and Research Division, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Eunike C McGowan
- Clinical Services and Research Division, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Jennifer A Condon
- Red Cell Reference Laboratory, Australian Red Cross Blood Service, West Melbourne, Victoria, Australia
| | - Elizna M Schoeman
- Clinical Services and Research Division, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Glenda M Millard
- Clinical Services and Research Division, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Helen O'Brien
- Clinical Services and Research Division, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Eileen V Roulis
- Clinical Services and Research Division, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Gorka Ochoa-Garay
- Immunohematology Center, Grifols Diagnostic Solutions, San Marcos, Texas
| | - Yew-Wah Liew
- Red Cell Reference Laboratory, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Robert L Flower
- Clinical Services and Research Division, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Catherine A Hyland
- Clinical Services and Research Division, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
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24
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de Haas M, Thurik FF, van der Ploeg CPB, Veldhuisen B, Hirschberg H, Soussan AA, Woortmeijer H, Abbink F, Page-Christiaens GCML, Scheffer PG, Ellen van der Schoot C. Sensitivity of fetal RHD screening for safe guidance of targeted anti-D immunoglobulin prophylaxis: prospective cohort study of a nationwide programme in the Netherlands. BMJ 2016; 355:i5789. [PMID: 27821701 PMCID: PMC5098549 DOI: 10.1136/bmj.i5789] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine the accuracy of non-invasive fetal testing for the RHD gene in week 27 of pregnancy as part of an antenatal screening programme to restrict anti-D immunoglobulin use to women carrying a child positive for RHD DESIGN: Prospectively monitoring of fetal RHD testing accuracy compared with serological cord blood typing on introduction of the test. Fetal RHD testing was performed with a duplex real time quantitative polymerase chain reaction, with cell-free fetal DNA isolated from 1 mL of maternal plasma The study period was between 4 July 2011 and 7 October 2012. The proportion of women participating in screening was determined. SETTING Nationwide screening programme, the Netherlands. Tests are performed in a centralised setting. PARTICIPANTS 25 789 RhD negative pregnant women. MAIN OUTCOME MEASURES Sensitivity, specificity, false negative rate, and false positive rate of fetal RHD testing compared with serological cord blood typing; proportion of technical failures; and compliance to the screening programme. RESULTS A fetal RHD test result and serological cord blood result were available for 25 789 pregnancies. Sensitivity for detection of fetal RHD was 99.94% (95% confidence interval 99.89% to 99.97%) and specificity was 97.74% (97.43% to 98.02%). Nine false negative results for fetal RHD testing were registered (0.03%, 95% confidence interval 0.01% to 0.06%). In two cases these were due to technical failures. False positive fetal RHD testing results were registered for 225 samples (0.87%, 0.76% to 0.99%). Weak RhD expression was shown in 22 of these cases, justifying anti-D immunoglobulin use. The negative and positive predictive values were 99.91% (95% confidence interval 99.82% to 99.95%) and 98.60% (98.40% to 98.77%), respectively. More than 98% of the women participated in the screening programme. CONCLUSIONS Fetal RHD testing in week 27 of pregnancy as part of a national antenatal screening programme is highly reliable and can be used to target both antenatal and postnatal anti-D immunoglobulin use.
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Affiliation(s)
- Masja de Haas
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Center for Clinical Transfusion Research, Sanquin Research and Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden
- Department of Immunohematology Diagnostic Services, Sanquin Research, Amsterdam, Netherlands
| | - Florentine F Thurik
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- University Medical Center Utrecht, Division Woman and Baby, Department of Obstetrics, Utrecht, Netherlands
| | | | - Barbera Veldhuisen
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Immunohematology Diagnostic Services, Sanquin Research, Amsterdam, Netherlands
| | - Hoang Hirschberg
- National Institute for Public Health and the Environment, Service for vaccine provision and prevention programs, Bilthoven, Netherlands
| | - Aicha Ait Soussan
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Heleen Woortmeijer
- Department of Immunohematology Diagnostic Services, Sanquin Research, Amsterdam, Netherlands
| | - Frithjofna Abbink
- National Institute for Public Health and the Environment, Center for population screening, Bilthoven, Netherlands
| | | | - Peter G Scheffer
- University Medical Center Utrecht, Division Woman and Baby, Department of Obstetrics, Utrecht, Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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25
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Stegmann TC, Ji Y, Bijman R, Wang Z, Wen J, Wei L, Veldhuisen B, Haer‐Wigman L, Lighthart P, Lodén‐van Straaten M, Luo G, van der Schoot CE. Identification of a novel frequentRHCE*ce308Tvariant allele in Chinese D– individuals, resulting in a C+c– phenotype. Transfusion 2016; 56:2314-21. [DOI: 10.1111/trf.13709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/28/2016] [Accepted: 05/05/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Tamara C. Stegmann
- Sanquin Research and Landsteiner LaboratoryAcademic Medical Centre, University of AmsterdamAmsterdam The Netherlands
| | - Yanli Ji
- Institute of Clinical Blood Transfusion, Guangzhou Blood CenterGuangzhou China; and
| | - Renate Bijman
- Sanquin Research and Landsteiner LaboratoryAcademic Medical Centre, University of AmsterdamAmsterdam The Netherlands
| | - Zhen Wang
- Institute of Clinical Blood Transfusion, Guangzhou Blood CenterGuangzhou China; and
| | - Jizhi Wen
- Institute of Clinical Blood Transfusion, Guangzhou Blood CenterGuangzhou China; and
| | - Ling Wei
- Institute of Clinical Blood Transfusion, Guangzhou Blood CenterGuangzhou China; and
| | - Barbera Veldhuisen
- Sanquin Research and Landsteiner LaboratoryAcademic Medical Centre, University of AmsterdamAmsterdam The Netherlands
| | - Lonneke Haer‐Wigman
- Sanquin Research and Landsteiner LaboratoryAcademic Medical Centre, University of AmsterdamAmsterdam The Netherlands
| | | | | | - Guangping Luo
- Institute of Clinical Blood Transfusion, Guangzhou Blood CenterGuangzhou China; and
| | - C. Ellen van der Schoot
- Sanquin Research and Landsteiner LaboratoryAcademic Medical Centre, University of AmsterdamAmsterdam The Netherlands
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26
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Thurik FF, Page-Christiaens GC, Ait Soussan A, Ligthart PC, Cheroutre GM, Bossers B, Veldhuisen B, van der Schoot CE, de Haas M. FetalRHDgenotyping after bone marrow transplantation. Transfusion 2016; 56:2122-6. [DOI: 10.1111/trf.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 01/15/2023]
Affiliation(s)
- Florentine F. Thurik
- Department of Experimental Immunohematology, Amsterdam and Landsteiner Laboratory, Academic Medical Center; Sanquin, University of Amsterdam; Amsterdam The Netherlands
- Division Woman and Baby, Department of Obstetrics; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Aicha Ait Soussan
- Department of Experimental Immunohematology, Amsterdam and Landsteiner Laboratory, Academic Medical Center; Sanquin, University of Amsterdam; Amsterdam The Netherlands
| | - Peter C. Ligthart
- Department of Immunohematology Diagnostic Services; Sanquin; Amsterdam The Netherlands
| | | | - Bernadette Bossers
- Department of Immunohematology Diagnostic Services; Sanquin; Amsterdam The Netherlands
| | - Barbera Veldhuisen
- Department of Experimental Immunohematology, Amsterdam and Landsteiner Laboratory, Academic Medical Center; Sanquin, University of Amsterdam; Amsterdam The Netherlands
- Department of Immunohematology Diagnostic Services; Sanquin; Amsterdam The Netherlands
| | - C. Ellen van der Schoot
- Department of Experimental Immunohematology, Amsterdam and Landsteiner Laboratory, Academic Medical Center; Sanquin, University of Amsterdam; Amsterdam The Netherlands
| | - Masja de Haas
- Department of Experimental Immunohematology, Amsterdam and Landsteiner Laboratory, Academic Medical Center; Sanquin, University of Amsterdam; Amsterdam The Netherlands
- Department of Immunohematology Diagnostic Services; Sanquin; Amsterdam The Netherlands
- Center for Clinical Transfusion Research, Sanquin Research and Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden The Netherlands
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