Phenotype frequencies of Rh (C, c, E, e), M, Mia and Kidd blood group systems among ethnic Thai blood donors from the north-east of Thailand

Development of Mia Phenotyping Using Paper-Based Device

The MNS7 (Mi^a) blood group antigen is found at a different prevalence among different ethnic groups. Anti-Mi^a can cause hemolytic disease of the fetus and newborn (HDFN) and both acute- and delayed-type hemolytic transfusion reactions (HTR). Mi^a typing should be performed in donors to prevent life-threatening hemolytic transfusion reactions. The gel card and standard tube methods still need specialized equipment, centrifugation, and expertise for result interpretation. We used a novel paper-based analytical device (PAD) pre-coated with monoclonal IgM anti-Mi^a for Mi^a phenotyping. We measured grey pixel intensity in blood typing results for interpretation processing using OpenCV at the sample (SP) and elution parts (EP); furthermore, we used the SP: EP ratio and F-score as analysis criteria. We typed 214 blood EDTA samples with PAD-Mi^a and then compared with gel card results for setting an analysis criterion. We observed 100% sensitivity, specificity, and accuracy when we applied the SP: EP ratio and F-score with the optimal criterion (1.07 and 0.17 for SP: EP ratio and F-score, respectively). The validation of PAD-Mi^a typing for blood donor samples (n = 150) via F-score gave 100% sensitivity and specificity when compared with the gel card method; therefore, we argue that PAD-Mi^a typing can be used for Mi^a phenotyping without sero-centrifugation. Moreover, to study the correlation between genotype and phenotype, PCR-SSP was performed to identify GYP(B-A-B) hybrids. The results revealed that all Mi^a+ blood samples gave a positive with GP. Hut, GP. HF, GP. Mur, GP. Hop, and GP. Bun. Results of the gel card method and PCR-SSP were concordant. Hence, using PAD-Mi^a typing in blood donors would be helpful for creating a phenotype database of blood donors for reducing alloimmunization risks.

Red blood cell alloimmunization and other transfusion-related complications in patients with transfusion-dependent thalassemia: A multi-center study in Thailand

BACKGROUND

Thalassemia is a common genetic disease in Southeast Asia. Red blood cell (RBC) transfusion is an essential treatment for severe forms of thalassemia. We performed a study to demonstrate RBC alloimmunization and other transfusion-related complications in patients with transfusion-dependent thalassemia (TDT).

STUDY DESIGN AND METHODS

A multi-center web-based registry of TDT was conducted in eight medical centers across Thailand. Thalassemia information, transfusion therapy, and transfusion-related complications were collected. Factors associated with each complication were demonstrated using the logistic regression analysis.

RESULTS

Of 1000 patients recruited for the study, 449 were males (44.9%). The mean age was 23.9 ± 15.4 years. The majority of patients, 738 (73.8%) had hemoglobin E/beta-thalassemia. In the study, 421 transfusion-related complications were reported from 357 patients (35.7%). Alloimmunization was the most common complication which was found in 156 patients (15.6%) with 284 positive antibody tests. The most frequent antibodies against RBC were anti-E (80/284, 28.2%) followed by anti-Mia (45/284, 15.8%) and anti-c (32/284, 11.3%). Age ≥3 years at initial blood transfusion, splenomegaly, higher frequencies, and volumes of transfusion were significant factors associated with alloimmunization. None of the patients had to terminate blood transfusion due to multiple alloantibodies. Other commonly seen complications were allergic reactions (130, 13.0%), autoimmune hemolytic anemia (70, 7.0%) and febrile non-hemolytic transfusion reaction (54, 5.4%).

CONCLUSIONS

Transfusion-related complications, especially alloimmunization, were common among Thai patients with TDT. Extended RBC antigen-matching for the Rh system and Mia should be implemented to prevent the development of alloantibodies in multi-transfused patients.

Major and minor subgroup profile of blood in patients receiving multiple transfusions and donors

OBJECTIVE

It was aimed to profile the blood subgroups of our region and to reveal the prevalence of auto/alloimmune sensitization in patients who had to undergo multiple erythrocyte transfusions and to establish the sensitization profile by screening major and minor subgroups.

MATERIALS AND METHODS

In this study, the distribution of ABO and Rh system major subgroups was studied in 100 donor blood. As the patient group, 50 patients who received three or more red blood cell transfusions were included. In addition to this group, Kell, Lewis, Duffy blood group systems were studied.

RESULTS

According to the ABO system, 35% of the donors were in O, 33% in A, 17% in AB, and 15% in B. According to the Rh system, 75% is Dvi positive. Rh system is 99% e positive and 33% E positive in major subgroups and Kell1 positivity is 8%. In the patient group, 22% D(-) was determined compared to Rh blood group. Among the major subgroups of Rh, C was 68%, E was 14%, c was 76%, and e positivity was found to be 100%. The Kell1 negativity rate is 96%. The highest negativity was found in 86% Lea antigen in Lewis system, in 36% S antigen in MNS system, 34% Fyb antigen in Duffy system, and 24% Jka antigen in Kidd system. When inappropriate blood is given for any antigen, a double population is formed. The double negativities we detected in our study occurred as follows according to blood group systems: E 18%, C 12%, c 8%, Cw 2%, Kell 1 2%, M 8%, N 4%, S 18%, s 6%, Fya 8%, Jka 6%, Jkb 22%. Indirect Agglutination Test (IAT) was negative in all patients.

CONCLUSION

IAT negativity in all patient groups suggests that we do not develop alloimmunization, but the high rates of double population suggest a high risk of alloimmunization.

Blood groups in Native Americans: a look beyond ABO and Rh

The study presents comparisons between blood group frequencies beyond ABO and Rh blood systems in Native American populations and previously published data from Brazilian blood donors. The frequencies of Diego (c.2561C>T, rs2285644), Kell (c.578C>T, rs8176058), Duffy (c.125A>G, rs12075, c.1-67T>C, rs2814778) and Kidd (c.838A>G, rs1058396) variants in Kaingang (n=72) and Guarani (n=234) populations from Brazil (1990-2000) were obtained and compared with data from these populations sampled during the 1960s and with individuals of different Brazilian regions. Data showed high frequencies of DI*01 and FY*01 alleles: 11.8% and 57.6% in Kaingang and 6.8% and 75.7% in Guarani groups, respectively. The main results indicated: (1) reduction in genetic distance over time of Kaingang and Guarani in relation to other Brazilian populations is suggestive of ongoing admixture; (2) significant differences in some frequencies of blood group markers (especially Diego, Kidd and Duffy) in relation to Native Americans and individuals from different geographical regions of Brazil. Our study shows that the frequency of red blood cell polymorphisms in two Native American groups is very different from that of blood donors, when we evaluated blood groups different from ABO and Rh systems, suggesting that a better ethnic characterization of blood unit receptors is necessary.

Specific Combinations of Erythrocyte Group Antigens in Blood Donors

Blood groups are inherited biological characteristics that do not change throughout life only in healthy people. Blood group antigens determine the adaptation of a human, as a biological species, to the surrounding environment. Our goal was to study the combination and frequency characteristics of three group systems (ABO, RH, KELL) in blood donors. The blood of 743 donors (aged ≥ 18 years) has been investigated on erythrocyte blood group antigens (521 male and 222 female). The sample has been provided from diagnostic laboratory of "Health Centre Medina Ltd" of Batumi. Research was agreed with hematology department of the clinic. Blood typing of the sample has been carried out on the basis of immunogenetic laboratory of Batumi Shota Rustaveli State University. The express method with universal mono-clone antibodies was used in order to reveal blood group system antigens. ABO blood group are distributed the following order: O > A > B > AB. We allocated 16 phenotypic groups. O, Rh+, K- (38.62 ± 1.7%) are represented with the highest percentage among donors and a rather large number of the investigated donors (287 donors) is the carrier of this phenotype. A frequency distribution of the A, Rh+, K- phenotype group 10% (28.93 ± 1.6) was less. 215 donors carry A, Rh+, K- phenotype combination. O, Rh+, K+ and A, Rh+, K+ variations of the phenotype are represented with an equal percentage (3.23 ± 0.4%). 7.94 ± 0.9% donors are characterized by features of the O, Rh-, K- Erythrocyte group. A frequency distribution of B, Rh+, K- phenotype is slightly less - 6.86 ± 0.9%. A, Rh-, K combination of phenotype occurs with a frequency of 4.97 ± 0.7%, and AB, Rh+, K- occurs with a frequency of 2.28 ± 0.5%. I n the donor population there were only single cases of B, Rh-, K+ (0.13 ± 0.01); AB, Rh+, K+ (0.13 ± 0.01); AB, Rh-, K- (0.40 ± 0.2); B, Rh+, K+ (0.26 ± 0.1); O, Rh-, K+ (0.40 ± 0.2); A, Rh-, K+ (0.67 ± 0.2) combination of phenotype. The phenotype AB, Rh-, K+ was not identified. The existence of this database will increase the safety level of transfusion, widen donors database and allow the clinics to find quickly the rare combination of blood group for transfusion and decrease of the risk of post-transfusion complications.

Hybrid glycophorin and red blood cell antigen genotyping in Asian American type O blood donors with Mia phenotype

BACKGROUND

The GP.Mur glycophorin with Mi^a phenotype is relatively common and clinically significant in the Southeast Asian populations. The aim of this study is to genotype Mi^a -positive Asian American type O blood donors. Red blood cell (RBC) minor antigens were also determined in the same cohort.

STUDY DESIGN AND METHODS

Asian American blood donors of the Gulf Coast Regional Blood Center (Houston, TX) were screened using a typing reagent (NOVACLONE Anti-Mi^a Monoclonal IgG Typing Reagent, Dominion Biologicals Ltd) from March 2016 to July 2018. Aliquots of Mi^a -positive blood from type O donors were subjected to serologic confirmation using Mi^a - and/or Mur-specific GAMA210 and 64D6 monoclonal antibodies, and two human antisera. Extracted genomic DNA was amplified by polymerase chain reaction (PCR) using GYP hybrid gene/allele-specific primers followed by bidirectional Sanger sequencing. Zygosity for GYP*Mur and GYP*Bun was determined using TaqMan real-time PCR assay. Phenotypes of 35 RBC antigens and three phenotypic variants were determined with use of an in vitro diagnostic test, PreciseType HEA Molecular BeadChip Test (Immucor).

RESULTS

By screening 4600 blood donations in the Houston metropolitan area, 209 samples from 103 unique donors were identified to be Mi^a -positive. By PCR and sequencing analysis, 97 of the 103 Mi^a -positive donors carried hybrid genes GYP*Mur (89.7% including two homozygotes), GYP*Bun (6.2%), GYP*Vw (3.1%) and GYP*Hut (1.0%). Concordance between serology and DNA analysis was 98%, 99%, and 100% for the GAMA210, 64D6, and human antisera, respectively. Genotyping of RBC antigens showed that the Mi^a -positive donors were predominantly associated M+ N- S- s+ (48.5%) and M+ N+ S- s+ (38.1%) phenotypes.

CONCLUSIONS

The GP.Mur glycophorin is most prevalent in the Mi^a -positive Asian American type O blood donors.