1
|
Moise KJ. The use of free DNA for fetal RHD genotyping in the Rh negative pregnant patient-the time has come. Am J Obstet Gynecol 2024:S0002-9378(24)00840-8. [PMID: 39153534 DOI: 10.1016/j.ajog.2024.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/31/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
Cell-free DNA to determine the fetal RHD genotype from the maternal circulation was first described in 1993. High throughput assays using polymerase chain reaction technology were introduced in Europe and gained widespread acceptance in the management of the Rhesus alloimmunized pregnancy. The specificity and sensitivity of these assays approached 99%. As confidence was gained with these results, Scandinavian countries began to employ cell-free DNA for fetal RHD typing as an integral component of their introduction of antenatal Rhesus immune globulin in non-alloimmunized pregnancies. Since 40% of RhD-negative pregnant women will carry an RhD-negative fetus, doses of Rhesus immune globulin were conserved. Recently 2 U.S. companies have introduced cell-free DNA assays for RHD as part of their noninvasive prenatal testing assays. Both utilize next generation sequencing and have developed methodologies to detect the aberrant RHD pseudogene and the hybrid RHD-CE-Ds genotype. In addition, excellent correlation studies with either neonatal genotyping or serology have been reported. The manufacturer of RhoGAM has recently announced a national shortage. Given the current availability of reliable cell-free DNA assays for determining the RHD status of the fetus, the time has come to implement this strategy to triage the antenatal use of Rhesus immune globulin in the U.S.
Collapse
Affiliation(s)
- Kenneth J Moise
- Department of Women's Health, Dell Medical School - UT Health Austin and the Comprehensive Fetal Center Dell Children's Medical Center, Austin, TX.
| |
Collapse
|
2
|
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.
Collapse
Affiliation(s)
- Frederik B Clausen
- Laboratory of Blood Genetics, Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
3
|
Maruta MB, Tesfaye K, Birhanu E, Yigazu N, Yuya M, Debella A, Mussa I. Prevalence and determinants of RH alloimmunization in Rh-negative women in teaching hospitals of Addis Ababa, Ethiopia: a hospital-based cross-sectional study. Front Glob Womens Health 2023; 4:1167736. [PMID: 37645591 PMCID: PMC10461565 DOI: 10.3389/fgwh.2023.1167736] [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: 02/16/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023] Open
Abstract
Background Despite the implementation of immunization with an anti-D antigen for pregnant women, adverse pregnancy outcomes continue to occur in Ethiopia and most Sub-Saharan African countries. Consequently, the woman's obstetric care is compromised, and there is an increase in perinatal morbidity and mortality. In Ethiopia, the burden of the disease is not well understood, and no research has been conducted in the study area. Therefore, this study aims to determine the prevalence and determinants of Rh alloimmunization in Rh-negative women receiving care at Addis Ababa teaching hospitals. Methods An institutional-based cross-sectional study was conducted from 5 October 2020 to 5 May 2021, among 328 Rh-negative pregnant women who received antenatal care and delivery services at Teaching Hospitals under Addis Ababa University. Face-to-face interviews were used to gather data using a pre-tested structured questionnaire, and a chart review was performed using a checklist. The data were entered into Epidata version 3.1 and analyzed using SPSS version 22. Multivariable analysis and logistic regression were used to evaluate the predictors, and the results were presented as an adjusted odds ratio (AOR) with a 95% confidence interval. Statistical significance was declared at a p-value < 0.05. Results Among Rh-D negative individuals, 56(17.1%) were alloimunized with 95% CI (15.1%, 19.23%). The prevalence of Rh-D negative was 2.1% with 95% CI (1.56%, 2.76%). Factors such as unemployment [AOR = 2.28, 95% CI: 1.21, 4.28], failure to use anti-D prophylaxis in previous pregnancy [AOR = 2.08, 95% CI: 1.10, 3.92), and the presence of sensitizing events [AOR = 0.52, 95% CI: 0.27, 0.84] were statistically significant with the outcome variables. Conclusions This study pointed out that the prevalence of Rh was relatively large and that almost one in every five pregnant women was alloimunized. Factors such as unemployment and failure to use anti-D prophylaxis in a previous pregnancy were found to be associated with outcome variables. Therefore, all stakeholders and concerned entities should prioritize enhancing access and affordability to anti-D prophylaxis to prevent the occurrence of Rh alloimmunization and its associated adverse outcomes.
Collapse
Affiliation(s)
- Melat B. Maruta
- Obstetrics and Gynecology, Menelik Comprehensive Specialized Hospital, Addis Ababa, Ethiopia
| | - Kiflom Tesfaye
- Obstetrics and Gynecology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Esayas Birhanu
- Obstetrics and Gynecology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Mohammed Yuya
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Ibsa Mussa
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| |
Collapse
|
4
|
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
|
5
|
Gajic-Veljanoski O, Li C, Schaink AK, Guo J, Shehata N, Charames GS, de Vrijer B, Clarke G, Pechlivanoglou P, Okun N, Kandel R, Dooley J, Higgins C, Ng V, Sikich N. Cost-effectiveness of noninvasive fetal RhD blood group genotyping in nonalloimmunized and alloimmunized pregnancies. Transfusion 2022; 62:1089-1102. [PMID: 35170037 DOI: 10.1111/trf.16826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND We sought to determine the cost-effectiveness of noninvasive fetal RhD blood group genotyping in nonalloimmunized and alloimmunized pregnancies in Canada. STUDY DESIGN AND METHODS We developed two probabilistic state-transition (Markov) microsimulation models to compare fetal genotyping followed by targeted management versus usual care (i.e., universal Rh immunoglobulin [RhIG] prophylaxis in nonalloimmunized RhD-negative pregnancies, or universal intensive monitoring in alloimmunized pregnancies). The reference case considered a healthcare payer perspective and a 10-year time horizon. Sensitivity analysis examined assumptions related to test cost, paternal screening, subsequent pregnancies, other alloantibodies (e.g., K, Rh c/C/E), societal perspective, and lifetime horizon. RESULTS Fetal genotyping in nonalloimmunized pregnancies (at per-sample test cost of C$247/US$311) was associated with a slightly higher probability of maternal alloimmunization (22 vs. 21 per 10,000) and a reduced number of RhIG injections (1.427 vs. 1.795) than usual care. It was more expensive (C$154/US$194, 95% Credible Interval [CrI]: C$139/US$175-C$169/US$213) and had little impact on QALYs (0.0007, 95%CrI: -0.01-0.01). These results were sensitive to the test cost (threshold achieved at C$88/US$111), and inclusion of paternal screening. Fetal genotyping in alloimmunized pregnancies (at test cost of C$328/US$413) was less expensive (-C$6280/US$7903, 95% CrI: -C$6325/US$7959 to -C$6229/US$7838) and more effective (0.19 QALYs, 95% CrI 0.17-0.20) than usual care. These cost savings remained robust in sensitivity analyses. DISCUSSION Noninvasive fetal RhD genotyping saves resources and represents good value for the management of alloimmunized pregnancies. If the cost of genotyping is substantially decreased, the targeted intervention can become a viable option for nonalloimmunized pregnancies.
Collapse
Affiliation(s)
- Olga Gajic-Veljanoski
- Ontario Health (Clinical Institutes and Quality Programs/Health Technology Assessment), Toronto, Ontario, Canada
| | - Chunmei Li
- Ontario Health (Clinical Institutes and Quality Programs/Health Technology Assessment), Toronto, Ontario, Canada
| | - Alexis K Schaink
- Ontario Health (Clinical Institutes and Quality Programs/Health Technology Assessment), Toronto, Ontario, Canada
| | - Jennifer Guo
- Ontario Health (Clinical Institutes and Quality Programs/Health Technology Assessment), Toronto, Ontario, Canada
| | - Nadine Shehata
- Mount Sinai Hospital (Division of Hematology), and Department of Medicine, Department of Laboratory Management and Evaluation, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - George S Charames
- Mount Sinai Hospital (Department of Pathology and Laboratory Medicine), and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Barbra de Vrijer
- Western University, Schulich School of Medicine and Dentistry/Department of Obstetrics and Gynaecology, and London Health Sciences Centre, London, Ontario, Canada
| | - Gwen Clarke
- Laboratory Services, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Petros Pechlivanoglou
- Child Health Evaluative Sciences, The Hospital for Sick Children, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nanette Okun
- Sunnybrook Health Sciences Centre (Maternal-Fetal Medicine Division), and Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Rita Kandel
- Mount Sinai Hospital (Department of Pathology and Laboratory Medicine), and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Dooley
- Department of Family Medicine, The Northern Ontario School of Medicine and Sioux Lookout Menoyawin Health Centre, Sioux Lookout, Ontario, Canada
| | - Caroline Higgins
- Ontario Health (Clinical Institutes and Quality Programs/Health Technology Assessment), Toronto, Ontario, Canada
| | - Vivian Ng
- Ontario Health (Clinical Institutes and Quality Programs/Health Technology Assessment), Toronto, Ontario, Canada
| | - Nancy Sikich
- Ontario Health (Clinical Institutes and Quality Programs/Health Technology Assessment), Toronto, Ontario, Canada
| |
Collapse
|
6
|
Gajic-Veljanoski O, Li C, Schaink AK, Guo J, Higgins C, Shehata N, Okun N, de Vrijer B, Pechlivanoglou P, Ng V, Sikich N. Noninvasive Fetal RhD Blood Group Genotyping: A Systematic Review of Economic Evaluations. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1416-1425.e5. [PMID: 34390866 DOI: 10.1016/j.jogc.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Noninvasive fetal rhesus D (RhD) blood group genotyping may prevent unnecessary use of anti-D immunoglobulin (RhIG) in non-alloimmunized RhD-negative pregnancies and can guide management of alloimmunized pregnancies. We conducted a systematic review of the economic literature to determine the cost-effectiveness of this intervention over usual care. DATA SOURCES Systematic literature searches of bibliographic databases (Ovid MEDLINE, Embase, and Cochrane) until February 26, 2019, and auto-alerts until October 30, 2020, and of grey literature sources were performed to retrieve all English-language studies. STUDY SELECTION We included studies done in serologically confirmed non-alloimmunized or alloimmunized RhD-negative pregnancies, comparing costs and effectiveness of the intervention versus usual care. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data from the eligible studies and assessed their methodological quality (risk of bias) using the Quality of Health Economic Studies (QHES) and Drummond tools. We narratively synthesized findings. Our review included 8 economic studies that evaluated non-invasive fetal RhD genotyping followed by targeted RhIG prophylaxis in non-alloimmunized pregnancies. Five studies further considered a subsequent alloimmunized pregnancy. The cost-effectiveness of the intervention versus usual care (e.g., universal RhIG or prophylaxis conditional on results of paternal testing) for non-alloiummunized pregnancies was inconsistent. Two studies indicated greater benefits and lower costs for the intervention, and another 2 suggested a trade-off. In 4 studies, the intervention was less effective and costlier than alternatives. Three studies were determined to be of high quality by both tools. Two of these studies favoured the intervention, and one assessed benefits in quality-adjusted life-years. No study clearly examined the cost-effectiveness of repetitive use of fetal genotyping in multiple non-alloimmunized or alloimmunized pregnancies. The cost of genotyping was the most influential parameter. CONCLUSION The cost-effectiveness of noninvasive fetal RhD genotyping for non-alloimmunized pregnancies varies between studies. Potential savings from targeted management of alloimmunized pregnancies requires further research.
Collapse
Affiliation(s)
- Olga Gajic-Veljanoski
- Ontario Health (Health Technology Assessment, Clinical Institutes and Quality Programs), Toronto, ON.
| | - Chunmei Li
- Ontario Health (Health Technology Assessment, Clinical Institutes and Quality Programs), Toronto, ON
| | - Alexis K Schaink
- Ontario Health (Health Technology Assessment, Clinical Institutes and Quality Programs), Toronto, ON
| | - Jennifer Guo
- Ontario Health (Health Technology Assessment, Clinical Institutes and Quality Programs), Toronto, ON
| | - Caroline Higgins
- Ontario Health (Health Technology Assessment, Clinical Institutes and Quality Programs), Toronto, ON
| | - Nadine Shehata
- Departments of Medicine, Laboratory Medicine and Pathobiology, Institute of Health Policy Management and Evaluation, University of Toronto, and Division of Hematology, Mount Sinai Hospital, Toronto, ON
| | - Nanette Okun
- Sunnybrook Health Sciences Centre, and Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON
| | - Barbra de Vrijer
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, Western University, and London Health Sciences Centre, London, ON
| | - Petros Pechlivanoglou
- Child Health Evaluative Sciences, The Hospital for Sick Children, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Vivian Ng
- Ontario Health (Health Technology Assessment, Clinical Institutes and Quality Programs), Toronto, ON
| | - Nancy Sikich
- Ontario Health (Health Technology Assessment, Clinical Institutes and Quality Programs), Toronto, ON
| |
Collapse
|
7
|
Pazourkova E, Zednikova I, Korabecna M, Kralova J, Pisacka M, Novotna M, Calda P, Horinek A. Optimization of diagnostic strategy for non-invasive cell-free foetal RHD determination from maternal plasma. Vox Sang 2021; 116:1012-1019. [PMID: 33761162 DOI: 10.1111/vox.13099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/20/2020] [Accepted: 03/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of the study was to optimize routine non-invasive prenatal detection of fetal RHD gene from plasma of RhD-negative pregnant women (the median of gestational age was 25 weeks, range 10-38) to detect RhD materno-fetal incompatibility and to avoid the redundant immunoprophylaxis. MATERIALS AND METHODS Initially only one exon of RHD gene (exon 10) was investigated in 281 plasma samples (144 verified after delivery), in the second phase three RHD exons (5, 7, 10) were analyzed in 246 samples of plasma and maternal genomic DNA (204 verified) by real-time PCR method. Detection of Y-chromosomal sequence DYS-14 and five X-chromosomal insertion/deletion polymorphisms was used to confirm the fetal cfDNA detectability in plasma. Specific polymorphisms in RHD gene were detected by sequence-specific primer PCR in nine samples. RESULTS When only the RHD exon 10 was tested, 2·8% of verified samples were false positive and 3·5% false negative. With three RHD exons (5, 7, 10) and maternal genomic DNA testing, only one case was false negative (0·5%). Nine samples were inconclusive due to RHD-positive results in maternal genomic DNA. These samples were analyzed for specific mutations in RHD gene. Combination of both methods for fetal cfDNA verification succeeded in 75% of tested group. CONCLUSION Implementation of analysis of three RHD exons and maternal genomic DNA to routine practice lowers dramatically the ratio of false positive and negative results. This method enables more accurate determination of fetal RHD status with the reduction of unnecessary medical care and RhD immunoprophylaxis.
Collapse
Affiliation(s)
- Eva Pazourkova
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic.,Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
| | - Iveta Zednikova
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
| | - Marie Korabecna
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
| | - Jana Kralova
- Department of Immunohematology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Martin Pisacka
- Department of Immunohematology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Michaela Novotna
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
| | - Pavel Calda
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
| | - Ales Horinek
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic.,3rd Department of Medicine, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
| |
Collapse
|
8
|
Shah A, Patel P, Patel K, Patel B, Jariwala K, Sharma P, Mishra K, Ghosh K. Comparison of serology and molecular detection of common red cell antigens in multitransfused thalassemia major and sickle cell disease patients. Transfus Apher Sci 2019; 59:102599. [PMID: 31326292 DOI: 10.1016/j.transci.2019.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Serological testing for extended RHCcEe, Kell, Kidd and Duffy blood grouping from multitransfused patients may not give correct blood grouping of the recipient. Hence molecular testing for these blood groups was compared with serological groups in a cohort of multitransfused thalassemia mjor and sickle cell anaemia patients. OBJECTIVE Molecular genotyping of antigens of Rh (D, C, c, E, e), Kell (K, k), Duffy (Fya, Fyb) and Kidd (Jka, Jkb) blood group antigens by PCR and PCR-RFLP methods and comparison of predicted genotypes with their serological phenotypes. MATERIALS AND METHODS A cohort of multitransfused thalassemia and sickle cell anemia patient were serologically and molecularly tested for RHCc, RHEe, K, k Fya, Fyb, Jka and Jkb antigens and compared. Serological testing was done by tube agglutination and molecular testing was done either by allele specific PCR or by RFLP technique just before next transfusion. RESULTS In more than 80% of the cases recipient's molecular testing blood groups were at variance with serologically tested blood groups (p < 0.0001). Mixed field reactions in serological typing were common. In sickle cell anemia patients no discrepancy was found. Molecular technique results were checked by Sanger's sequencing. DISCUSSION Extended phenotyping in multitransfused thalassemia patients by serological technique often donot detect the exact red cell phenotype of the recipient and molecular techniques for such grouping is preferable, especially in multitransfused thalassemia patients where red cells from previous transfusions continues to be present in significant numbers whenever the testing is done.
Collapse
Affiliation(s)
- Avani Shah
- Surat Raktadan Kendra & Research Centre, Surat, Gujarat, India
| | - Parizad Patel
- Surat Raktadan Kendra & Research Centre, Surat, Gujarat, India
| | - Keyur Patel
- Surat Raktadan Kendra & Research Centre, Surat, Gujarat, India
| | - Binal Patel
- Surat Raktadan Kendra & Research Centre, Surat, Gujarat, India; Department of Biotechnology, Veer Narmad South Gujarat University, Surat, Gujarat, India
| | - Keyuri Jariwala
- Surat Raktadan Kendra & Research Centre, Surat, Gujarat, India
| | - Preeti Sharma
- Department of Biotechnology, Veer Narmad South Gujarat University, Surat, Gujarat, India
| | - Kanchan Mishra
- Surat Raktadan Kendra & Research Centre, Surat, Gujarat, India
| | - Kanjaksha Ghosh
- Surat Raktadan Kendra & Research Centre, Surat, Gujarat, India.
| |
Collapse
|
9
|
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
| |
Collapse
|
10
|
Prenatal non-invasive foetal RHD genotyping: diagnostic accuracy of a test as a guide for appropriate administration of antenatal anti-D immunoprophylaxis. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 16:514-524. [PMID: 29757138 DOI: 10.2450/2018.0270-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/13/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Foetal RHD genotyping can be predicted by real-time polymerase chain reaction (qPCR) using cell-free foetal DNA extracted from maternal plasma. The object of this study was to determine the diagnostic accuracy and feasibility of non-invasive RHD foetal genotyping, using a commercial multiple-exon assay, as a guide to appropriate administration of targeted antenatal immunoprophylaxis. MATERIAL AND METHODS Cell-free foetal DNA was extracted from plasma of RhD-negative women between 11-30 weeks of pregnancy. The foetal RHD genotype was determined non-invasively by qPCR amplification of exons 5, 7 and 10 of the RHD gene using the Free DNA Fetal Kit® RhD. Results were compared with serological RhD cord blood typing at birth. The analysis of diagnostic accuracy was restricted to the period (24-28+6 weeks) during which foetal genotyping is usually performed for targeted antenatal immunoprophylaxis. RESULTS RHD foetal genotyping was performed on 367 plasma samples (24-28+6 weeks). Neonatal RhD phenotype results were available for 284 pregnancies. Foetal RHD status was inconclusive in 9/284 (3.2%) samples, including four cases with RhD maternal variants. Two false-positive results were registered. The sensitivity was 100% and the specificity was 97.5% (95% CI: 94.0-100). The diagnostic accuracy was 99.3% (95% CI: 98.3-100), decreasing to 96.1% (95% CI: 93.9-98.4) when the inconclusive results were included. The negative and positive predictive values were 100% (95% CI: 100-100) and 99.0% (95% CI: 97.6-100), respectively. There was one false-negative result in a sample collected at 18 weeks. After inclusion of samples at early gestational age (<23+6 week), sensitivity and accuracy were 99.6% (95% CI: 98.7-100) and 95.5% (95% CI: 93.3-97.8), respectively. DISCUSSION This study demonstrates that foetal RHD detection on maternal plasma using a commercial multiple-exon assay is a reliable and accurate tool to predict foetal RhD phenotype. It can be a safe guide for the appropriate administration of targeted prenatal immunoprophylaxis.
Collapse
|
11
|
Phithakwatchara N, Nawapun K, Panchalee T, Viboonchart S, Mongkolchat N, Wataganara T. Current Strategy of Fetal Therapy I: Principles of In-utero Treatment, Pharmacologic Intervention, Stem Cell Transplantation and Gene Therapy. JOURNAL OF FETAL MEDICINE 2017. [DOI: 10.1007/s40556-017-0129-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
12
|
Cell-Free Fetal DNA for the Prediction of Pre-Eclampsia at the First and Second Trimesters: A Systematic Review and Meta-Analysis. Mol Diagn Ther 2016; 21:125-135. [DOI: 10.1007/s40291-016-0245-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
13
|
Performance of Droplet Digital PCR in Non-Invasive Fetal RHD Genotyping - Comparison with a Routine Real-Time PCR Based Approach. PLoS One 2015; 10:e0142572. [PMID: 26562517 PMCID: PMC4642940 DOI: 10.1371/journal.pone.0142572] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/25/2015] [Indexed: 02/06/2023] Open
Abstract
Detection and characterization of circulating cell-free fetal DNA (cffDNA) from maternal circulation requires an extremely sensitive and precise method due to very low cffDNA concentration. In our study, droplet digital PCR (ddPCR) was implemented for fetal RHD genotyping from maternal plasma to compare this new quantification alternative with real-time PCR (qPCR) as a golden standard for quantitative analysis of cffDNA. In the first stage of study, a DNA quantification standard was used. Clinical samples, including 10 non-pregnant and 35 pregnant women, were analyzed as a next step. Both methods' performance parameters-standard curve linearity, detection limit and measurement precision-were evaluated. ddPCR in comparison with qPCR has demonstrated sufficient sensitivity for analysing of cffDNA and determination of fetal RhD status from maternal circulation, results of both methods strongly correlated. Despite the more demanding workflow, ddPCR was found to be slightly more precise technology, as evaluated using quantitative standard. Regarding the clinical samples, the precision of both methods equalized with decreasing concentrations of tested DNA samples. In case of cffDNA with very low concentrations, variance parameters of both techniques were comparable. Detected levels of fetal cfDNA in maternal plasma were slightly higher than expected and correlated significantly with gestational age as measured by both methods (ddPCR r = 0.459; qPCR r = 0.438).
Collapse
|
14
|
Ma KK, Rodriguez MI, Cheng YW, Norton ME, Caughey AB. Should cell-free DNA testing be used to target antenatal rhesus immune globulin administration? J Matern Fetal Neonatal Med 2015; 29:1866-70. [PMID: 26169705 DOI: 10.3109/14767058.2015.1066773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the rates of alloimmunization with the use of cell-free DNA (cfDNA) screening to target antenatal rhesus immune globulin (RhIG) prenatally, versus routine administration of RhIG in rhesus D (RhD)-negative pregnant women in a theoretic cohort using a decision-analytic model. METHODS A decision-analytic model compared cfDNA testing to routine antenatal RhIG administration. The primary outcome was maternal sensitization to RhD antigen. Sensitivity and specificity of cfDNA testing were assumed to be 99.8% and 95.3%, respectively. Univariate and bivariate sensitivity analyses, Monte Carlo simulation, and threshold analyses were performed. RESULTS In a cohort of 10,000 RhD-negative women, 22.6 sensitizations would occur with utilization of cfDNA, while 20 sensitizations would occur with routine RhIG. Only when the sensitivity of the cfDNA test reached 100%, the rate of sensitization was equal for both cfDNA and RhIG. Otherwise, routine RhIG minimized the rate of sensitization, especially given RhIG is readily available in the United States. CONCLUSIONS Adoption of cfDNA testing would result in a 13.0% increase in sensitization among RhD-negative women in a theoretical cohort taking into account the ethnic diversity of the United States' population.
Collapse
Affiliation(s)
- Kimberly K Ma
- a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , University of Washington , Seattle , WA , USA
| | - Maria I Rodriguez
- b Department of Obstetrics and Gynecology , Oregon Health & Science University , Portland , OR , USA
| | - Yvonne W Cheng
- c Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , University of California , Davis, Sacramento , CA , USA , and
| | - Mary E Norton
- d Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Medicine , University of California , San Francisco , CA , USA
| | - Aaron B Caughey
- b Department of Obstetrics and Gynecology , Oregon Health & Science University , Portland , OR , USA
| |
Collapse
|
15
|
|
16
|
|
17
|
Guinchard E, Bricca P, Monnier S, Rigal D. [Non-invasive fetal RHD genotyping: Validation of the method with 200 patients]. Transfus Clin Biol 2014; 21:1-14. [PMID: 24559796 DOI: 10.1016/j.tracli.2013.12.001] [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: 08/23/2012] [Accepted: 12/09/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Non-invasive fetal RHD genotyping is an important tool to assess the risk of fetuse's hemolytic disease of anti-D allo-immunized pregnant woman by non-invasive method. A method of genotyping has been developed in the laboratory of Lyon-GHE according to Minon's team (J Gynecol Obstet Biol Reprod 2005): exon 4, 5, and 10 are amplified by real time PCR. At first, genotyping results of 200 pregnant women have been compared with RH1 phenotype at birth. The most important parameters of validation have been tested: the sensibility and the specificity; the negative predictive value; the correlation study permitted to define criteria of biological interpretation. The validation of this method permitted to determine critical points and the limits of the method due to the minor amount of fetal DNA in the maternal plasma and existence of many variant forms of the RHD gene. CONCLUSION We worked too in the perspective to the accreditation for our genetic laboratory.
Collapse
Affiliation(s)
- E Guinchard
- EFS Rhône-Alpes, site de Lyon-GHE, 28, rue Doyen-Lepine, 69677 Bron cedex, France.
| | - P Bricca
- EFS Rhône-Alpes, site de Lyon-GHE, 28, rue Doyen-Lepine, 69677 Bron cedex, France
| | - S Monnier
- EFS Rhône-Alpes, site de Lyon-GHE, 28, rue Doyen-Lepine, 69677 Bron cedex, France
| | - D Rigal
- EFS Rhône-Alpes, site de Lyon-Gerland, 1, rue du Vercors, 69007 Lyon, France
| |
Collapse
|
18
|
Kolialexi A, Tounta G, Mavrou A. Noninvasive fetal RhD genotyping from maternal blood. Expert Rev Mol Diagn 2014; 10:285-96. [DOI: 10.1586/erm.10.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
19
|
Manzanares S, Entrala C, Sánchez-Gila M, Fernández-Rosado F, Cobo D, Martinez E, Molina L, Reche R, Pineda A, Gallo JL. Noninvasive Fetal RhD Status Determination in Early Pregnancy. Fetal Diagn Ther 2013; 35:7-12. [DOI: 10.1159/000356078] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 10/01/2013] [Indexed: 11/19/2022]
|
20
|
Evaluation of sample stability and automated DNA extraction for fetal sex determination using cell-free fetal DNA in maternal plasma. BIOMED RESEARCH INTERNATIONAL 2013; 2013:195363. [PMID: 24222898 PMCID: PMC3814069 DOI: 10.1155/2013/195363] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/24/2013] [Accepted: 09/16/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The detection of paternally inherited sequences in maternal plasma, such as the SRY gene for fetal sexing or RHD for fetal blood group genotyping, is becoming part of daily routine in diagnostic laboratories. Due to the low percentage of fetal DNA, it is crucial to ensure sample stability and the efficiency of DNA extraction. We evaluated blood stability at 4°C for at least 24 hours and automated DNA extraction, for fetal sex determination in maternal plasma. METHODS A total of 158 blood samples were collected, using EDTA-K tubes, from women in their 1st trimester of pregnancy. Samples were kept at 4°C for at least 24 hours before processing. An automated DNA extraction was evaluated, and its efficiency was compared with a standard manual procedure. The SRY marker was used to quantify cfDNA by real-time PCR. RESULTS Although lower cfDNA amounts were obtained by automated DNA extraction (mean 107,35 GE/mL versus 259,43 GE/mL), the SRY sequence was successfully detected in all 108 samples from pregnancies with male fetuses. CONCLUSION We successfully evaluated the suitability of standard blood tubes for the collection of maternal blood and assessed samples to be suitable for analysis at least 24 hours later. This would allow shipping to a central reference laboratory almost from anywhere in Europe.
Collapse
|
21
|
Mazières S, Temory SA, Vasseur H, Gallian P, Di Cristofaro J, Chiaroni J. Blood group typing in five Afghan populations in the North Hindu-Kush region: implications for blood transfusion practice. Transfus Med 2013; 23:167-74. [DOI: 10.1111/tme.12038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 11/29/2022]
Affiliation(s)
- S. Mazières
- Aix Marseille Université; CNRS, EFS, ADÉS; UMR 7268; Marseille; France
| | - S. A. Temory
- Centre National de Transfusion Sanguine de Kabul; Kabul; Afghanistan
| | - H. Vasseur
- Etablissement Français du Sang Auvergne-Loire; Saint-Etienne; France
| | | | | | | |
Collapse
|
22
|
Ordoñez E, Rueda L, Cañadas MP, Fuster C, Cirigliano V. Development and validation of multiplex real-time PCR assay for noninvasive prenatal assessment of fetal RhD status and fetal sex in maternal plasma. Fetal Diagn Ther 2013; 34:13-8. [PMID: 23548569 DOI: 10.1159/000346809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 01/04/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Noninvasive prenatal detection of RhD status and fetal sex is becoming part of daily practice in clinical laboratories. We evaluated a high throughput procedure for automated DNA extraction and developed a multiplex real-time PCR (rt-PCR) for the simultaneous detection of three fetal loci in a single reaction to assess fetal sex and RhD status in maternal plasma. METHODS An automated DNA extraction method was evaluated together with a new multiplex rt-PCR assay for the simultaneous detection of exons 5 and 7 of the RHD gene together with the Y chromosome marker DYS14 in maternal plasma. The test was evaluated on 60 samples of known fetal genotype obtained from RhD-negative pregnant women before being applied prospectively on 158 consecutive clinical cases. Results were compared with newborn phenotypes. RESULTS Automated DNA extraction allowed successful analysis of all samples. DYS14 was detected in 118 cases (male fetuses) and both RHD exon 5 and 7 were detected in 148 samples. In 70 samples neither RHD exon 5 nor RHD exon 7 were detected (RhD-negative fetuses). Absence of all three sequences (female RhD-negative fetuses) was assessed in 33 samples. All prenatal results were in concordance with postnatal RhD status and fetal sex without false- positive or -negative results. CONCLUSION The automated DNA extraction procedure coupled with a novel multiplex rt-PCR assay proved accurate, efficient and reliable allowing rapid and high throughput noninvasive determination of fetal sex and RhD status in clinical samples.
Collapse
Affiliation(s)
- Elena Ordoñez
- Departament de Genètica Molecular, Labco Diagnostics, Barcelona, Spain
| | | | | | | | | |
Collapse
|
23
|
Moise KJ, Boring NH, O'Shaughnessy R, Simpson LL, Wolfe HM, Baxter JK, Polzin W, Eddleman KA, Hassan SS, Skupski D, McLennan G, Paladino T, Oeth P, Bombard A. Circulating cell-free fetal DNA for the detection of RHD status and sex using reflex fetal identifiers. Prenat Diagn 2012; 33:95-101. [PMID: 23225162 DOI: 10.1002/pd.4018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the sensitivity and specificity of circulating cell-free fetal DNA in determining the fetal RHD status and fetal sex. METHODS Maternal blood was collected in each trimester of pregnancy from RhD negative nonalloimmunized women. Whole blood was centrifuged, separated into plasma and buffy coat, and frozen at -80°C. DNA analysis was conducted via allele-specific primer extensions for exons 4, 5, and 7 of the RHD gene and for a 37-base pair insertion in exon 4 (RHD pseudogene; psi) three Y-chromosome sequences (SRY, DBY, and TTY2), and an extraction control (TGIFL-like X/Y). RhD serotyping on cord blood and gender assessment of the newborns were entered into a Web-based database. RESULTS One hundred twenty women were enrolled. The median gestational age at the first venipuncture was 12.4 (range: 10.6-13.9) weeks with 120 samples drawn; 118 samples were drawn at 17.6 (16-20.9) weeks; and 113 samples at 28.7 (27.9-33.9) weeks. Overall accuracy for RHD was 99.1%, 99.1%, and 98.1% for each trimester and was 99.1%, 99.1%, and 100% for fetal sex determination. CONCLUSIONS Fetal RHD genotyping and sex can be very accurately determined in all three trimesters using circulating cell-free fetal DNA in the maternal circulation.
Collapse
Affiliation(s)
- K J Moise
- Baylor College of Medicine, Houston, TX, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Damkjaer MB, Perslev A, Clausen FB, Dziegiel MH, Jørgensen FS. Study of compliance with a new, targeted antenatal D immunization prevention programme in Denmark. Vox Sang 2012; 103:145-9. [DOI: 10.1111/j.1423-0410.2012.01602.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
25
|
Macher HC, Noguerol P, Medrano-Campillo P, Garrido-Márquez MR, Rubio-Calvo A, Carmona-González M, Martin-Sánchez J, Pérez-Simón JA, Guerrero JM. Standardization non-invasive fetal RHD and SRY determination into clinical routine using a new multiplex RT-PCR assay for fetal cell-free DNA in pregnant women plasma: results in clinical benefits and cost saving. Clin Chim Acta 2011; 413:490-4. [PMID: 22133782 DOI: 10.1016/j.cca.2011.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 11/08/2011] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Among negative RhD mothers it is essential to know the fetal RhD status in order to avoid the possibility of hemolytic disease of the newborn. In this regard, the detection of fetal DNA in maternal plasma might become a new diagnostic tool. In the current study, we have evaluated the standardization of a Multiplex-PCR targeted towards two exons of the RHD and one SRY gene to monitor RhD negative women. The current study addresses questions concerning feasibility and applicability of this approach into the clinical practice. MATERIALS AND METHODS Both single and multiplex real-time PCRs targeting RHD exons 5 and 7 and SRY were applied for the detection of fetal-specific RHD sequences and sex in maternal plasma. A large cohort of 2127 women was studied between 10 and 28 weeks of pregnancy. 134 of them were used for single TaqMan PCR studies and 1993 were evaluated using Multiplex TaqMan PCR studies. All of them were serologically typed as RhD negative according to Spanish guidelines. Single and multiplex real-time PCR results were compared with postnatal serology and sex identification. RESULTS There was a 100% concordance between results obtained with single and multiplex real-time PCR assays. At present, 1012 of the 1993 pregnant women studied gave birth and the results of RHD status obtained with the multiplex TaqMan PCR assay were confirmed postpartum by serological methods showing that sensitivity, specificity, and accuracy of the multiplex assay were 100, 98.6, and 99.3%, respectively. This procedure improved the speed of the assay, avoided over-treatment among RhD negative pregnant women bearing RhD negative fetus, and reduced the requirements for clinical and biological monitoring, resulting in a clinical benefit and cost saving. CONCLUSIONS The routine determination of fetal RHD status and SRY in maternal plasma, using multiplex real-time PCR, is feasible. The use of multiplex real-time PCR allows improving the response of the laboratory, saving time and reagent costs, opening the door to a complete automatization of the process.
Collapse
Affiliation(s)
- Hada C Macher
- Department of Clinical Biochemistry, The Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), Seville, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Implementing non-invasive RHD genotyping on cell-free foetal DNA from maternal plasma: the Pavia experience. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 10:34-8. [PMID: 22153691 DOI: 10.2450/2011.0021-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 06/08/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND The occurrence of cell-free foetal DNA in maternal circulation opens new possibilities in non-invasive antenatal diagnosis. Real-time polymerase chain reaction (PCR) analysis is an useful approach to foetal RhD blood group determination, thus being important in the prevention of haemolytic disease of foetus and new-born (HDFN). STUDY DESIGN AND METHODS Using real-time PCR assays we typed 20 samples of plasma, provided in a blinded fashion, from the International Reference Laboratory, two plasma samples sent by the "2010 Workshop on Molecular Blood Group Genotyping"; seven samples from D-negative mothers at the 16th week of gestation provided by our Hospital as prospective validation cases, and two plasma samples received from the "1(st) Collaborative study establishing the sensitivity standard for non-invasive prenatal determination of foetal RHD genotype". To confirm the RHD typing of the seven prospective samples, PCR with sequence specific primers (PCR-SSP) was applied on genomic DNA from amniocytes (5 cases) and paternal peripheral blood (2 cases). RESULTS The results for the 31 investigated samples showed 100% concordance. Our measurable benefits were: confidence with a new technology, awareness of having gained the European standard level and increased self-assurance regarding the introduction of this typing technique in prenatal diagnostics. DISCUSSION These results demonstrate the feasibility and accuracy of our validation protocol. RHD typing on cell-free foetal DNA is a procedure which requires particular care and a great degree of expertise for diagnostic use. International collaborations are essential for monitoring the performance of laboratories in the absence of specific quality control programmes.
Collapse
|
27
|
Amaral DRT, Credidio DC, Pellegrino J, Castilho L. Fetal RHD genotyping by analysis of maternal plasma in a mixed population. J Clin Lab Anal 2011; 25:100-4. [PMID: 21438001 DOI: 10.1002/jcla.20440] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Maternal plasma analysis for the determination of the fetal RHD status is an exciting tool for the management of RhD-negative pregnant women, specially sensitized women. We assessed the accuracy of fetal RHD genotyping by analysis of maternal plasma in a multi-ethnic population. METHODS We analyzed plasma samples from 88 RhD-negative pregnant women between 11 and 39 weeks of gestation, median age of 28 years old to determine the fetal RHD genotype. This population was from Southeastern Brazil with high mixed ethnic background. Fourteen patients (16%) had anti-D alloantibody. We used Taqman primers and probes to detect by real-time PCR, exons 4, 5, and 10 of RHD. As internal controls we used primers/probes sets to SRY and CCR5. Peripheral or umbilical cord bloods from respective neonates were collected during delivery and hemagglutination was performed. RESULTS Fifty-eight samples (66%) were genotyped as RHD+, 27 samples (31%) showed complete absence of RHD and 3 samples (3 %) presented a D variant (RHDψ). All the results agreed with the neonatal typing, including the three fetuses with the RHDψ, phenotyped as RhD-negative. Thus, the accuracy of the fetal RHD genotyping in this mixed population was 100%. The earliest pregnancy in which fetal RHD was detected was 11 weeks. CONCLUSION Our findings indicate that the accuracy of RHD gene using three regions (exons 4, 5, and 10) can be sufficient for clinical application in a multi-ethnic population. This knowledge helped us on the development of a feasible protocol for fetal RHD genotyping on DNA from maternal plasma for our population.
Collapse
|
28
|
Tounta G, Kolialexi A, Papantoniou N, Tsangaris GT, Kanavakis E, Mavrou A. Non-invasive prenatal diagnosis using cell-free fetal nucleic acids in maternal plasma: Progress overview beyond predictive and personalized diagnosis. EPMA J 2011. [PMID: 23199146 PMCID: PMC3405386 DOI: 10.1007/s13167-011-0085-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The discovery of circulating cell-free fetal DNA (cffDNA) in maternal plasma allowed for the development of alternative methodologies that may facilitate safe non-invasive prenatal diagnosis (NIPD). The low concentration of cffDNA in maternal plasma, however, and the coexistence of maternal DNA limit its clinical application to the detection or exclusion of fetal targets that are not present in the mother, such as Y chromosome sequences, the RHD gene in a RhD-negative woman and genetic conditions inherited from the father. Strategies for NIPD of monogenic disorders and fetal chromosomal aneuploidies have also been achieved using next-generation sequencing and could be introduced to the clinics as soon as cost-effective and high throughput protocols are developed.
Collapse
Affiliation(s)
- Georgia Tounta
- Department of Medical Genetics, Athens University School of Medicine, Athens, Greece
| | | | | | | | | | | |
Collapse
|
29
|
Achargui S, Tijane M, Benchemsi N. Génotypage RHD fœtal par PCR dans le plasma de femmes enceintes D négatif. Transfus Clin Biol 2011; 18:13-9. [DOI: 10.1016/j.tracli.2010.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 10/01/2010] [Indexed: 11/25/2022]
|
30
|
Abstract
Rhesus is the clinically most important protein-based blood group system. It represents the largest number of antigens and the most complex genetics of the 30 known blood group systems. The RHD and RHCE genes are strongly homologous. Some genetic complexity is explained by their close chromosomal proximity and unusual orientation, with their tail ends facing each other. The antigens are expressed by the RhD and the RhCE proteins. Rhesus exemplifies the correlation of genotype and phenotype, facilitating the understanding of general genetic mechanisms. For clinical purposes, genetic diagnostics of Rhesus antigens will improve the cost-effective development of transfusion medicine.
Collapse
Affiliation(s)
- Willy A Flegel
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892, United States.
| |
Collapse
|
31
|
Guelsin GAS, Sell AM, Castilho L, Masaki VL, Melo FC, Hashimoto MN, Higa TT, Hirle LS, Visentainer JEL. Benefits of blood group genotyping in multi-transfused patients from the south of Brazil. J Clin Lab Anal 2011; 24:311-6. [PMID: 20872565 DOI: 10.1002/jcla.20407] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We evaluated the usefulness of blood group genotyping as a supplement to hemagglutination to determine the red blood cell (RBC) antigen profile of polytransfused patients with hematological diseases and renal failure. Seventy-nine patients were selected. They all received more than three units of blood and eight (10%) had already clinical significant alloantibodies occurring alone or in combination against Rh, K, Fya, and Di antigens. DNA was prepared from blood samples and RHCE*E/e, KEL*01/KEL*02, FY*01/FY*02 and JK*01/JK*02 alleles were determined by using PCR-RFLP. RHD*/RHD*Ψ and RHCE*C/c were tested using multiplex PCR. Discrepancies for Rh, Kell, Duffy, and Kidd systems were found between the phenotype and genotype-derived phenotype in 16 of the 38 chronically transfused patients. The genotypes of these patients were confirmed by DNA array analysis (HEA Beadchip(™); Bioarray Solutions, Warren, NJ). Genotyping was very important for the determination of the true blood groups of the polytransfused patients, helped in the identification of suspected alloantibodies and in the selection of antigen-negative RBCs for transfusion.
Collapse
Affiliation(s)
- Gláucia Andréia Soares Guelsin
- Laboratório de Imunogenética, Departamento de Ciências Básicas da Saúde, Universidade Estadual de Maringá, Maringá, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Illanes S, Soothill P. Management of red cell alloimmunisation in pregnancy: the non-invasive monitoring of the disease. Prenat Diagn 2010; 30:668-73. [DOI: 10.1002/pd.2551] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
33
|
|
34
|
Di Cristofaro J, Silvy M, Chiaroni J, Bailly P. Single PCR multiplex SNaPshot reaction for detection of eleven blood group nucleotide polymorphisms: optimization, validation, and one year of routine clinical use. J Mol Diagn 2010; 12:453-60. [PMID: 20431033 DOI: 10.2353/jmoldx.2010.090222] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Hemagglutination-based assays have several clinical shortcomings. To overcome this difficulty, we have developed a multiplex-PCR SNaPshot assay adapted to the Southern French population, which includes individuals from sub-Saharan Africa and the Comoros archipelago. Single nucleotide polymorphisms (SNPs) associated with clinically relevant blood antigens as well as with null phenotypes were profiled (i.e., K/k, Fy(a)/Fy(b)/Fy(bw)/Fy(null), S/s/U-/U+(var), Jk(a)/Jk(b), Do(a)/Do(b), Yt(a)/Yt(b), and Co(a)/Co(b)). A single multiplex-PCR reaction was used to amplify nine gene regions encompassing 11 SNPs. Identification was obtained by incorporation of the complementary dye-conjugated single base at the 3' end of each probe primer annealed proximal to the target SNP. After optimization, the SNaPshot assay was validated with 265 known allele or phenotype pairs. Results were found fully concordant with those of hemagglutination, allele-specific PCR, and/or sequencing. The assay was then evaluated on 227 blood samples in a clinical context. A total of 203 derived-phenotypes were generated, including 82 atypical phenotypes [i.e., Fy(b+(w)) (n = 32); K(+) (n = 22); Co(b+) (n = 8); Yt(b+) (n = 18); S-s+U+(var) (n = 2), 105 null phenotypes, i.e., Fy(a-b-) (n = 97); S-s-U- (n = 6); S-s-U+(var) (n = 2)] and sixteen Fy-positive samples carried a FY*Fy allele. The findings show that this assay can provide a low-cost and fast genotyping tool well adapted to local ethnically mixed populations.
Collapse
Affiliation(s)
- Julie Di Cristofaro
- Etablissement Français du Sang Alpes Méditerranée, UMR 6578, Université de la Méditerranée, Marseille, France
| | | | | | | |
Collapse
|
35
|
Gutensohn K, Müller SP, Thomann K, Stein W, Suren A, Körtge-Jung S, Schlüter G, Legler TJ. Diagnostic accuracy of noninvasive polymerase chain reaction testing for the determination of fetal rhesus C, c and E status in early pregnancy. BJOG 2010; 117:722-9. [DOI: 10.1111/j.1471-0528.2010.02518.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
36
|
Wang XD, Wang BL, Ye SL, Liao YQ, Wang LF, He ZM. Non-invasive foetal RHD genotyping via real-time PCR of foetal DNA from Chinese RhD-negative maternal plasma. Eur J Clin Invest 2009; 39:607-17. [PMID: 19545247 DOI: 10.1111/j.1365-2362.2009.02148.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A majority of studies predicting the foetal RhD blood group in free foetal DNA from RhD-negative maternal plasma have been conducted in Caucasian populations, whereas limited data have been accumulated for Asian populations. In this study, we assessed the feasibility of prenatal genotyping of RHD in RhD-negative Chinese pregnant women. MATERIALS AND METHODS Cell-free plasma DNA was extracted from 78 RhD-negative Chinese women carrying a singleton foetus (gestation between 14 and 40 weeks). Foetal DNA was confirmed by testing SRY or nine different polymorphic STR loci in the maternal plasma and buffy coat. Foetal RHD exons 5, 7 and 10 and intron 4 were successfully amplified with RQ-PCR. The RHD1227A allele was examined in all RhD-positive individuals. The foetal RHD genotyping results were compared with the infant cord blood serological analysis. RESULTS Among the 78 specimens, RHD genotyping results of 70 cases were in complete concordance with serological results from foetal umbilical cord blood. Sixty of these cases were identified as RhD-positive, and 10 cases were typed as RhD-negative. In addition, five cases were 'false-positives', while three cases were considered inconclusive. The detection rate was 89.7% (70/78). In four of the five 'false-positive' cases, the RhDel phenotype was assessed by detecting the RHD1227A allele. Thus, this method yielded a 94.9% (74/78) accuracy rate. CONCLUSIONS The correct foetal RhD phenotype may be accurately predicted from RhD-negative maternal plasma in Chinese subjects. The RHD1227A allele proved to be an important genetic marker in the RhDel Chinese population.
Collapse
Affiliation(s)
- X D Wang
- Cancer Research Institute, Xiangya Medical School, Central South University, Changsha, China
| | | | | | | | | | | |
Collapse
|
37
|
Ghosh K, Shetty S, Tulsiani M. Evolution of prenatal diagnostic techniques from phenotypic diagnosis to gene arrays: its likely impact on prenatal diagnosis of hemophilia. Clin Appl Thromb Hemost 2009; 15:277-82. [PMID: 19562834 DOI: 10.1177/1076029607308870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Prenatal diagnostic techniques in hemophilia have evolved through the early sex-determination techniques of offering a nonspecific diagnosis in case of a male fetus through the various mutation screening techniques to the more recent gene array techniques. Each of these techniques has specific advantages and disadvantages. The sampling techniques have evolved simultaneously to suit the requirements of each technique and also the different gestation periods. The DNA-based testing methods provide a range of aberrations detected with different levels of genomic resolution. The more recent gene array analysis is poised to have substantial impact on prenatal diagnosis of hemophilia not only in studying the highly heterogeneous mutations but may also be useful in studying the effect of various ameliorating or epistatic genetic mutations/ polymorphisms simultaneously, providing a wide range of options to the prenatal diagnosis experts, the genetic counselors, and the couples opting for prenatal diagnosis.
Collapse
Affiliation(s)
- Kanjaksha Ghosh
- Department of Haemostasis, Institute of Immunohaematology, KEM Hospital Campus, Parel, Mumbai 400 012, India.
| | | | | |
Collapse
|
38
|
Abstract
After the revolutionary detection of ffDNA (free fetal DNA) in maternal circulation by real-time PCR in 1997 and advances in molecular techniques, NIPD (non-invasive prenatal diagnosis) is now a clinical reality. Non-invasive diagnosis using ffDNA has been implemented, allowing the detection of paternally inherited alleles, sex-linked conditions and some single-gene disorders and is a viable indicator of predisposition to certain obstetric complications [e.g. PET (pre-eclampsia)]. To date, the major use of ffDNA genotyping in the clinic has been for the non-invasive detection of the pregnancies that are at risk of HDFN (haemolytic disease of the fetus and newborn). This has seen numerous clinical services arising across Europe and many large-scale NIPD genotyping studies taking place using maternal plasma. Because of the interest in performing NIPD and the speed at which the research in this area was developing, the SAFE (Special Non-Invasive Advances in Fetal and Neonatal Evaluation) NoE (Network of Excellence) was founded. The SAFE project was set up to implement routine, cost-effective NIPD and neonatal screening through the creation of long-term partnerships within and beyond the European Community and has played a major role in the standardization of non-invasive RHD genotyping. Other research using ffDNA has focused on the amount of ffDNA present in the maternal circulation, with a view to pre-empting various complications of pregnancy. One of the key areas of interest in the non-invasive arena is the prenatal detection of aneuploid pregnancies, particularly Down's syndrome. Owing to the high maternal DNA background, detection of ffDNA from maternal plasma is very difficult; consequently, research in this area is now more focused on ffRNA to produce new biomarkers.
Collapse
|
39
|
Finning K, Martin P, Daniels G. The use of maternal plasma for prenatal RhD blood group genotyping. Methods Mol Biol 2008; 496:143-57. [PMID: 18839110 DOI: 10.1007/978-1-59745-553-4_11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Alloimmunization to the blood group antibody anti-RhD (anti-D) is the most common cause of hemolytic disease of the fetus and newborn. Knowledge of fetal D type in women with anti-D makes management of the pregnancy much easier and avoids unnecessary procedures in those women with a D-negative fetus. Fetal D typing can be performed by detection of an RHD gene in cell-free DNA in the plasma of D-negative pregnant women. The technology involves real-time quantitative polymerase chain reactions targeting exons 4, 5, and 10 of RHD, with the exons 4 and 10 tests performed as a multiplex. Testing for SRY in multiplex with the RHD exon 5 test provides an internal control for the presence of fetal DNA when the fetus is male. Fetal D typing has become the standard of care in England in pregnant women with a significant level of anti-D.
Collapse
Affiliation(s)
- Kirstin Finning
- International Blood Group Reference Laboratory, NHS Blood and Transplant, Bristol, UK
| | | | | |
Collapse
|
40
|
Freeman K, Szczepura A, Osipenko L. Non-invasive fetal RHD genotyping tests: a systematic review of the quality of reporting of diagnostic accuracy in published studies. Eur J Obstet Gynecol Reprod Biol 2008; 142:91-8. [PMID: 19081172 DOI: 10.1016/j.ejogrb.2008.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 10/08/2008] [Accepted: 10/17/2008] [Indexed: 11/29/2022]
Abstract
Articles reporting the diagnostic accuracy of non-invasive prenatal diagnostic (NIPD) tests for RHD genotyping using fetal material extracted from maternal blood have been published steadily for over a decade. Health care providers in Europe have started to use this technology for management of the small number of sensitised pregnancies (ca. 220-600 per annum in the Netherlands, Germany, France and the UK). Scientists and clinicians are also advocating widespread implementation for the far larger number of non-sensitised RhD-negative pregnancies (ca. 34,000-125,000 per annum in the same countries). Large-scale, prospective trials are only now underway. Estimates of the technical performance of these tests are currently based on results from small-scale studies, together with formal meta-analysis. The issue of early assessment of test performance is one faced by many new genetic tests. As part of a wider study we have investigated the quality of reporting of diagnostic accuracy in publications and produced guidelines for future studies. A systematic search of the literature identified 27 papers which met predefined inclusion criteria. All 27 papers were, first, assessed against an international quality (STARD) checklist for reporting of diagnostic accuracy and, second, against our own in-house NIPD proforma to assess the implications of the quality of reporting specifically for the RhD NIPD test. Authors were found to generally present an optimistic view of NIPD, bearing in mind weaknesses identified in reporting and conduct of their studies and the analysis of results, as evidenced by the low STARD scores. The NIPD proforma identified that specific biases were potentially introduced through selective population sampling and/or failure to report the make-up of the population tested, omission of inconclusive results, inconsistencies in the handling of repeat results on a sample, and lack of adequate controls. These factors would inevitably affect the validity of diagnostic accuracy as reported in individual publications, as well as any subsequent meta-analyses. Together, published reports to date may provide a biased picture of the actual potential of NIPD testing for fetal RHD genotyping. Generalisation of the available evidence on diagnostic accuracy, especially to large-scale implementation of NIPD testing of non-sensitised women, will also require that decision makers consider further aspects such as test reliability and cost of routine testing in clinical practice. It is recommended that all studies of diagnostic accuracy of NIPD tests adhere to the STARD quality checklist in order to improve reporting, thereby, minimising bias and increasing the comparability of studies. Researchers should also consider specific shortcomings for NIPD and avoid selective participant sampling; report population characteristics; report handling of replicate sampling as well as their failure rates; and include controls for genotypes tested in the study. Furthermore, meta-analyses should consider the quality, as well as the sample size, of NIPD studies in their analysis. Larger trials, required to produce results that are valid and meaningful for clinical practice, must also adhere to these reporting standards.
Collapse
Affiliation(s)
- Karoline Freeman
- Warwick Medical School, Warwick University, Gibbet Hill Road, Coventry CV4 7AL, UK.
| | | | | |
Collapse
|
41
|
Müller SP, Bartels I, Stein W, Emons G, Gutensohn K, Köhler M, Legler TJ. The determination of the fetal D status from maternal plasma for decision making on Rh prophylaxis is feasible. Transfusion 2008; 48:2292-301. [DOI: 10.1111/j.1537-2995.2008.01843.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
Chan LW, Lau TK, Chung TKH. Fetal anaemia as a cause of fetal injury: diagnosis and management. Curr Opin Obstet Gynecol 2008; 18:100-5. [PMID: 16601468 DOI: 10.1097/01.gco.0000192981.69352.dc] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review provides up-to-date information on the diagnosis and management of fetal anaemia. RECENT FINDINGS Exciting advances in the field of red blood cell isoimmunization are phasing out the need for invasive procedures. Rhesus blood group genotyping using fetal DNA in maternal plasma has been introduced into clinical practice with remarkable success. The role of middle cerebral artery peak systolic velocity in screening for fetal anaemia has been confirmed in various causes of fetal anaemia. A recent review of a successful Iran national screening programme for thalassaemia provided a timely and valuable educational opportunity. The value of intrauterine transfusion as a treatment for fetal anaemia was demonstrated by both high success rate and low procedure-related pregnancy loss rate. SUMMARY Fetal anaemia is one of the severe fetal conditions that affect the worldwide population. Rhesus isoimmunization remains an important health issue despite the recommendation for anti-D immunoglobulin prophylaxis and injection after sensitizing events. Noninvasive ultrasound diagnostic methods have replaced traditional invasive procedures in the assessment of fetus at risk of anaemia due to various causes, including red blood cell isoimmunization, parvovirus B19 infection and thalassaemia. The increased availability of intrauterine transfusion will help to improve the prognosis of these anaemic fetuses.
Collapse
Affiliation(s)
- Lin Wai Chan
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
| | | | | |
Collapse
|
43
|
Geifman-Holtzman O, Grotegut CA, Gaughan JP, Holtzman EJ, Floro C, Hernandez E. Noninvasive fetal RhCE genotyping from maternal blood. BJOG 2008; 116:144-51. [DOI: 10.1111/j.1471-0528.2008.01744.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
44
|
Abstract
PURPOSE OF REVIEW This review summarizes recent developments in blood grouping and compatibility testing in transfusion medicine. RECENT FINDINGS Identification of the molecular characteristics of the major human blood groups has provided an opportunity to develop methods for blood group phenotyping using DNA-based technology. Various studies have demonstrated the feasibility of such an approach and have demonstrated the potential to change current procedures for identifying compatible blood, both in routine settings and in highly immunized patients, for whom compatible blood is difficult to obtain. In the obstetric setting, isolation of cell-free DNA from maternal plasma for fetal blood grouping provides a minimally invasive method for determining the risk for haemolytic disease in the newborn. Recombinant technology for synthesizing blood group proteins, although in its infancy, has the potential to change longstanding antibody identification procedures. SUMMARY The molecular revolution occurring throughout medicine is broadly manifest in all areas of transfusion medicine and should contribute to transfusion safety.
Collapse
Affiliation(s)
- Jill R Storry
- Blood Centre, University Hospital, SE-221 85 Lund, Sweden.
| |
Collapse
|
45
|
Finning K, Martin P, Summers J, Daniels G. Fetal genotyping for the K (Kell) and Rh C, c, and E blood groups on cell-free fetal DNA in maternal plasma. Transfusion 2008; 47:2126-33. [PMID: 17958542 DOI: 10.1111/j.1537-2995.2007.01437.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND When a pregnant woman has an antibody with the potential to cause hemolytic disease of the fetus and newborn, it is beneficial to determine whether her fetus has the corresponding antigen to assess risk. In many countries this is now done routinely for RhD, by testing cell-free fetal DNA in the maternal plasma. Similar tests for K, C, c, and E are reported. STUDY DESIGN AND METHODS Real-time quantitative polymerase chain reaction incorporating an allele-specific primer was developed for detecting the K allele of KEL and the C, c, and E alleles of RHCE. These methods were used to test DNA isolated from plasma of pregnant women with antibodies to K, C, c, or E. Accuracy of the tests was determined by comparing results with serologic tests performed on cord red blood cells (RBCs) after delivery or by molecular genotyping on DNA obtained from fetal cells. RESULTS The K test incorporated an allele-specific primer with two locked nucleic acids and a mismatch. In 70 tests, including 27 K+ fetuses, only one false-negative and no false-positive results were obtained. The C, c, and E tests, performed on 13, 44, and 46 samples, respectively, gave rise to no false results. CONCLUSION Reliable methods have been developed for predicting fetal K, C, c, and E phenotypes, by testing fetal DNA in the plasma samples of pregnant women whose RBCs lack the corresponding antigens. These methods are now being used routinely in a diagnostic service in the United Kingdom.
Collapse
Affiliation(s)
- Kirstin Finning
- International Blood Group Reference Laboratory, NHSBT, Bristol, UK
| | | | | | | |
Collapse
|
46
|
Daniels G, Finning K, Martin P, Summers J. Fetal RhD genotyping: A more efficient use of anti-D immunoglobulin. Transfus Clin Biol 2007; 14:568-71. [DOI: 10.1016/j.tracli.2008.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 03/04/2008] [Indexed: 10/22/2022]
|
47
|
Minon JM, Gerard C, Senterre JM, Schaaps JP, Foidart JM. Routine fetal RHD genotyping with maternal plasma: a four-year experience in Belgium. Transfusion 2007; 48:373-81. [PMID: 18039319 DOI: 10.1111/j.1537-2995.2007.01533.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The objective was to evaluate the diagnostic value of RHD fetal genotyping from the plasma of D- mothers as soon as 10 weeks' gestation in a routine clinical practice in Belgium. STUDY DESIGN AND METHODS A prospective study was conducted between November 2002 and December 2006. DNA extraction was performed in an automated closed tube system. Fetal RHD/SRY genotypes were detected in the plasma of 563 pregnant mothers by real-time polymerase chain reaction (PCR) targeting multiple exons 4, 5, and 10 of the RHD gene and targeting an SRY gene sequence. These were compared to the D phenotypes determined in the 581 babies they delivered. RESULTS By combining amplification of three exons, the concordance rate of fetal RHD genotypes in maternal plasma and newborn D phenotypes at delivery was 100 percent (99.8% including one unusual false-positive). The presence of nonfunctional RHD genes and the absence of a universal fetal marker, irrespective of fetal sex, did not influence the accuracy of fetal RhD status prediction. The RHD genotyping from 18 twin pregnancies was also assessed. Five weak D women were excluded from the RHD fetal genotyping prediction. Three discrepant results (0.5%) between predicted fetal genotype and cord blood phenotype were not confirmed by the baby phenotypes from venipuncture blood. CONCLUSION Prenatal prediction of fetal RHD by targeting multiple exons from the maternal plasma with real-time PCR is highly sensitive and accurate. Over 4 years, this experience has highly modified our management of D- pregnant women.
Collapse
Affiliation(s)
- Jean-Marc Minon
- Department of Laboratory Medicine, the University Department of Fetal Medicine, Centre Hospitalier Régional de la Citadelle, Liège, Belgium.
| | | | | | | | | |
Collapse
|
48
|
Abstract
Fetal anaemia can by treated by in-utero therapy, which results in a significant improvement in perinatal outcome. The important causes of fetal anaemia are rhesus alloimmunisation, kell alloimmunisation and parvovirus infection. At-risk pregnancies require serial monitoring to ensure timely intervention with intrauterine transfusion. Non-invasive testing with middle cerebral artery Doppler is becoming the monitoring modality of choice.
Collapse
|
49
|
Gooch A, Parker J, Wray J, Qureshi H. Guideline for blood grouping and antibody testing in pregnancy. Transfus Med 2007; 17:252-62. [PMID: 17680951 DOI: 10.1111/j.1365-3148.2007.00767.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
50
|
Avent ND, Martinez A, Flegel WA, Olsson ML, Scott ML, Nogués N, Písăcka M, Daniels G, van der Schoot E, Muñiz-Diaz E, Madgett TE, Storry JR, Beiboer SH, Maaskant-van Wijk PA, von Zabern I, Jiménez E, Tejedor D, López M, Camacho E, Cheroutre G, Hacker A, Jinoch P, Svobodova I, de Haas M. The BloodGen project: toward mass-scale comprehensive genotyping of blood donors in the European Union and beyond. Transfusion 2007; 47:40S-6S. [PMID: 17593285 DOI: 10.1111/j.1537-2995.2007.01309.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Neil D Avent
- Center for Research in Biomedicine and Bristol Genomics Research Institute, Faculty of Applied Sciences, University of the West of England, and Bristol Institute for Transfusion Sciences, Bristol, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|