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Leiva-Torres GA, Cigna M, Constanzo-Yanez J, St-Louis M, Perreault J, Lavoie J, Laflamme G, Lewin A, Pastore Y, Robitaille N. Transfusing children with sickle cell disease using blood group genotyping when the pool of Black donors is limited. Transfusion 2024; 64:716-726. [PMID: 38497419 DOI: 10.1111/trf.17778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 01/19/2024] [Accepted: 02/26/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Red blood cell transfusion is an effective treatment for patients with sickle cell disease (SCD). Alloimmunization can occur after a single transfusion, limiting further usage of blood transfusion. It is recommended to match for the ABO, D, C, E, and K antigens to reduce risks of alloimmunization. However, availability of compatible blood units can be challenging for blood providers with a limited number of Black donors. STUDY DESIGN AND METHODS A prospective cohort of 205 pediatric patients with SCD was genotyped for the RH and FY genes. Transfusion and alloimmunization history were collected. Our capacity to find RhCE-matched donors was evaluated using a database of genotyped donors. RESULTS Nearly 9.8% of patients carried a partial D variant and 5.9% were D-. Only 45.9% of RHCE alleles were normal, with the majority of variants affecting the RH5 (e) antigen. We found an alloimmunization prevalence of 20.7% and a Rh alloimmunization prevalence of 7.1%. Since Black donors represented only 1.40% of all blood donors in our province, D- Caucasian donors were mostly used to provide phenotype matched products. Compatible blood for patients with rare Rh variants was found only in Black donors. A donor with compatible RhCE could be identified for all patients. CONCLUSION Although Rh-compatible donors were identified, blood units might not be available when needed and/or the extended phenotype or ABO group might not match the patient. A greater effort has to be made for the recruitment of Black donors to accommodate patients with SCD.
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Affiliation(s)
| | - Maude Cigna
- Division of Hematology-Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, Canada
| | | | | | | | - Josée Lavoie
- Hema-Quebec, Medical Affairs and Innovation, Quebec, Canada
| | | | - Antoine Lewin
- Hema-Quebec, Medical Affairs and Innovation, Quebec, Canada
- Faculty of Medicine and Health Science, Sherbrooke University, Sherbrooke, Canada
| | - Yves Pastore
- Division of Hematology-Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, Canada
| | - Nancy Robitaille
- Hema-Quebec, Transfusion Medicine, Montreal, Canada
- Division of Hematology-Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, Canada
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Probabilistic mathematical modelling to predict the red cell phenotyped donor panel size. PLoS One 2022; 17:e0276780. [PMID: 36367895 PMCID: PMC9651592 DOI: 10.1371/journal.pone.0276780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/13/2022] [Indexed: 11/13/2022] Open
Abstract
In the last decade, Australia has experienced an overall decline in red cell demand, but there has been an increased need for phenotyped matched red cells. Lifeblood and mathematicians from Queensland universities have developed a probabilistic model to determine the percentage of the donor panel that would need extended antigen typing to meet this increasing demand, and an estimated timeline to achieve the optimum required phenotyped (genotyped) panel. Mathematical modelling, based on Multinomial distributions, was used to provide guidance on the percentage of typed donor panel needed, based on recent historical blood request data and the current donor panel size. Only antigen combinations determined to be uncommon, but not rare, were considered. Simulations were run to attain at least 95% success percentage. Modelling predicted a target of 38% of the donor panel, or 205,000 donors, would need to be genotyped to meet the current demand. If 5% of weekly returning donors were genotyped, this target would be reached within 12 years. For phenotyping, 35% or 188,000 donors would need to be phenotyped to meet Lifeblood’s demand. With the current level of testing, this would take eight years but could be performed within three years if testing was increased to 9% of weekly returning donors. An additional 26,140 returning donors need to be phenotyped annually to maintain this panel. This mathematical model will inform business decisions and assist Lifeblood in determining the level of investment required to meet the desired timeline to achieve the optimum donor panel size.
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Trépanier P, Chevrier MC, Constanzo Yanez J, Baillargeon N, St-Pierre C, Perreault J. Adapting to supply-and-demand emerging trends for antigen-negative red blood cell units. Transfusion 2021; 61:1489-1494. [PMID: 33515215 DOI: 10.1111/trf.16285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND A global downtrend in blood usage has been observed by many countries, while the demand for antigen-negative red blood cell (RBC) units used in antigen-matched transfusions keeps increasing. The declining number of units collected exposes blood providers to a rapidly evolving supply challenge. METHODS This study was conducted retrospectively with use of internal data analysis to weigh Québec's situation regarding global and antigen-negative RBC demand, to measure the effects of community-directed recruitment and blood drives, and to evaluate the benefits of mass-scale RBC genotyping. RESULTS Our findings confirm a global RBC usage downtrend of over 20% total in the past 10 years with a steady antigen-negative usage and highlight the most requested negative antigen combinations. Our data also show our +39.5% progress regarding the number of Black donors recruited for antigen matching of patients with sickle cell disease in the past 3 years, as well as a constantly growing number of just-in-time blood collection for complex orders. Finally, our data summarize the efficiency of our mass-scale RBC genotyping efforts. CONCLUSION Altogether, this study confirms the demand trends for regular and antigen-negative RBC units in Québec and the efficient effects of our recruitment and typing strategies.
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Affiliation(s)
- Patrick Trépanier
- Héma-Québec, Medical Affairs and Innovation, Québec City, Québec, Canada
| | | | | | | | - Christine St-Pierre
- Héma-Québec, Customer Experience and Business Intelligence, St-Laurent, Québec, Canada
| | - Josée Perreault
- Héma-Québec, Medical Affairs and Innovation, Québec City, Québec, Canada
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4
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Denomme GA, Anani WQ. Mass‐scale red cell genotyping of blood donors: from data visualization to historical antigen labeling and donor recruitment. Transfusion 2019; 59:2768-2770. [DOI: 10.1111/trf.15419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/06/2019] [Accepted: 06/03/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Gregory A. Denomme
- Diagnostic LaboratoriesVersiti Wisconsin Milwaukee Wisconsin
- Blood Research InstituteVersiti Wisconsin Wauwatosa Wisconsin
| | - Waseem Q. Anani
- Diagnostic LaboratoriesVersiti Wisconsin Milwaukee Wisconsin
- Blood Research InstituteVersiti Wisconsin Wauwatosa Wisconsin
- Department of PathologyMedical College of Wisconsin Milwaukee Wisconsin
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Wagner FF, Doescher A, Bittner R, Müller TH. Extended Donor Typing by Pooled Capillary Electrophoresis: Impact in a Routine Setting. Transfus Med Hemother 2018; 45:225-237. [PMID: 30283272 DOI: 10.1159/000490155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/11/2018] [Indexed: 01/15/2023] Open
Abstract
Background PCR with sequence-specific priming using allele-specific fluorescent primers and analysis on a capillary sequencer is a standard technique for DNA typing. We aimed to adapt this method for donor typing in a medium-throughput setting. Methods Using the Extract-N-Amp PCR system, we devised a set of eight multiplex allele-specific PCR with fluorescent primers for Fya/Fyb, Jka/Jkb, M/N, and S/s. The alleles of a gene were discriminated by the fluorescent color; donor and polymorphism investigated were encoded by product length. Time, cost, and routine performance were collated. Discrepant samples were investigated by sequencing. The association of new alleles with the phenotype was evaluated by a step-wise statistical analysis. Results On validation using 312 samples, for 1.1% of antigens (in 5.4% of samples) no prediction was obtained. 99.96% of predictions were correct. Consumable cost per donor were below EUR 2.00. In routine use, 92.2% of samples were successfully predicted. Discrepancies were most frequently due to technical reasons. A total of 11 previously unknown alleles were detected in the Kell, Lutheran, and Colton blood group systems. In 2017, more than 20% of the RBC units prepared by our institution were from donors with predicted antigen status. A steady supply of Yt(a-), Co(a-) and Lu(b-) RBC units was ensured. Conclusions Pooled capillary electrophoresis offers a suitable alternative to other methods for extended donor DNA typing. Establishing a large cohort of typed donors improved transfusion support for patients.
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Affiliation(s)
- Franz F Wagner
- DRK Blutspendedienst NSTOB, Institute Springe, Springe, Germany
| | - Andrea Doescher
- DRK Blutspendedienst NSTOB, Institute Oldenburg, Oldenburg, Germany
| | - Rita Bittner
- DRK Blutspendedienst NSTOB, Institute Springe, Springe, Germany
| | - Thomas H Müller
- DRK Blutspendedienst NSTOB, Institute Springe, Springe, Germany
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Chen DP, Wen YH, Lu JJ, Tseng CP, Wang WT. Rapid rare ABO blood typing using a single PCR based on a multiplex SNaPshot reaction. J Formos Med Assoc 2018; 118:395-400. [PMID: 29970336 DOI: 10.1016/j.jfma.2018.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/06/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND ABO subgroups would be considered when discrepancies in ABO grouping occur. Serological methods including adsorption-elution test, salivary ABH inhibition test, and anti-A1 (lectin) saline method could be used. However, these serological methods are laboring and obscure. Therefore, reliable and affordable method to assess the ABO subgroups is of particular interest. METHODS To solve this problem, the multiplex SNaPshot-based assays were designed to determine rare A and B subgroups. Primers used as probes for determination of rare ABO blood groups known in Taiwanese population were designed. Many ABO subtype samples were used to validate the accuracy and reproducibility of our SNaPshot panel. RESULTS A panel of primer probes were successfully designed in determining 8 SNP sites (261, 539, 838, 820, 745, 664, IVS6 +5, and 829 in exon 6 and 7) for A phenotype and 6 SNP sites (261, 796, IVS3 +5, 247, 523, and 502 in exon 2, 6 and 7 and intron 3) for B phenotype. SNaPshot analysis for defining blood group A alleles (A1, A2, A3, Am and Ael) and blood group B alleles (B1, B3, Bw and Bel) was therefore available. CONCLUSION SNaPshot analysis could be used in reference laboratories for typing known rare subgroups of A and B without DNA cloning and traditional sequencing. Moreover, this method would help to construct databases of genotyped blood donors, and it potentially plays a role in determining fetal-maternal ABO incompatibility.
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Affiliation(s)
- Ding-Ping Chen
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ying-Hao Wen
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jang-Jih Lu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Ping Tseng
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Ting Wang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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7
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Jongruamklang P, Gassner C, Meyer S, Kummasook A, Darlison M, Boonlum C, Chanta S, Frey BM, Olsson ML, Storry JR. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis of 36 blood group alleles among 396 Thai samples reveals region-specific variants. Transfusion 2018; 58:1752-1762. [PMID: 29656499 DOI: 10.1111/trf.14624] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/24/2018] [Accepted: 02/26/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Blood group phenotype variation has been attributed to potential resistance to pathogen invasion. Variation was mapped in blood donors from Lampang (northern region) and Saraburi (central region), Thailand, where malaria is endemic. The previously unknown blood group allele profiles were characterized and the data were correlated with phenotypes. The high incidence of the Vel-negative phenotype previously reported in Thais was investigated. STUDY DESIGN AND METHODS DNA from 396 blood donors was analyzed by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry. Outliers were investigated by serology and DNA sequencing. Allele discrimination assays for SMIM1 rs1175550A/G and ACKR1 rs118062001C/T were performed and correlated with antigen expression. RESULTS All samples were phenotyped for Rh, MNS, and K. Genotyping/phenotyping for RhD, K, and S/s showed 100% concordance. Investigation of three RHCE outliers revealed an e-variant antigen encoded by RHCE*02.22. Screening for rs147357308 (RHCE c.667T) revealed a frequency of 3.3%. MN typing discrepancies in 41 samples revealed glycophorin variants, of which 40 of 41 were due to Mia . Nine samples (2.3%) were heterozygous for FY*01W.01 (c.265C > T), and six samples (1.5%) were heterozygous for JK*02N.01. All samples were wildtype SMIM1 homozygotes with 97% homozygosity for rs1175550A. CONCLUSIONS Matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry is an efficient method for rapid routine genotyping and investigation of outliers identified novel variation among our samples. The expected high prevalence of the Mi(a+) phenotype was observed from both regions. Of potential clinical relevance in a region where transfusion-dependent thalassemia is common, we identified two RHCE*02 alleles known to encode an e-variant antigen.
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Affiliation(s)
- Philaiphon Jongruamklang
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Christoph Gassner
- Molecular Diagnostics & Research (MOC), Blood Transfusion Service Zürich, Zürich-Schlieren, Switzerland
| | - Stefan Meyer
- Molecular Diagnostics & Research (MOC), Blood Transfusion Service Zürich, Zürich-Schlieren, Switzerland
| | - Aksarakorn Kummasook
- Department of Medical Technology, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
| | - Marion Darlison
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Chayanun Boonlum
- Transfusion Medicine, Department of Medical Technology and Clinical Laboratory, Saraburi Hospital, Saraburi, Thailand
| | - Surin Chanta
- Transfusion Medicine, Department of Medical Technology and Clinical Laboratory, Lampang Hospital, Lampang, Thailand
| | - Beat M Frey
- Molecular Diagnostics & Research (MOC), Blood Transfusion Service Zürich, Zürich-Schlieren, Switzerland
| | - Martin L Olsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.,Clinical Immunology and Transfusion Medicine, Laboratory Medicine, Office of Medical Services, Lund, Sweden
| | - Jill R Storry
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.,Clinical Immunology and Transfusion Medicine, Laboratory Medicine, Office of Medical Services, Lund, Sweden
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8
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Gorakshakar A, Gogri H, Ghosh K. Evolution of technology for molecular genotyping in blood group systems. Indian J Med Res 2018; 146:305-315. [PMID: 29355136 PMCID: PMC5793464 DOI: 10.4103/ijmr.ijmr_914_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The molecular basis of the blood group antigens was identified first in the 1980s and 1990s. Since then the importance of molecular biology in transfusion medicine has been described extensively by several investigators. Molecular genotyping of blood group antigens is one of the important aspects and is successfully making its way into transfusion medicine. Low-, medium- and high-throughput techniques have been developed for this purpose. Depending on the requirement of the centre like screening for high- or low-prevalence antigens where antisera are not available, correct typing of multiple transfused patients, screening for antigen-negative donor units to reduce the rate of alloimmunization, etc. a suitable technique can be selected. The present review discusses the evolution of different techniques to detect molecular genotypes of blood group systems and how these approaches can be used in transfusion medicine where haemagglutination is of limited value. Currently, this technology is being used in only a few blood banks in India. Hence, there is a need for understanding this technology with all its variations.
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Affiliation(s)
- Ajit Gorakshakar
- Department of Transfusion Medicine, ICMR- National Institute of Immunohaematology, Mumbai, India
| | - Harita Gogri
- Department of Transfusion Medicine, ICMR- National Institute of Immunohaematology, Mumbai, India
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9
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Wagner FF, Flegel WA, Bittner R, Döscher A. Molecular typing for blood group antigens within 40 min by direct polymerase chain reaction from plasma or serum. Br J Haematol 2016; 176:814-821. [PMID: 27991657 DOI: 10.1111/bjh.14469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/05/2016] [Indexed: 01/15/2023]
Abstract
Determining blood group antigens by serological methods may be unreliable in certain situations, such as in patients after chronic or massive transfusion. Red cell genotyping offers a complementary approach, but current methods may take much longer than conventional serological typing, limiting their utility in urgent situations. To narrow this gap, we devised a rapid method using direct polymerase chain reaction (PCR) amplification while avoiding the DNA extraction step. DNA was amplified by PCR directly from plasma or serum of blood donors followed by a melting curve analysis in a capillary rapid-cycle PCR assay. We evaluated the single nucleotide polymorphisms underlying the clinically relevant Fya , Fyb , Jka and Jkb antigens, with our analysis being completed within 40 min of receiving a plasma or serum sample. The positive predictive value was 100% and the negative predictive value at least 84%. Direct PCR with melting point analysis allowed faster red cell genotyping to predict blood group antigens than any previous molecular method. Our assay may be used as a screening tool with subsequent confirmatory testing, within the limitations of the false-negative rate. With fast turnaround times, the rapid-cycle PCR assay may eventually be developed and applied to red cell genotyping in the hospital setting.
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Affiliation(s)
- Franz F Wagner
- DRK Blutspendedienst NSTOB, Institute Springe, Springe, Germany
| | - Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Rita Bittner
- DRK Blutspendedienst NSTOB, Institute Springe, Springe, Germany
| | - Andrea Döscher
- DRK Blutspendedienst NSTOB, Institute Bremen-Oldenburg, Oldenburg, Germany
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10
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Evaluation of red blood cell and platelet antigen genotyping platforms (ID CORE XT/ID HPA XT) in routine clinical practice. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 14:160-7. [PMID: 26674823 DOI: 10.2450/2015.0124-15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/31/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND High-throughput genotyping platforms enable simultaneous analysis of multiple polymorphisms for blood group typing. BLOODchip® ID is a genotyping platform based on Luminex® xMAP technology for simultaneous determination of 37 red blood cell (RBC) antigens (ID CORE XT) and 18 human platelet antigens (HPA) (ID HPA XT) using the BIDS XT software. MATERIALS AND METHODS In this international multicentre study, the performance of ID CORE XT and ID HPA XT, using the centres' current genotyping methods as the reference for comparison, and the usability and practicality of these systems, were evaluated under working laboratory conditions. DNA was extracted from whole blood in EDTA with Qiagen methodologies. Ninety-six previously phenotyped/genotyped samples were processed per assay: 87 testing samples plus five positive controls and four negative controls. RESULTS Results were available for 519 samples: 258 with ID CORE XT and 261 with ID HPA XT. There were three "no calls" that were either caused by human error or resolved after repeating the test. Agreement between the tests and reference methods was 99.94% for ID CORE XT (9,540/9,546 antigens determined) and 100% for ID HPA XT (all 4,698 alleles determined). There were six discrepancies in antigen results in five RBC samples, four of which (in VS, N, S and Do(a)) could not be investigated due to lack of sufficient sample to perform additional tests and two of which (in S and C) were resolved in favour of ID CORE XT (100% accuracy). The total hands-on time was 28-41 minutes for a batch of 16 samples. Compared with the reference platforms, ID CORE XT and ID HPA XT were considered simpler to use and had shorter processing times. DISCUSSION ID CORE XT and ID HPA XT genotyping platforms for RBC and platelet systems were accurate and user-friendly in working laboratory settings.
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11
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Affiliation(s)
- T. Peyrard
- Département Centre National de Référence pour les Groupes Sanguins; Institut National de la Transfusion Sanguine (INTS); Paris France
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12
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Silvy M, Brès JC, Grimaldi A, Movia C, Muriel V, Roubinet F, Chiaroni J, Bailly P. A simple genotyping procedure without DNA extraction to identify rare blood donors. Vox Sang 2015; 109:173-80. [PMID: 25854538 DOI: 10.1111/vox.12261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/14/2015] [Accepted: 01/19/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transfusion-induced alloimmunization has severe clinical consequences including haemolytic transfusion reactions, impaired transfused RBCs longevity and greater difficulty in finding compatible blood. Molecular analysis of genomic DNA now permits prediction of blood group phenotypes based on identification of single nucleotide polymorphisms. Implementation of molecular technologies in donor centres would be helpful in finding RBC units for special patient populations, but DNA extraction remains an obstacle to donor genotyping. MATERIALS AND METHODS We propose a simple method compatible with high throughput that allows blood group genotyping using a multiplex commercial kit without the need for DNA extraction. The principle relies on pre-PCR treatment of whole blood using heating/cooling procedure in association with a recombinant hotstart polymerase. RESULTS In a prospective analysis, we yielded 5628 alleles identification and designated 63 donors with rare blood, that is either negative for a high-frequency antigen or with a rare combination of common antigens. CONCLUSION The procedure was optimized for simplicity of use in genotyping platform and would allow not only to supply antigen-matched products to recipients but also to find rare phenotypes. This methodology could also be useful for establishing a donor repository for human platelet antigens (HPA)-matched platelets since the same issues are involved for patients with neonatal alloimmune thrombocytopenia or post-transfusion purpura.
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Affiliation(s)
- M Silvy
- Établissement Français du Sang, Blood Cell Grand Sud, Montpellier-Marseille, France.,UMR 7268 ADÉS Aix-Marseille Université-EFS-CNRS, Marseille, France
| | - J-C Brès
- Établissement Français du Sang, Blood Cell Grand Sud, Montpellier-Marseille, France
| | - A Grimaldi
- UMR 7268 ADÉS Aix-Marseille Université-EFS-CNRS, Marseille, France
| | - C Movia
- UMR 7268 ADÉS Aix-Marseille Université-EFS-CNRS, Marseille, France
| | - V Muriel
- UMR 7268 ADÉS Aix-Marseille Université-EFS-CNRS, Marseille, France
| | - F Roubinet
- Établissement Français du Sang, Blood Cell Grand Sud, Montpellier-Marseille, France
| | - J Chiaroni
- Établissement Français du Sang, Blood Cell Grand Sud, Montpellier-Marseille, France.,UMR 7268 ADÉS Aix-Marseille Université-EFS-CNRS, Marseille, France
| | - P Bailly
- Établissement Français du Sang, Blood Cell Grand Sud, Montpellier-Marseille, France.,UMR 7268 ADÉS Aix-Marseille Université-EFS-CNRS, Marseille, France
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13
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Paris S, Rigal D, Barlet V, Verdier M, Coudurier N, Bailly P, Brès JC. Flexible automated platform for blood group genotyping on DNA microarrays. J Mol Diagn 2014; 16:335-42. [PMID: 24726279 DOI: 10.1016/j.jmoldx.2014.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 02/06/2014] [Accepted: 02/12/2014] [Indexed: 11/17/2022] Open
Abstract
The poor suitability of standard hemagglutination-based assay techniques for large-scale automated screening of red blood cell antigens severely limits the ability of blood banks to supply extensively phenotype-matched blood. With better understanding of the molecular basis of blood antigens, it is now possible to predict blood group phenotype by identifying single-nucleotide polymorphisms in genomic DNA. Development of DNA-typing assays for antigen screening in blood donation qualification laboratories promises to enable blood banks to provide optimally matched donations. We have designed an automated genotyping system using 96-well DNA microarrays for blood donation screening and a first panel of eight single-nucleotide polymorphisms to identify 16 alleles in four blood group systems (KEL, KIDD, DUFFY, and MNS). Our aim was to evaluate this system on 960 blood donor samples with known phenotype. Study data revealed a high concordance rate (99.92%; 95% CI, 99.77%-99.97%) between predicted and serologic phenotypes. These findings demonstrate that our assay using a simple protocol allows accurate, relatively low-cost phenotype prediction at the DNA level. This system could easily be configured with other blood group markers for identification of donors with rare blood types or blood units for IH panels or antigens from other systems.
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Affiliation(s)
- Sandra Paris
- Établissement Français du Sang Rhône Alpes, Lyon, France
| | | | - Valérie Barlet
- Établissement Français du Sang Rhône Alpes, Lyon, France
| | | | | | - Pascal Bailly
- Établissement Français du Sang Alpes Méditerranée, Marseille, France
| | - Jean-Charles Brès
- Établissement Français du Sang Rhône Alpes, Lyon, France; Établissement Français du Sang Pyrénées Méditerranée, Montpellier, France.
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15
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Abstract
Blood group genotyping has many advantages over conventional phenotyping for both blood donors and patients, and a number of high-throughput methods have now been developed. However, these are limited by a requirement for existing knowledge of the relevant blood group gene polymorphisms, and rare or novel mutations will not be detected. These mutations could be successfully identified by DNA sequencing of the blood group genes, and such an approach has been made feasible by the introduction of Next Generation Sequencing (NGS) technology. NGS enables many genes from multiple samples to be sequenced in parallel, resulting in sequencing information that could be used to obtain accurate blood group phenotype predictions in both blood donors and patients.
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Affiliation(s)
- Louise Tilley
- International Blood Group Reference Laboratory, NHS Blood and Transplant, Bristol, UK.
| | - Shane Grimsley
- International Blood Group Reference Laboratory, NHS Blood and Transplant, Bristol, UK
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16
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Applying molecular immunohaematology to regularly transfused thalassaemic patients in Thailand. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12:28-35. [PMID: 24120606 DOI: 10.2450/2013.0058-13] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 04/18/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Red blood cell transfusion is the principal therapy in patients with severe thalassaemias and haemoglobinopathies, which are prevalent in Thailand. Serological red blood cell typing is confounded by chronic transfusion, because of circulating donor red blood cells. We evaluated the concordance of serological phenotypes between a routine and a reference laboratory and with red cell genotyping. MATERIALS AND METHODS Ten consecutive Thai patients with β-thalassemia major who received regular transfusions were enrolled in Thailand. Phenotypes were tested serologically at Songklanagarind Hospital and at the National Institutes of Health. Red blood cell genotyping was performed with commercially available kits and a platform. RESULTS In only three patients was the red cell genotyping concordant with the serological phenotypes for five antithetical antigen pairs in four blood group systems at the two institutions. At the National Institutes of Health, 32 of the 100 serological tests yielded invalid or discrepant results. The positive predictive value of serology did not reach 1 for any blood group system at either of the two institutions in this set of ten patients. DISCUSSION Within this small study, numerous discrepancies were observed between serological phenotypes at the two institutes; red cell genotyping enabled determination of the blood group when serology failed due to transfused red blood cells. We question the utility of serological tests in regularly transfused paediatric patients and propose relying solely on red cell genotyping, which requires training for laboratory personnel and physicians. Red cell genotyping outperformed red cell serology by an order of magnitude in regularly transfused patients.
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DNA biosensor/biochip for multiplex blood group genotyping. Methods 2013; 64:241-9. [PMID: 24080420 DOI: 10.1016/j.ymeth.2013.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/12/2013] [Accepted: 09/17/2013] [Indexed: 11/20/2022] Open
Abstract
At present, 33 blood groups representing over 300 antigens are listed by the International Society of Blood Transfusion (ISBT). Most of them result from a single nucleotide polymorphism (SNP) in the corresponding DNA sequence, i.e. approx. 200 SNPs. In immunohematology laboratories, blood group determination is classically carried out by serological tests, but these have some limitations, mostly in term of multiplexing and throughput. Yet, there is a growing need of extended blood group typing to prevent alloimmunization in transfused patients and transfusion accidents. The knowledge of the molecular bases of blood groups allows the use of molecular biology methods within immunohematology laboratories. Numerous assays focused on blood group genotyping were developed and described during the last 10 years. Some of them were real biochips or biosensors while others were more characterized by the particular molecular biology techniques they used, but all were intending to produce multiplex analysis. PCR techniques are most of the time used followed by an analytical step involving a DNA biosensor, biochip or analysis system (capillary electrophoresis, mass spectrometry). According to the method used, the test can then be classified as low-, medium- or high-throughput. There are several companies which developed platforms dedicated to blood group genotyping able to analyze simultaneously various SNPs or variants associated with blood group systems. This review summarizes the characteristics of each molecular biology method and medium-/high-throughput platforms dedicated to the blood group genotyping.
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Abstract
Blood group genotyping is gaining widespread adoption in blood centres and transfusion services. The current interest for a blood centre is its use as a screening tool to accurately predict donor phenotypes. However, not only is blood group genotyping used to screen for uncommon and rare types on a mass-scale, it can be used to optimize the inventory of multiple antigen-negative screened units. In addition, blood group genotyping provides blood types when antisera are not available, it can predict weak and variant antigens, and can aid in the resolution of ABO discrepancies. There are quality improvement benefits in blood group genotyping because it can screen for RHD alleles in Rh-negative blood donors and can be used to confirm that donors are suitable for reagent red cell production. It is possible that blood group genotyping information may be used as a donor recruitment tool. Given that genotyping can convey much more information about the expression of some complex antigens, e.g. hrB, Uvar, and Duffy, clinical trials are probably needed to show that genotyped or 'dry matched' transfusions are superior to phenotyped blood.
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Affiliation(s)
- Gregory A Denomme
- Diagnostic Laboratories, BloodCenter of Wisconsin, Milwaukee, WI, USA
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Flegel WA. ABO genotyping: the quest for clinical applications. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11:6-9. [PMID: 23245718 PMCID: PMC3557469 DOI: 10.2450/2012.0250-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 11/14/2012] [Indexed: 11/21/2022]
Affiliation(s)
- Willy A. Flegel
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States of America
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Boyle J, Thorpe SJ, Hawkins JR, Lockie C, Fox B, Matejtschuk P, Halls C, Metcalfe P, Rigsby P, Armstrong-Fisher S, Varzi AM, Urbaniak S, Daniels G. International reference reagents to standardise blood group genotyping: evaluation of candidate preparations in an international collaborative study. Vox Sang 2012; 104:144-52. [DOI: 10.1111/j.1423-0410.2012.01641.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Alternative blood products and clinical needs in transfusion medicine. Stem Cells Int 2012; 2012:639561. [PMID: 22567025 PMCID: PMC3337502 DOI: 10.1155/2012/639561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 12/30/2011] [Indexed: 01/19/2023] Open
Abstract
The primary focus of national blood programs is the provision of a safe and adequate blood supply. This goal is dependent on regular voluntary donations and a regulatory infrastructure that establishes and enforces standards for blood safety. Progress in ex vivo expansion of blood cells from cell sources including peripheral blood, cord blood, induced pluripotent stem cells, and human embryonic stem cell lines will likely make alternative transfusion products available for clinical use in the near future. Initially, alloimmunized patients and individuals with rare blood types are most likely to benefit from alternative products. However, in developed nations voluntary blood donations are projected to be inadequate in the future as blood usage by individuals 60 years and older increases. In developing nations economic and political challenges may impede progress in attaining self-sufficiency. Under these circumstances, ex vivo generated red cells may be needed to supplement the general blood supply.
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Jungbauer C, Hobel CM, Schwartz DWM, Mayr WR. High-throughput multiplex PCR genotyping for 35 red blood cell antigens in blood donors. Vox Sang 2011; 102:234-42. [PMID: 22098427 DOI: 10.1111/j.1423-0410.2011.01542.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES One to two per cent of patients in need of red cell transfusion carry irregular antibodies to red blood cell (RBC) antigens and have to be supplied with specially selected blood units. To be able to respond to those requests, blood centres have to screen a significant number of donors for a variety of antigens serologically, which is a costly and through the shortage of reagents, also limited procedure. To make this procedure more efficient, the Austrian Red Cross has developed a genotyping assay as an alternative approach for high throughput RBC typing. MATERIALS AND METHODS A multiplex polymerase chain reaction (PCR) assay was designed for typing 35 RBC antigens in six reaction mixes. The assay includes both common as well as high-frequency-alleles: MNS1, MNS2, MNS3 and MNS4; LU1, LU2, LU8 and LU14; KEL1, KEL2, KEL3, KEL4, KEL6, KEL7, KEL11, KEL17 and KEL21; FY1, FY2, FYB(WK) and FY0 (FYB(ES)); JK1 and JK2; DI1, DI2, DI3 and DI4; YT1 and YT2; DO1 and DO2; CO1 and CO2; IN1 and IN2. The assay was validated using 370 selected serologically typed samples. Subsequently 6000 individuals were screened to identify high frequency antigen (HFA)-negative donors and to facilitate the search for compatible blood for alloimmunized patients. RESULTS All controls showed complete concordance for the tested markers. The screening of 6000 donors revealed 57 new HFA-negative donors and the blood group database was extended by approximately 210,000 results. CONCLUSION The study shows that in practice, this high-throughput genotyping assay is feasible, fast and provides reliable results. Compared to serological testing, this molecular approach is also very cost-efficient.
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Affiliation(s)
- C Jungbauer
- Vienna Blood Centre, Blood Service, Austrian Red Cross, Vienna, Austria.
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Abstract
During the last decade a number of blood establishments started using molecular methods for typing a subset of their blood donors for minor red cell antigens as a part of their routine work. It can be expected that this development will continue and that DNA testing will take a significant role in future. A sufficient number of antigen-typing in the donor-database allows for the efficient supply of red cell units for patients who carry irregular antibodies directed to red cell antigens. Therefore blood centres often operate antigen typing programs for a subset of their repeat donors. Large-scale donor typing programs are labour-intensive and costly. DNA testing is a feasible alternative to standard serological assays. The most important advantage is the easy access to a spectrum of hundreds of antigens independent of the availability of serological reagents. Besides, that there are both positive, but also less favourable aspects, which are related to the different particular methods and platforms available for molecular testing. Several of them enable medium- and high-throughput applications and some are more cost-efficient than serology.
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Affiliation(s)
- Christof Jungbauer
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna Blood Centre, Wiedner Hauptstraße 32, 1040 Vienna, Austria.
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Monteiro F, Tavares G, Ferreira M, Amorim A, Bastos P, Rocha C, Araújo F, Cunha-Ribeiro LM. Technologies involved in molecular blood group genotyping. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1751-2824.2011.01425.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abstract
Blood centers are able to recruit and process large numbers of blood donations to meet the demand for antigen-matched blood. However, there are limitations with the use of hemagglutination that can be circumvented with blood group genotyping. Antisera do not exist for several clinically important blood group antigens and many methods have been developed (direct hemagglutination, indirect antiglobulin-dependent, solid phase, or gel column). There is increasing interest to apply mass-scale red cell genotyping of blood donors to find rare (predicted) phenotypes, rare combinations of antigens and locus haplotypes, and to have access to information on the common clinically relevant blood group antigens. This review outlines technological advances, emerging algorithms, and the future of mass-scale red cell genotyping of blood donors.
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Affiliation(s)
- Gregory A Denomme
- Immunohematolgy Reference Laboratory, Blood Center of Wisconsin, 638 18th Street, Milwaukee, WI 53201-2178, United States.
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Identification of a novel A4GALT exon reveals the genetic basis of the P1/P2 histo-blood groups. Blood 2011; 117:678-87. [DOI: 10.1182/blood-2010-08-301333] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The A4GALT locus encodes a glycosyltransferase that synthesizes the terminal Galα1-4Gal of the Pk (Gb3/CD77) glycosphingolipid, important in transfusion medicine, obstetrics, and pathogen susceptibility. Critical nucleotide changes in A4GALT not only abolish Pk formation but also another Galα1-4Gal–defined antigen, P1, which belongs to the only blood group system for which the responsible locus remains undefined. Since known A4GALT polymorphisms do not explain the P1−Pk+ phenotype, P2, we set out to elucidate the genetic basis of P1/P2. Despite marked differences (P1 > P2) in A4GALT transcript levels in blood, luciferase experiments showed no difference between P1/P2-related promoter sequences. Investigation of A4GALT mRNA in cultured human bone marrow cells revealed novel transcripts containing only the noncoding exon 1 and a sequence (here termed exon 2a) from intron 1. These 5′-capped transcripts include poly-A tails and 3 polymorphic sites, one of which was P1/P2-specific among > 200 donors and opens a short reading frame in P2 alleles. We exploited these data to devise the first genotyping assays to predict P1 status. P1/P2 genotypes correlated with both transcript levels and P1/Pk expression on red cells. Thus, P1 zygosity partially explains the well-known interindividual variation in P1 strength. Future investigations need to focus on regulatory mechanisms underlying P1 synthesis.
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St-Louis M, Perreault J, Lavoie J, Émond J, St-Laurent J, Long A, Richard M. Génotypage de 21 000 donneurs de sang au Québec et analyse du RHD. Transfus Clin Biol 2010; 17:242-8. [DOI: 10.1016/j.tracli.2010.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 08/24/2010] [Indexed: 10/18/2022]
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Abstract
When one looks at the field of molecular pathology or transplantation, it is evident that molecular biology has made a positive impact on medicine. However, the progress in transfusion medicine has been slower and more cautious than in other areas of the clinical laboratory. To understand where the field may go in the next 10 years requires that the reader understand what technology is available now. Therefore, this article discusses the current state of the art for red-cell genotyping and newer, ever-evolving molecular technologies. Because it is impossible to present all of the molecular techniques and their variations in this article, the author selects a group of methodologies to review and speculates where the field of molecular immunohematology may be in 2020.
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Affiliation(s)
- Joann M Moulds
- Clinical Immunogenetics, LifeShare Blood Centers, 8910 Linwood Avenue, Shreveport, LA 71106, USA.
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31
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Abstract
Since the first issue of TRANSFUSION in 1961, there has been a tremendous expansion in not only the number of blood group antigens identified but also in our knowledge of their biochemical basis, function, and more recently, associated DNA changes. As certain techniques became available, our ability to discover and elucidate blood group antigens and appreciate their contribution to biology became possible. In particular, Western blotting, monoclonal antibodies, cloning, and polymerase chain reaction-based assays have led to an explosion of our knowledge base. The study of blood groups has had a significant effect on human genetics where they serve as useful markers in genetic linkage analyses. Indeed blood groups have provided several "firsts" in certain aspects of genetics. Blood group-null phenotypes, as natural human knockouts, have provided valuable insights into the importance of red blood cell membrane components. This review summarizes key aspects of the discovery of blood groups; the inconsistent terminology that has arisen; and the contribution of blood groups to genetics, safe transfusion, transplantation, evolution, and biology.
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Affiliation(s)
- Geoff Daniels
- Bristol Institute for Transfusion Sciences, Filton, Bristol, UK.
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Daniels G. The molecular genetics of blood group polymorphism. Hum Genet 2009; 126:729-42. [PMID: 19727826 DOI: 10.1007/s00439-009-0738-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 08/19/2009] [Indexed: 02/07/2023]
Abstract
Over 300 blood group specificities on red cells have been identified, many of which are polymorphic. The molecular mechanisms responsible for these polymorphisms are diverse, though many simply represent single nucleotide polymorphisms (SNPs). Other mechanisms include the following: gene deletion; single nucleotide deletion and sequence duplication, which introduce reading-frame shifts; nonsense mutation; intergenic recombination between closely linked genes, giving rise to hybrid genes and hybrid proteins; and a SNP in the promoter region of a blood group gene. Examples of these various genetic mechanisms are taken from the ABO, Rh, Kell, and Duffy blood group systems. Null phenotypes, in which no antigens of a blood group system are expressed, are not generally polymorphic, but provide good examples of the effect of inactivating mutations on blood group expression. As natural human 'knock-outs', null phenotypes provide useful clues to the functions of blood group antigens. Knowledge of the molecular backgrounds of blood group polymorphisms provides a means to predict blood group phenotypes from genomic DNA. This has two main applications in transfusion medicine: determination of foetal blood groups to assess whether the foetus is at risk from haemolytic disease and ascertainment of blood group phenotypes in multiply transfused, transfusion-dependent patients, where serological tests are precluded by the presence of donor red cells. Other applications are being developed for the future.
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Affiliation(s)
- Geoff Daniels
- Bristol Institute for Transfusion Sciences, NHS Blood and Transplant, Filton, Bristol, UK.
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Affiliation(s)
- Maryse St-Louis
- Recherche et développement, Héma-Québec, 1070, Avenue des Sciences-de-la-Vie, Québec (Québec), G1V 5C3 Canada
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