1
|
Hutchison CJ, Srivastava K, Polin H, Bueno MU, Flegel WA. Rh flow cytometry: An updated methodology for D antigen density applied to weak D types 164 and 165. Transfusion 2023; 63:2141-2151. [PMID: 37792462 PMCID: PMC10680490 DOI: 10.1111/trf.17543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND An original methodology for determining the D antigen density on red cells was published in 2000 and has been applied in many publications since. This flow cytometry-based assay remained largely unrevised utilizing monoclonal anti-Ds that are not readily available anymore. We updated the methodology to quantify erythrocyte D antigen sites using microspheres and monoclonal anti-Ds that are commercially available today. METHODS The absolute D antigen density of a frozen standard CcDEe cell, drawn in 2003, a fresh blood donation from the same individual, drawn in 2022, and an internal control CcDEe cell, was quantified by flow cytometry using fluorescence-labeled microspheres. The internal control CcDEe cell was used in conjunction with 9 commercial anti-Ds to determine D antigen densities of 7 normal D, 4 partial D, and 11 weak D type samples, including 2 novel alleles. RESULTS The reproducibility of the updated assay was evaluated with red cells of published D antigen densities. The current results matched the known ones closely. The new weak D types 164 and 165 carried 4500 and 1505 D antigens/red cell, respectively. The absolute D antigen density decreased from 27,231 to 26,037 in an individual over 19 years. DISCUSSION The updated assay gave highly reproducible results for the D antigen densities of Rh phenotypes. Readily available anti-Ds allowed for the determination of the D antigen densities of 7 weak D types. The assay is suitable to evaluate the effects of distinct amino acid substitutions on the RhD phenotype.
Collapse
Affiliation(s)
- Chloe Jayne Hutchison
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Helene Polin
- Department of Immunogenetics, Red Cross Transfusion Service for Upper Austria, Linz, Austria
| | - Marina Ursula Bueno
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
2
|
Yin Q. DEL variants: review of molecular mechanisms, clinical consequences and molecular testing strategy. Funct Integr Genomics 2023; 23:318. [PMID: 37840046 DOI: 10.1007/s10142-023-01249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
Patients with DEL phenotype, a D variant with a low number of D antigens per red blood cell, are routinely typed as RhD-negative in serology testing and are detectable only by adsorption and elution techniques or molecular methods. DEL is of clinical importance worldwide, as indicated by its genotype-phenotype discrepancies among different populations and its potential to cause anti-D alloimmunization when DEL phenotype individuals are inadvertently managed as RhD-negative. This narrative review summarized the DEL alleles causing DEL phenotype and the underlying mechanisms. The clinical consequences and current molecular testing approach were discussed to manage the transfusion needs of patients and donors with DEL phenotype.
Collapse
Affiliation(s)
- Qinan Yin
- Henan Engineering Research Center of Digital Pathology and Artificial Intelligence Diagnosis, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
- Precision Medicine Laboratory, School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China.
| |
Collapse
|
3
|
Uzuni A, Wlosinski L, Lopez-Plaza I. Updated Evaluation of RhD Status Among Women of Child-Bearing Age in Detroit, Michigan. Am J Clin Pathol 2021; 156:1000-1006. [PMID: 34050357 DOI: 10.1093/ajcp/aqab061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The Rh blood group system is one of the most important and immunogenic blood group systems after the ABO blood group system and, like other blood group antigens, it follows ethnic and racial trends. However, when it comes to D variants-partial D and weak D-most of the cohorts studied in the literature have been of European descent. This study aimed to discover the variant D trends in Detroit, Michigan, with an emphasis on Black communities. METHODS From 2016 to 2018, there were 102 patients (women of childbearing potential: < 50 years) at Henry Ford Hospital that had serologic D discrepant testing. These patients were sent out for molecular RHD determination. RESULTS In total, 12.7% of patients were characterized as RhD positive and 87.3% of patients were characterized as RhD variants (nominated as RhD negative at our institution). CONCLUSIONS Our predominantly Black cohort sheds light on the diversity of the RhD antigen. The majority of Blacks were classified as RhD variants (RhD negative nomination at our institution). Therefore, molecular testing for this patient population with serologic RhD discrepancies is paramount to properly manage their obstetric care.
Collapse
Affiliation(s)
- Ajna Uzuni
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Lindsey Wlosinski
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Ileana Lopez-Plaza
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|
4
|
Khetan D, Verma A, Chaudhary RK, Shukla JS. Molecular characterisation of RhD variants in North Indian blood donor population. Transfus Med 2020; 30:295-303. [PMID: 32488899 DOI: 10.1111/tme.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/01/2020] [Accepted: 05/10/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES A molecular analysis of serologically RhD variant samples was conducted to find the incidence of various D variants in our blood donor population. BACKGROUND Determining a blood donor's RhD phenotype and genotype is important as transfusion of units with a weak D or partial D phenotype can result in immunisation of the recipients. METHODS Samples with discrepant D and weak D phenotypes identified on testing with at least five different monoclonal anti-D antisera were considered serological RhD variant and subjected to molecular testing (Massarray kit, Agena Bioscience, San Diego) for variant RHD gene. RESULTS A total of 39 samples, including 19 RhD discrepant samples and 20 weak D samples, were identified as serological RhD variant from a total of 4386 samples. Thirteen (13/39) samples carried variants leading to weak D phenotype, and eight samples had variants leading to partial D categories. Seven samples (7) could not be characterised, whereas 11 samples were identified as Rh negative (RHD*01N.01) after molecular testing. Overall incidence of D variants in the study population was 0.48%. RHD*weak D type 1(5, 0.1%) and RHD*DFR1 (5, 1%) were the most common variants identified. CONCLUSIONS Few samples with weak reaction on serological testing were found to be partial D variant and vice versa. Donor centres should develop a protocol for genotyping of samples with aberrant results on serological testing for assessing the actual RhD status of an individual as results of serological testing may be misleading.
Collapse
Affiliation(s)
- Dheeraj Khetan
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anviti Verma
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajendra K Chaudhary
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Jai Shankar Shukla
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
5
|
Shih AW, Yan MTS, Elahie AL, Barty RL, Liu Y, Berardi P, Azzam M, Siddiqui R, Parvizian MK, Mcdougall T, Heddle NM, Al-Habsi KS, Goldman M, Cote J, Athale U, Verhovsek MM. Utilising red cell antigen genotyping and serological phenotyping in sickle cell disease patients to risk-stratify patients for alloimmunisation risk. Transfus Med 2020; 30:263-274. [PMID: 32432400 DOI: 10.1111/tme.12685] [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: 02/01/2020] [Revised: 03/23/2020] [Accepted: 04/25/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Alloimmunisation and haemolytic transfusion reactions (HTRs) can occur in patients with sickle cell disease (SCD) despite providing phenotype-matched red blood cell (RBC) transfusions. Variant RBC antigen gene alleles/polymorphisms can lead to discrepancies in serological phenotyping. We evaluated differences between RBC antigen genotyping and phenotyping methods and retrospectively assessed if partial antigen expression may lead to increased risk of alloimmunisation and HTRs in SCD patients at a tertiary centre in Canada. METHODS RBC antigen phenotyping and genotyping were performed by a reference laboratory on consenting SCD patients. Patient demographic, clinical and transfusion-related data were obtained from a local transfusion registry and chart review after research ethics board approval. RESULTS A total of 106 SCD patients were enrolled, and 91% (n = 96) showed additional clinically relevant genotyping information when compared to serological phenotyping alone. FY*02N.01 (FY*B GATA-1) (n = 95; 90%) and RH variant alleles (n = 52, 49%; majority accompanied by FY*02N.01) were common, the latter with putative partial antigen expression in 25 patients. Variability in genotype-phenotype antigen prediction occurred mostly in the Rh system, notably with the e antigen (kappa: 0.17). Fifteen (14.2%) patients had a history of alloimmunisation, with five having HTR documented; no differences in clinical outcomes were found in patients with partial antigen expression. Genotype/extended-phenotype matching strategies may have prevented alloimmunisation events. CONCLUSION We show a high frequency of variant alleles/polymorphisms in the SCD population, where genotyping may complement serological phenotyping. Genotyping SCD patients before transfusion may prevent alloimmunisation and HTRs, and knowledge of the FY*02N.01 variant allele increases feasibility of finding compatible blood.
Collapse
Affiliation(s)
- Andrew W Shih
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew T S Yan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Medical Services and Hospital Relations, Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Allahna L Elahie
- Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca L Barty
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Yang Liu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Philip Berardi
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Mona Azzam
- Department of Pediatrics, Suez Canal University, Ismailia, Egypt
| | - Reda Siddiqui
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael K Parvizian
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Tara Mcdougall
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nancy M Heddle
- Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Centre for Innovation, Canadian Blood Services, Hamilton, Ontario, Canada
| | - Khalid S Al-Habsi
- Department of Blood Banks Services, Directorate General of Specialized Medical Care, Ministry of Health, Muscat, Oman
| | - Mindy Goldman
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Jacqueline Cote
- National Immunohematology Reference Laboratory, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Uma Athale
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Madeleine M Verhovsek
- Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
6
|
Koutsouri T, Chaiκali A, Giannopoulos A, Douramani P, Flesiopoulou I, Panos P, Tsantes A, Zoi K, Gialeraki A, Valsami S, Stamoulis K, Politou M. Frequency distribution of RHD alleles among Greek donors with weak D phenotypes demonstrates a distinct pattern in central European countries. Transfus Med 2019; 29:468-470. [DOI: 10.1111/tme.12623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 07/01/2019] [Accepted: 07/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- T. Koutsouri
- Haematology Laboratory‐Blood BankNational and Kapodistrian University of Athens, Aretaieion Hospital Athens Greece
| | | | - A. Giannopoulos
- Biomedical Research Foundation, Academy of Athens, IIBEAA Athens Athens
| | - P. Douramani
- Hematology Laboratory‐Blood BankNational and Kapodistrian University of Athens, Attiko Hospital Athens Greece
| | - I. Flesiopoulou
- Hematology Laboratory‐Blood BankGeneral Hospital of Peiraia‐Nikaia Athens Greece
| | - P. Panos
- National Blood Center, EKEA Athens Athens
| | - A. Tsantes
- Hematology Laboratory‐Blood BankNational and Kapodistrian University of Athens, Attiko Hospital Athens Greece
| | - K. Zoi
- Biomedical Research Foundation, Academy of Athens, IIBEAA Athens Athens
| | - A. Gialeraki
- University of Athens, Medical SchoolHaematology laboratory and Blood Bank Athens Greece
| | - S. Valsami
- Haematology Laboratory‐Blood BankNational and Kapodistrian University of Athens, Aretaieion Hospital Athens Greece
| | | | - M. Politou
- Haematology Laboratory‐Blood BankNational and Kapodistrian University of Athens, Aretaieion Hospital Athens Greece
| |
Collapse
|
7
|
Molano A, Apraiz I, España P, Azkarate M, Vesga MÁ, Rubia M, Piedrabuena M, Puente F, Veldhuisen B, Schoot E, Tejedor D, López M. Performance evaluation study of ID RHD XT, a new genotyping assay for the detection of high‐prevalence RhD negative and weak D types. Vox Sang 2018; 113:694-700. [DOI: 10.1111/vox.12701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/27/2018] [Accepted: 07/16/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Araitz Molano
- R&D Area Progenika Biopharma A Grifols Company Derio Spain
| | - Izaskun Apraiz
- R&D Area Progenika Biopharma A Grifols Company Derio Spain
| | | | - Maria Azkarate
- Centro Vasco de Transfusiones y Tejidos Humanos Galdakao Spain
| | | | | | | | | | | | - Ellen Schoot
- Sanquin Blood Supply Research Amsterdam the Netherlands
| | - Diego Tejedor
- R&D Area Progenika Biopharma A Grifols Company Derio Spain
| | - Mónica López
- R&D Area Progenika Biopharma A Grifols Company Derio Spain
| |
Collapse
|
8
|
Polin H, Brisner M, Reiter A, Danzer M. Identification of four novel RHD
alleles by weakened antigen D expression. Transfusion 2018; 58:267-268. [DOI: 10.1111/trf.14380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/17/2017] [Accepted: 09/05/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Helene Polin
- Red Cross Transfusion Service of Upper Austria; Linz Austria
| | - Melanie Brisner
- Red Cross Transfusion Service of Upper Austria; Linz Austria
| | - Anna Reiter
- Red Cross Transfusion Service of Upper Austria; Linz Austria
| | - Martin Danzer
- Red Cross Transfusion Service of Upper Austria; Linz Austria
| |
Collapse
|
9
|
Sandler SG, Chen L, Flegel WA. Serological weak D phenotypes: a review and guidance for interpreting the RhD blood type using the RHD genotype. Br J Haematol 2017; 179:10-19. [PMID: 28508413 PMCID: PMC5612847 DOI: 10.1111/bjh.14757] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Approximately 0·2-1% of routine RhD blood typings result in a "serological weak D phenotype." For more than 50 years, serological weak D phenotypes have been managed by policies to protect RhD-negative women of child-bearing potential from exposure to weak D antigens. Typically, blood donors with a serological weak D phenotype have been managed as RhD-positive, in contrast to transfusion recipients and pregnant women, who have been managed as RhD-negative. Most serological weak D phenotypes in Caucasians express molecularly defined weak D types 1, 2 or 3 and can be managed safely as RhD-positive, eliminating unnecessary injections of Rh immune globulin and conserving limited supplies of RhD-negative RBCs. If laboratories in the UK, Ireland and other European countries validated the use of potent anti-D reagents to result in weak D types 1, 2 and 3 typing initially as RhD-positive, such laboratory results would not require further testing. When serological weak D phenotypes are detected, laboratories should complete RhD testing by determining RHD genotypes (internally or by referral). Individuals with a serological weak D phenotype should be managed as RhD-positive or RhD-negative, according to their RHD genotype.
Collapse
Affiliation(s)
- S. Gerald Sandler
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Leonard Chen
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Willy A. Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
10
|
McGowan EC, Lopez GH, Knauth CM, Liew YW, Condon JA, Ramadi L, Parsons K, Turner EM, Flower RL, Hyland CA. Diverse and novelRHDvariants in Australian blood donors with a weak D phenotype: implication for transfusion management. Vox Sang 2017; 112:279-287. [DOI: 10.1111/vox.12488] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 12/13/2022]
Affiliation(s)
- E. C. McGowan
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - G. H. Lopez
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - C. M. Knauth
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
- School of Biomedical Sciences; Faculty of Health; Queensland University of Technology; Brisbane QLD Australia
| | - Y.-W. Liew
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - J. A. Condon
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; West Melbourne Vic. Australia
| | - L. Ramadi
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; West Melbourne Vic. Australia
| | - K. Parsons
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; Alexandria NSW Australia
| | - E. M. Turner
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - R. L. Flower
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - C. A. Hyland
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Borgmann DM, Mayr S, Polin H, Schaller S, Dorfer V, Obritzberger L, Endmayr T, Gabriel C, Winkler SM, Jacak J. Single Molecule Fluorescence Microscopy and Machine Learning for Rhesus D Antigen Classification. Sci Rep 2016; 6:32317. [PMID: 27580632 PMCID: PMC5007495 DOI: 10.1038/srep32317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/02/2016] [Indexed: 01/24/2023] Open
Abstract
In transfusion medicine, the identification of the Rhesus D type is important to prevent anti-D immunisation in Rhesus D negative recipients. In particular, the detection of the very low expressed DEL phenotype is crucial and hence constitutes the bottleneck of standard immunohaematology. The current method of choice, adsorption-elution, does not provide unambiguous results. We have developed a complementary method of high sensitivity that allows reliable identification of D antigen expression. Here, we present a workflow composed of high-resolution fluorescence microscopy, image processing, and machine learning that - for the first time - enables the identification of even small amounts of D antigen on the cellular level. The high sensitivity of our technique captures the full range of D antigen expression (including D+, weak D, DEL, D-), allows automated population analyses, and results in classification test accuracies of up to 96%, even for very low expressed phenotypes.
Collapse
Affiliation(s)
- Daniela M. Borgmann
- University of Applied Sciences Upper Austria, School of Informatics, Communications and Media, Softwarepark 11, 4232 Hagenberg, Austria
| | - Sandra Mayr
- University of Applied Sciences Upper Austria, School of Applied Health and Social Sciences, Garnisonstrasse 21, 4020 Linz, Austria
| | - Helene Polin
- Red Cross Transfusion Service for Upper Austria, Krankenhausstrasse 7, 4020 Linz, Austria
| | - Susanne Schaller
- University of Applied Sciences Upper Austria, School of Informatics, Communications and Media, Softwarepark 11, 4232 Hagenberg, Austria
| | - Viktoria Dorfer
- University of Applied Sciences Upper Austria, School of Informatics, Communications and Media, Softwarepark 11, 4232 Hagenberg, Austria
| | - Lisa Obritzberger
- University of Applied Sciences Upper Austria, School of Informatics, Communications and Media, Softwarepark 11, 4232 Hagenberg, Austria
| | - Tanja Endmayr
- University of Applied Sciences Upper Austria, School of Applied Health and Social Sciences, Garnisonstrasse 21, 4020 Linz, Austria
| | - Christian Gabriel
- Red Cross Transfusion Service for Upper Austria, Krankenhausstrasse 7, 4020 Linz, Austria
| | - Stephan M. Winkler
- University of Applied Sciences Upper Austria, School of Informatics, Communications and Media, Softwarepark 11, 4232 Hagenberg, Austria
| | - Jaroslaw Jacak
- University of Applied Sciences Upper Austria, School of Applied Health and Social Sciences, Garnisonstrasse 21, 4020 Linz, Austria
| |
Collapse
|
13
|
Polin H, Matzhold EM, Schlenke P, Gabriel C, Danzer M, Wagner T. RHD Tyr311Stop encoded by a novel nonsense mutation. Transfusion 2016; 56:2389-90. [PMID: 27351456 DOI: 10.1111/trf.13702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 04/27/2016] [Accepted: 05/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Helene Polin
- Red Cross Transfusion Service of Upper Austria and the, Linz. .,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Linz, Austria; and the, Linz.
| | - Eva Maria Matzhold
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Peter Schlenke
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Christian Gabriel
- Red Cross Transfusion Service of Upper Austria and the, Linz.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Linz, Austria; and the, Linz
| | - Martin Danzer
- Red Cross Transfusion Service of Upper Austria and the, Linz.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Linz, Austria; and the, Linz
| | - Thomas Wagner
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| |
Collapse
|
14
|
Nuchnoi P, Thongbus J, Srisarin A, Kerdpin U, Prachayasittikul V. Clinical and laboratory update on the DEL variant. Lab Med 2016; 45:285-90. [PMID: 25316658 DOI: 10.1309/lmtuz00o7vftgceb] [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] [Indexed: 10/23/2022] Open
Abstract
Serological assays for the RhD blood group are based on detection of the RhD antigen on human red blood cells using a specific anti-D antibody. The weak expression of the RhD antigen in the DEL variant hinders the sensitivity of conventional serological assays. Evidence of anti-D immunization in patients with D-negativity who have received DEL-variant blood units has been reported in various populations. This observation has prompted the need for genetic epidemiological and clinical data on the DEL variant in the development of DEL molecular diagnostic testing. This review highlights the molecular features of the DEL variant, the clinical consequences of DEL-blood transfusion, and current approaches for detection of the DEL-variant for donor screening and transfusion.
Collapse
Affiliation(s)
- Pornlada Nuchnoi
- Department of Clinical Microscopy, Mahidol University, Bangkok, Thailand Center for Innovation Development and Technology Transfer, Mahidol University, Bangkok, Thailand
| | - Jairak Thongbus
- Department of Clinical Microscopy, Mahidol University, Bangkok, Thailand National Blood Center, Thai Red Cross Society, Bangkok, Thailand
| | - Apapan Srisarin
- Department of Clinical Microscopy, Mahidol University, Bangkok, Thailand
| | - Usanee Kerdpin
- Department of Chemistry, Naresuan University, Phitsanulok, Thailand
| | | |
Collapse
|
15
|
Polin H, Pelc-Klopotowska M, Danzer M, Suessner S, Gabriel C, Wilflingseder J, Żmudzin A, Orzińska A, Guz K, Michalewska B, Brojer E. Compound heterozygosity of two novelRHAGalleles leads to a considerable disruption of the Rh complex. Transfusion 2016; 56:950-5. [DOI: 10.1111/trf.13476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/13/2015] [Accepted: 11/19/2015] [Indexed: 01/14/2023]
Affiliation(s)
- Helene Polin
- Red Cross Transfusion Service of Upper Austria; Linz Austria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Linz Austria
| | | | - Martin Danzer
- Red Cross Transfusion Service of Upper Austria; Linz Austria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Linz Austria
| | - Susanne Suessner
- Red Cross Transfusion Service of Upper Austria; Linz Austria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Linz Austria
| | - Christian Gabriel
- Red Cross Transfusion Service of Upper Austria; Linz Austria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Linz Austria
| | | | | | | | - Katarzyna Guz
- Institute of Hematology and Transfusion Medicine; Warsaw Poland
| | | | - Ewa Brojer
- Institute of Hematology and Transfusion Medicine; Warsaw Poland
| |
Collapse
|
16
|
Flegel WA, Gottschall JL, Denomme GA. Implementing mass-scale red cell genotyping at a blood center. Transfusion 2015; 55:2610-5; quiz 2609. [PMID: 26094790 DOI: 10.1111/trf.13168] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND When problems with compatibility beyond ABO and D arise, currently transfusion services search their inventories and perform time-consuming serologic testing to locate antigen-negative blood. These clinically important blood group antigens can be detected reliably by red cell genotyping, which is a technology whereby DNA-based techniques are used to evaluate gene polymorphisms that determine the expression of blood group antigens. We introduced mass-scale genotyping and measured availability of genotyped blood. STUDY DESIGN AND METHODS All non-Caucasian donors qualified for genotyping along with donors who had a history of repeat donation. Mass-scale red cell genotyping, performed on an electronic interfaced open array platform, was implemented to screen blood donors for 32 single-nucleotide polymorphisms that predicted 42 blood group antigens. Genotype screening results were confirmed by phenotyping, when needed for antigen-negative transfusion, before release of the red blood cell (RBC) unit. RESULTS Approximately 22,000 donors were red cell genotyped within 4 months and a total of 43,066 donors in 4 years. There were 463 discordances (0.52% of 89,596 genotypes with a phenotype). Among the 307 resolved discordances, approximate equal numbers represented historical serologic or genotyping discrepancies (n = 151 and n = 156, respectively). In the final year of the study, a mean of 29% of the daily inventory had a genotype. CONCLUSIONS Red cell genotyping of blood donors using an electronic interface created a large and stable supply of RBC units with historical genotypes. The database served the needs of antigen-negative blood requests for a large regional blood center and allowed us to abandon screening by serology.
Collapse
Affiliation(s)
- Willy A Flegel
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Jerome L Gottschall
- Department of Pathology, Medical College of Wisconsin.,Diagnostic Laboratories, BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | - Gregory A Denomme
- Diagnostic Laboratories, BloodCenter of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
17
|
Ouchari M, Romdhane H, Chakroun T, Abdelkefi S, Jarrey I, Houissa B, Jemni Yacoub S. The Duffy blood group system in the Tunisian population. Transfus Clin Biol 2015; 22:76-9. [PMID: 25936942 DOI: 10.1016/j.tracli.2015.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/20/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tunisia was described to as genetically heterogenous. Besides the 1% native Berber, the genetically influence of the Europeans seems much larger than that of sub-Saharan populations. Due to their ethnic variability, blood group variants have the potential to support population analyses. The aim of this study was to estimate the Duffy blood group system in this mixed population with enhanced characterization of samples with aberrant expression. MATERIALS AND METHODS Standard serological testing for the Duffy antigen was done for 105 Tunisian blood donors. Samples with altered Fy expression underwent DNA sequencing of the DARC, RHD and RHCE genes. RESULTS The Fy(a-b+) was the most common phenotype identified in the Tunisian population (38.1%). Five samples with Fy(a-b-) phenotype were determined as FY*02N.01/FY*02N.01 by a homozygous occurrence of the FY*B-67C>T alteration. Another three individuals exhibited a Fy(b+(w))Fy(x) expression, confirmed by a FY*A/FY*02M.01 (n = 1) and a FY*02M.01/FY*02M.01 (n = 2) genotype. RHD and RHCE sequencing (n= 8) revealed altered alleles observed in black populations in 5 samples. One individual with FY*02M.01/FY*02M.01 have the silent 165C>T nucleotide substitution each in the RHD and RHCE gene. DISCUSSION The composition of blood group variants determined in this study confirms the genetically proximity of Tunisia to Europe. The small sub-Saharan genetic influence was approved by a limited number of variant samples associated with the black population.
Collapse
Affiliation(s)
- M Ouchari
- Centre régional de transfusion sanguine, hôpital Farhat Hached, Sousse, Tunisia
| | - H Romdhane
- Centre régional de transfusion sanguine, hôpital Farhat Hached, Sousse, Tunisia
| | - T Chakroun
- Centre régional de transfusion sanguine, hôpital Farhat Hached, Sousse, Tunisia
| | - S Abdelkefi
- Centre régional de transfusion sanguine, hôpital Farhat Hached, Sousse, Tunisia
| | - I Jarrey
- Centre régional de transfusion sanguine, hôpital Farhat Hached, Sousse, Tunisia
| | - B Houissa
- Centre régional de transfusion sanguine, hôpital Farhat Hached, Sousse, Tunisia
| | - S Jemni Yacoub
- Centre régional de transfusion sanguine, hôpital Farhat Hached, Sousse, Tunisia.
| |
Collapse
|
18
|
Sandler SG, Flegel WA, Westhoff CM, Denomme GA, Delaney M, Keller MA, Johnson ST, Katz L, Queenan JT, Vassallo RR, Simon CD. It's time to phase in RHD genotyping for patients with a serologic weak D phenotype. College of American Pathologists Transfusion Medicine Resource Committee Work Group. Transfusion 2015; 55:680-9. [PMID: 25438646 PMCID: PMC4357540 DOI: 10.1111/trf.12941] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 11/29/2022]
Affiliation(s)
- S Gerald Sandler
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Van Sandt VS, Gassner C, Emonds MP, Legler TJ, Mahieu S, Körmöczi GF. RHDvariants in Flanders, Belgium. Transfusion 2014; 55:1411-7. [DOI: 10.1111/trf.12947] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/22/2014] [Accepted: 10/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Vicky S.T. Van Sandt
- Histocompatibility and Immunogenetic Laboratory; Red Cross Flanders; Mechelen Belgium
| | - Christoph Gassner
- Blood Transfusion Service Zürich; Swiss Red Cross; Schlieren Switzerland
| | - Marie-Paule Emonds
- Histocompatibility and Immunogenetic Laboratory; Red Cross Flanders; Mechelen Belgium
| | - Tobias J. Legler
- Department of Transfusion Medicine; University of Göttingen; Göttingen Germany
| | - Sarah Mahieu
- Histocompatibility and Immunogenetic Laboratory; Red Cross Flanders; Mechelen Belgium
- ZNA Stuivenberg; Antwerp Belgium
| | - Günther F. Körmöczi
- Department of Blood Group Serology and Transfusion Medicine; Medical University of Vienna; Vienna Austria
| |
Collapse
|
20
|
Gowland P, Gassner C, Hustinx H, Stolz M, Gottschalk J, Tissot JD, Thierbach J, Maier A, Sigurdardottir S, Still F, Fontana S, Frey BM, Niederhauser C. Molecular RHD screening of RhD negative donors can replace standard serological testing for RhD negative donors. Transfus Apher Sci 2014; 50:163-8. [DOI: 10.1016/j.transci.2014.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Abstract
Starting in 2013, blood donors must be tested at least using: (1) one monoclonal anti-D and one anti-CDE (alternatively full RhCcEe phenotyping), and (2) all RhD negative donors must be tested for RHD exons 5 and 10 plus one further exonic, or intronic RHD specificity, according to the guidelines of the Blood Transfusion Service of the Swiss Red Cross (BTS SRC). In 2012 an adequate stock of RHD screened donors was built. Of all 25,370 RhD negative Swiss donors tested in 2012, 20,015 tested at BTS Berne and 5355 at BTS Zürich, showed 120 (0.47%) RHD positivity. Thirty-seven (0.15%) had to be redefined as RhD positive. Routine molecular RHD screening is reliable, rapid and cost-effective and provides safer RBC units in Switzerland.
Collapse
|
22
|
Ouchari M, Chakroun T, Abdelkefi S, Romdhane H, Houissa B, Jemni Yacoub S. Anti-D auto-immunization in a patient with weak D type 4.0. Transfus Clin Biol 2013; 21:43-6. [PMID: 24365172 DOI: 10.1016/j.tracli.2013.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 10/01/2013] [Indexed: 11/19/2022]
Abstract
We report the case of a 56-year-old patient with blood group O+C-c+E-e+K-, followed for a myelodysplasic syndrome and treated by regular pheno-identical and compatible (RBCs) transfusion since December 2007. In June 2009, a positive crossmatch was found with 2 RBCs O+C-c+E-e+K-. A positive anti-body screening with a positive autocontrol was detected and anti-D was unidentified in the patient's serum. The DAT was positive (IgG) and elution identified an anti-D. The following assumptions were then made: it could be a partial D phenotype with anti-D alloantibodies or RH: 1 phenotype with an anti-D auto-antibodies. Molecular analysis by multiplex PCR and sequencing have depisted a weak D type 4.0 phenotype. In October 2009, over three months of RH:-1 RBC transfusion, the antibody screening and DAT (IgG) remained positive, and an eluate made from the patient's erythrocytes contained an anti-D. All these funding confirmed the autoimmune nature of the anti-D. This case report illustrates the importance of a well-conducted and immunohematological laboratories test in order to distinguish between auto- or allo-immune of anti-D in a RH: 1 poly-transfused patients. This distinction is of great importance for transfusion support.
Collapse
Affiliation(s)
- M Ouchari
- Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia
| | - T Chakroun
- Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia
| | - S Abdelkefi
- Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia
| | - H Romdhane
- Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia
| | - B Houissa
- Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia
| | - S Jemni Yacoub
- Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia.
| |
Collapse
|
23
|
Orzińska A, Guz K, Polin H, Pelc-Kłopotowska M, Bednarz J, Gieleżyńska A, Sliwa B, Kowalewska M, Pawłowska E, Włodarczyk B, Malaga Alicja Żmudzin M, Krzemienowska M, Srivastava K, Michalewska B, Gabriel C, Flegel WA, Brojer E. RHD variants in Polish blood donors routinely typed as D-. Transfusion 2013; 53:2945-53. [PMID: 23634715 PMCID: PMC5497842 DOI: 10.1111/trf.12230] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 01/10/2013] [Accepted: 02/10/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Blood donors exhibiting a weak D or DEL phenotypical expression may be mistyped D- by standard serology hence permitting incompatible transfusion to D- recipients. Molecular methods may overcome these technical limits. Our aim was to estimate the frequency of RHD alleles among the apparently D- Polish donor population and to characterize its molecular background. STUDY DESIGN AND METHODS Plasma pools collected from 31,200 consecutive Polish donors typed as D- were tested by real-time polymerase chain reaction (PCR) for the presence of RHD-specific markers located in Intron 4 and Exons 7 and 10. RHD+ individuals were characterized by PCR or cDNA sequencing and serology. RESULTS Plasma cross-pool strategy revealed 63 RHD+ donors harboring RHD*01N.03 (n = 17), RHD*15 (n = 12), RHD*11 (n = 7), RHD*DEL8 (n = 3), RHD*01W.2 (n = 3), RHD-CE(10) (n = 3), RHD*01W.3, RHD*01W.9, RHD*01N.05, RHD*01N.07, RHD*01N.23, and RHD(IVS1-29G>C) and two novel alleles, RHD*(767C>G) (n = 3) and RHD*(1029C>A). Among 47 cases available for serology, 27 were shown to express the D antigen CONCLUSION 1) Plasma cross-pool strategy is a reliable and cost-effective tool for RHD screening. 2) Only 0.2% of D- Polish donors carry some fragments of the RHD gene; all of them were C or E+. 3) Almost 60% of the detected RHD alleles may be potentially immunogenic when transfused to a D- recipient.
Collapse
Affiliation(s)
- Agnieszka Orzińska
- Department of Immunohematology and Immunology of Transfusion Medicine, Institute of Haematology and Blood Transfusion, Warsaw, Poland; Regional Blood Transfusion Centers in Warsaw, Kraków, Gdańsk, Racibórz, Kalisz, Kielce, Radom, Poland; Red Cross Transfusion Centre of Upper Austria, Linz, Austria; Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Ouchari M, Polin H, Romdhane H, Abdelkefi S, Houissa B, Chakroun T, Gabriel C, Hmida S, Jemni Yacoub S. RHD*weak partial 4.0 is associated with an altered RHCE*ce(48C, 105T, 733G, 744C, 1025T) allele in the Tunisian population. Transfus Med 2013; 23:245-9. [PMID: 23742316 DOI: 10.1111/tme.12037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 03/02/2013] [Accepted: 03/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES D is the most immunogenic blood group antigen. About 1% of whites carry an altered RHD allele leading to quantitative or qualitative changes in the antigen D expression. T201R and F223V encoded by 602C>G and 667T>G are specific amino acid substitutions of the weak D type 4 cluster of African origin, comprising the alleles RHD*09.01, RHD*09.02, RHD*09.03, RHD*09.04 and RHD*09.05. The purpose of this study was to estimate the presence of these RHD genotypes in the Tunisian population. MATERIALS AND METHODS Ethylenediaminetetraacetate blood samples from 907 D+ and 93 D- blood donors were tested for markers 602G and 667G by allele-specific primer-polymerase chain reaction (PCR-ASP). Samples with positive reactions were re-evaluated by DNA sequencing for RHD and RHCE exons 1-10 and adjacent intronic sequences. RESULTS Among 907 D+ samples, 19 individuals were identified to harbour the RHD*weak partial 4.0 allele. RHCE sequencing post-haplotype-specific extraction (HSE) revealed an altered RHCE*ce(48C, 105T, 733G, 744C, 1025T) in those samples. The linkage of the RHCE polymorphisms to one haplotype was proven by DNA sequencing post-HSE. CONCLUSION The RHD*weak partial 4.0 allele syn. RHD*09.03 was estimated to occur 1 in 47 among D+ Tunisians. There was no evidence for other RHD alleles included in the weak D type 4 cluster.
Collapse
Affiliation(s)
- M Ouchari
- Unité de recherche "UR06SP05" Centre Régional de Transfusion Sanguine, Sousse, Tunisia
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Wagner FF. RHD PCR of D-Negative Blood Donors. ACTA ACUST UNITED AC 2013; 40:172-81. [PMID: 23922542 DOI: 10.1159/000351604] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 04/25/2013] [Indexed: 11/19/2022]
Abstract
SUMMARY RHD PCR of blood donors may be used to reveal weak D, partial D, DEL and chimeric D+/D- donors among presumed D-negative blood donors. Units donated by such donors pose a definite yet low risk for anti-D immunization of transfusion recipients. The frequency of DEL donors among D-negative donors is 1:350 to 1:2,000 in Europe and up to 1:5 in Asian countries. Different strategies for RHD PCR of blood donors have been used. Probably, the most cost-efficient implementation is replacement of sensitive D antigen testing with the indirect antiglobulin test by RHD PCR in pools which might even reduce total testing cost.
Collapse
|
26
|
A simple diagnostic strategy for RhD typing in discrepant cases in the Indian population. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2012; 11:37-42. [PMID: 22871818 DOI: 10.2450/2012.0006-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/08/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND The D antigen is the most immunogenic antigen in the Rh system. D variants must be considered if there is a significant discrepancy in the strength of reaction obtained with different anti-D reagents, a discrepancy between current and historical test results and if anti-D is detected in an individual serologically typed as RhD positive. A panel of monoclonal anti-D reagents can be used to identify partial D and weak D variants. The aim of this study was to develop a strategy for RhD typing in discrepant cases. MATERIALS AND METHODS Sixty RhD discrepant samples referred to our Institute for confirmation of RhD status were tested with a panel of 12 monoclonal anti-D reagents (ALBAclone advanced partial RhD typing kit) and Rh phenotype was determined using C, c, D, E, and e antisera. RESULTS Ninety-three percent of the RhD discrepant cases were classified into weak and partial D using this kit. Among the D variants characterised, 37% belonged to DFR, 23% to DOL, 12% to weak D, and the remaining 21% to DAR, DV, DMH, DCS and DVI categories. Ninety-seven percent of the D variants were "C" antigen positive. Out of the panel of 12 monoclonal anti-D used, cell line LHM-70/45 gave negative reactions with all RhD discrepant cases and cell lines LHM-76/59, LHM-76/55 and ESD-1 gave positive reactions with all 60 RhD discrepant cases studied. DISCUSSION The Advanced partial D kit was very useful in characterising and identifying D variants in the Indian population. A preliminary strategy for the detection and identification of D variants in discrepant cases could be to test for the presence of "C" antigen with anti-C, and for "D" antigen with anti-D of cell line LHM 70/45. A more comprehensive, but simple way to identify D variants in routine RhD typing is to use two anti-D reagents i.e LHM 70/45 and one out of LHM-76/59, LHM-76/55 and ESD-1. D variants can be further characterised by using the partial D typing kit and molecular genotyping in specialised laboratories.
Collapse
|
27
|
Moussa H, Tsochandaridis M, Chakroun T, Jridi S, Abdelneji B, Hmida S, Silvy M, Bailly P, Gabert J, Levy-Mozziconacci A, Jemni-Yacoub S. Molecular background of D-negative phenotype in the Tunisian population. Transfus Med 2012; 22:192-8. [PMID: 22420413 DOI: 10.1111/j.1365-3148.2012.01142.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most studies of the molecular basis of Rhesus D-negative phenotype have been conducted in Caucasian and African populations. A comprehensive survey of RHD alleles was lacking in people from North Africa (Tunisians, Moroccans and Algerians) which could be very efficient for managing donors and patients carrying an RHD molecular variant. We analyse the molecular background of D-negative population in Tunisia in the present study. MATERIALS AND METHODS Blood samples were collected from native Tunisians. A total of 448 D-negative donors from different regions of Tunisia were analysed by RHD genotyping according to an adopted strategy using real-time PCR, ASP-PCR and sequencing. RESULTS Among the 448 D-negative samples, 443 were phenotyped unequivocally as true D-negative including three molecular backgrounds which were RHD gene deletion (n = 437), RHDψ pseudogene (n = 2) and RHD-CE-D hybrid gene (n = 4) with the respective frequencies of 0·9900, 0·0023 and 0·0046. The remaining five samples, in discordance with the serological results, were identified as two weak D type 11, one weak D type 29, one weak D type 4·0 and one DBT-1 partial D. CONCLUSION This study showed that the Tunisian population gets closer to Caucasians, given that the RHD gene deletion is the most prevalent cause of D-negative phenotype, but it is slightly different by the presence of the RHDψ pseudogene which was found with a very low frequency compared with that described in the African population. Nevertheless, the relative occurrence of weak D variants among studied serologically D-negative samples make necessary the adaptation of RHD genotyping strategy to the spectrum of prevalent alleles.
Collapse
Affiliation(s)
- H Moussa
- Unité de Recherche UR06SP05 Centre Régional de Transfusion Sanguine, Sousse, Tunisia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Silvy M, Chapel-Fernandes S, Callebaut I, Beley S, Durousseau C, Simon S, Lauroua P, Dubosc-Marchenay N, Babault C, Mouchet C, Ferrera V, Chiaroni J, Bailly P. Characterization of novel RHD alleles: relationship between phenotype, genotype, and trimeric architecture. Transfusion 2012; 52:2020-9. [DOI: 10.1111/j.1537-2995.2011.03544.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
29
|
Polin H, Gaszner W, Hackl C, Danzer M, Niklas N, Gabriel C. On the trail of anti-CDE to unexpected highlights of the RHD*weak 4.3 allele in the Upper Austrian population. Vox Sang 2012; 103:130-6. [DOI: 10.1111/j.1423-0410.2012.01586.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
30
|
Brajovich MEL, Trucco Boggione C, Biondi CS, Racca AL, Tarragó M, Nogués N, Muñiz-Díaz E, Cotorruelo CM. Comprehensive analysis of RHD alleles in Argentineans with variant D phenotypes. Transfusion 2011; 52:389-96. [DOI: 10.1111/j.1537-2995.2011.03297.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
31
|
Krog GR, Clausen FB, Berkowicz A, Jørgensen L, Rieneck K, Nielsen LK, Dziegiel MH. Is current serologic RhD typing of blood donors sufficient for avoiding immunization of recipients? Transfusion 2011; 51:2278-85. [PMID: 21569040 DOI: 10.1111/j.1537-2995.2011.03156.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Avoiding immunization with clinically important antibodies is a primary objective in transfusion medicine. Therefore, it is central to identify the extent of D antigens that escape routine RhD typing of blood donors and to improve methodology if necessary. STUDY DESIGN AND METHODS We screened 5058 D- donors for the presence of the RHD gene, targeting Exons 5, 7, and 10 with real-time polymerase chain reaction. Samples that were positive in the screen test were investigated further by adsorption-elution, antibody consumption, flow cytometry, and sequencing of all RHD exons with intron-specific primers. Lookback was performed on all recipients of RBCs from RHD+ donors. RESULTS We found 13 RHD+ samples (0.26%). No variants or chimeras were found. Characterization of DNA revealed a novel DEL type (IVS2-2 A>G). In the lookback of the 136 transfusions with subsequent antibody follow-up, of which 13 were from DEL donors, one recipient developed anti-D. However, in this case, a competing and more likely cause of immunization was the concurrent transfusion of D+ platelets. Eleven recipients were immunized with 13 antibodies different from anti-D, of which five were anti-K. CONCLUSION In our laboratory, serologic RhD typing was safe. We detected all D variants and only missed DEL types. In assessing the immunization risk we included a DEL donor, found previous to this study, that did immunize a recipient with anti-D. We conclude that inadvertent immunization with D antigens in our setting was rare and in the order of 1.4 in 100,000 D- transfusions.
Collapse
Affiliation(s)
- Grethe Risum Krog
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | | | | | | | | | | |
Collapse
|
32
|
Stabentheiner S, Danzer M, Niklas N, Atzmüller S, Pröll J, Hackl C, Polin H, Hofer K, Gabriel C. Overcoming methodical limits of standard RHD genotyping by next-generation sequencing. Vox Sang 2010; 100:381-8. [PMID: 21133932 DOI: 10.1111/j.1423-0410.2010.01444.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Molecular variations of the RHD gene may result in the reduced expression of the D antigen and altered Rh phenotypes. In many occasions, they cannot be typed reliably by standard serological methods. Sequence-based typing is the gold standard to determine rare and unknown RHD genotypes. For this pilot study, sequence-based typing by standard Sanger sequencing was compared to a newly established next-generation sequencing approach based on pyrosequencing. MATERIALS AND METHODS Twenty-six DNA samples were selected after primary serological testing exhibiting a weak reaction in Rh phenotype. Parallel sequence analysis of the complete coding sequence including adjacent intronic sequences allowed a comparison of the methodical potency in mutation detection of Sanger with next-generation sequencing. RESULTS Sanger sequencing revealed 39 RHD polymorphisms in 21 of 26 samples in the RHD coding region, while pyrosequencing detected all but two alterations resulting in a concordance rate of 94·9% and clearly revealed a heterozygous compound mutation in one sample with RHDψ and Weak D type 4 alleles. The resolution of cis/trans linkage of polymorphisms and exact characterization of a 37 bp duplication was achieved by next-generation sequencing. CONCLUSION Our data suggest that next-generation sequencing offers a new development for high-throughput and clonal sequencing for molecular RHD genotyping. However, further attempts in the methodical set-up have to be undertaken prior to validation and introduction as a routine service.
Collapse
Affiliation(s)
- S Stabentheiner
- Red Cross Transfusion Service for Upper Austria, Krankenhausstrasse 7, Linz, Austria.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Silvy M, Simon S, Gouvitsos J, Di Cristofaro J, Ferrera V, Chiaroni J, Bailly P. Weak D and DEL alleles detected by routine SNaPshot genotyping: identification of four novel RHD alleles. Transfusion 2010; 51:401-11. [DOI: 10.1111/j.1537-2995.2010.02830.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
|
35
|
Abstract
Abstract
Over the past 20 years the molecular bases of almost all the major blood group antigens have been determined. This research has enabled development of DNA-based methods for determining blood group genotype. The most notable application of these DNA-based methods has been for determining fetal blood group in pregnancies when the fetus is at risk for hemolytic disease of the fetus and newborn. The replacement of all conventional serologic methods for pretransfusion testing by molecular methods is not straightforward. For the majority of transfusion recipients matching beyond ABO and D type is unnecessary, and the minority of untransfused patients at risk of alloimmunization who would benefit from more extensively blood group–matched blood cannot be identified reliably. Even if a method to identify persons most likely to make alloantibodies were available, this would not of itself guarantee the provision of extensively phenotype-matched blood for these patients because this is determined by the size and racial composition of blood donations available for transfusion. However, routine use of DNA-based extended phenotyping to provide optimally matched donations for patients with preexisting antibodies or patients with a known predisposition to alloimmunization, such as those with sickle cell disease, is widely used.
Collapse
|
36
|
Veldhuisen B, van der Schoot CE, de Haas M. Blood group genotyping: from patient to high-throughput donor screening. Vox Sang 2009; 97:198-206. [PMID: 19548962 DOI: 10.1111/j.1423-0410.2009.01209.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Blood group antigens, present on the cell membrane of red blood cells and platelets, can be defined either serologically or predicted based on the genotypes of genes encoding for blood group antigens. At present, the molecular basis of many antigens of the 30 blood group systems and 17 human platelet antigens is known. In many laboratories, blood group genotyping assays are routinely used for diagnostics in cases where patient red cells cannot be used for serological typing due to the presence of auto-antibodies or after recent transfusions. In addition, DNA genotyping is used to support (un)-expected serological findings. Fetal genotyping is routinely performed when there is a risk of alloimmune-mediated red cell or platelet destruction. In case of patient blood group antigen typing, it is important that a genotyping result is quickly available to support the selection of donor blood, and high-throughput of the genotyping method is not a prerequisite. In addition, genotyping of blood donors will be extremely useful to obtain donor blood with rare phenotypes, for example lacking a high-frequency antigen, and to obtain a fully typed donor database to be used for a better matching between recipient and donor to prevent adverse transfusion reactions. Serological typing of large cohorts of donors is a labour-intensive and expensive exercise and hampered by the lack of sufficient amounts of approved typing reagents for all blood group systems of interest. Currently, high-throughput genotyping based on DNA micro-arrays is a very feasible method to obtain a large pool of well-typed blood donors. Several systems for high-throughput blood group genotyping are developed and will be discussed in this review.
Collapse
Affiliation(s)
- B Veldhuisen
- Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | | |
Collapse
|
37
|
Flegel WA, von Zabern I, Doescher A, Wagner FF, Strathmann KP, Geisen C, Palfi M, Písacka M, Poole J, Polin H, Gabriel C, Avent ND. D variants at the RhD vestibule in the weak D type 4 and Eurasian D clusters. Transfusion 2009; 49:1059-69. [PMID: 19309476 PMCID: PMC10710224 DOI: 10.1111/j.1537-2995.2009.02102.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND One branch of the RHD phylogenetic tree is represented by the weak D type 4 cluster of alleles with F223V as the primordial amino acid substitution. F223V as well as a large number of further substitutions causing D variants are located at the extracellular RhD protein vestibule, which represents the entrance to the transmembraneous channel of the RhD protein. STUDY DESIGN AND METHODS RHD and RHCE nucleotide sequences were determined from genomic DNA and cDNA. D epitope patterns were established with commercial monoclonal anti-D panels. RESULTS The RHD alleles DOL-1 and DOL-2 had the two amino acid substitutions M170T (509T>C) and F223V (667T>G) in common. DOL-2 harbored the additional substitution L378V (1132C>G). Both alleles were observed in Africans and are probably evolutionary related. DMI carried M170I (510G>A), which differed from the DOL-typical substitution. DFW and DFL harbored the substitutions H166P (497A>C) and Y165C (494A>G). The antigen densities of DOL-1, DFL, and DFW were only moderately reduced. CONCLUSION DOL-1 and DOL-2 belong to the weak D type 4 cluster of RHD alleles. Together with DMI, DFL, and DFW they represent D variants with amino acid substitutions located at extracellular loops 3 or 4 lining the RhD protein vestibule. These substitutions were of minor influence on antigen density while adjacent substitutions in the transmembraneous section caused weak D antigen expression. All these D variants were partial D and alloanti-D immunizations have been observed in DOL-1, DMI, and DFL carriers. The substitution at position 170 causes partial D although located deep in the vestibule.
Collapse
Affiliation(s)
- Willy A Flegel
- Institute for Transfusion Medicine, University Hospital, Ulm, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Döscher A, Vogt C, Bittner R, Gerdes I, Petershofen EK, Wagner FF. RHCE alleles detected after weak and/or discrepant results in automated Rh blood grouping of blood donors in Northern Germany. Transfusion 2009; 49:1803-11. [PMID: 19453979 DOI: 10.1111/j.1537-2995.2009.02221.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND More than 170 weak or partial RHD alleles are currently known. A similar heterogeneity of RHCE alleles may be anticipated, but a large-scale systematic analysis of the molecular bases of altered C, c, E, and e antigenicity in European blood donors was lacking. STUDY DESIGN AND METHODS Between November 2004 and October 2006, samples collected from 567,105 blood donors in the northwest of Germany were surveyed for weakened and/or discrepant serologic reaction patterns of the C, c, E, or e antigens in automated testing. Samples from 187 donors with systematic typing problems were further investigated by manual typing and in 122 donors by DNA typing. The polymorphisms determining C, c, E, and e, as well as three repeatedly found substitutions, M167K, G96S, and L115R, were tested by PCR-SSP. Further analysis consisted of sequencing of the exons of RHCE. In addition, 13 referred samples were analyzed. RESULTS RHcE(M167K) known as E variant I was the most frequent allele, found in 70 of 122 analyzed donors. Among 13 referred samples, C typing problems predominated. Overall, 34 different underlying alleles were detected, 23 of which were new. Molecular causes included single-amino-acid substitutions, gene conversions, multiple dispersed amino acid substitutions, protein extensions, and in-frame amino acid deletions. CONCLUSION In addition to RHcE(M167K), a large number of different alleles are underlying CcEe typing problems. Molecular mechanisms parallel those found in RHD. Elucidation of the molecular bases of variant antigens is important to improve serologic and molecular typing methods.
Collapse
Affiliation(s)
- Andrea Döscher
- DRK Blutspendedienst NSTOB, Institut Bremen-Oldenburg, Oldenburg, Germany
| | | | | | | | | | | |
Collapse
|
39
|
Polin H, Danzer M, Gaszner W, Broda D, St-Louis M, Pröll J, Hofer K, Gabriel C. Identification ofRHDalleles with the potential of anti-D immunization among seemingly D− blood donors in Upper Austria. Transfusion 2009; 49:676-81. [DOI: 10.1111/j.1537-2995.2008.02046.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Flegel WA, von Zabern I, Wagner FF. Six years' experience performing RHD genotyping to confirm D- red blood cell units in Germany for preventing anti-D immunizations. Transfusion 2009; 49:465-71. [PMID: 19243542 PMCID: PMC10690736 DOI: 10.1111/j.1537-2995.2008.01975.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Red blood cell (RBC) units of D+ donors are falsely labeled D- if regular serologic typing fails to detect low D antigen expression or chimerism. The limitations of serology can be overcome by molecular typing. STUDY DESIGN AND METHODS In January 2002, we introduced a polymerase chain reaction (PCR)-based assay for RHD as a routine test for first-time donors who typed D- by serologic methods including the indirect antiglobulin test. Samples were tested in pools of 20 for the RHD-specific polymorphism in Intron 4. RHD alleles were identified by PCR and nucleotide sequencing. RESULTS Within 6 years, 46,133 serologically D- first-time donors were screened for the RHD gene. The prevalence of RHD gene carriers detected by this method was 0.21 percent. Twenty-three RHD alleles were found of which 15 were new. Approximately one-half of the RHD gene carriers harbored alleles expressing a DEL phenotype resulting in a prevalence of 0.1 percent. CONCLUSION The integration of RHD genotyping into the routine screening program was practical. We report 6 years' experience of this donor testing policy, which is not performed in most transfusion services worldwide. RBC units of donors with DEL phenotype have been reported to anti-D immunize D- recipients. We transferred those donors to the D+ donor pool with the rationale of preventing anti-D immunizations, especially dreaded in pregnancies. For each population, it will be necessary to adapt the RHD genotyping strategy to the spectrum of prevalent alleles.
Collapse
Affiliation(s)
- Willy A Flegel
- German Red Cross (DRK) Blood Donor Service Baden-Württemberg-Hessen, Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, Ulm, Germany.
| | | | | |
Collapse
|
41
|
Denomme GA, Flegel WA. Applying molecular immunohematology discoveries to standards of practice in blood banks: now is the time. Transfusion 2008; 48:2461-75. [DOI: 10.1111/j.1537-2995.2008.01855.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
42
|
Hillyer CD, Shaz BH, Winkler AM, Reid M. Integrating Molecular Technologies for Red Blood Cell Typing and Compatibility Testing Into Blood Centers and Transfusion Services. Transfus Med Rev 2008; 22:117-32. [PMID: 18353252 DOI: 10.1016/j.tmrv.2007.12.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
43
|
|