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Westhoff CM, Floch A. Blood group genotype matching for transfusion. Br J Haematol 2024. [PMID: 39104129 DOI: 10.1111/bjh.19664] [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: 05/08/2024] [Accepted: 07/11/2024] [Indexed: 08/07/2024]
Abstract
The last decade has seen significant growth in the application of DNA-based methods for extended antigen typing, and the use of gene sequencing to consider variation in blood group genes to guide clinical care. The challenge for the field now lies in educating professionals, expanding accessibility and standardizing the use of genotyping for routine patient care. Here we discuss applications of genotyping when transfusion is not straightforward including when compatibility cannot be demonstrated by routine methods, when Rh type is unclear, when allo- and auto-antibodies are encountered in stem cell and organ transplantation, for prenatal testing to determine maternal and foetal risk for complications, and Group A subtyping for kidney and platelet donors. We summarize current commercial testing resources and new approaches to testing including high-density arrays and targeted next-generation sequencing (NGS).
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Affiliation(s)
- Connie M Westhoff
- New York Blood Center Enterprises, National Center for Blood Group Genomics, New York, New York, USA
| | - Aline Floch
- Univ Paris Est Creteil, INSERM U955 Equipe Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France
- Laboratoire de Biologie Medicale de Référence en Immuno-Hematologie Moleculaire, Etablissement Francais du Sang Ile-de-France, Creteil, France
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2
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Srivastava K, Bueno MU, Flegel WA. Breakpoint regions of an RHD-CE(4-9)-D allele and a rare JK allele in a Pacific Islander individual. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2024; 22:189-197. [PMID: 37677094 PMCID: PMC11073622 DOI: 10.2450/bloodtransfus.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/07/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Among 710 RHD alleles, 3 alleles have been shown to express CcEe antigens and, among 67 hybrid alleles of the RHD gene, 2 alleles have evolved to include RHCE exons 4-9. No breakpoint region had been described for such RHD-CE(4-9)-D hybrid alleles. In the Kidd blood group system, the JK*02N.01 null allele is found with high prevalence in the Polynesian population. We investigated a self-identified Pacific Islander with discrepant serologic and molecular results for his C and Jkb antigens. Another 8 samples with genotype-phenotype discrepancies in the Kidd blood group system were assessed. MATERIALS AND METHODS A combination of published molecular methods and commercial kits were applied to analyze the RHD, RHCE, and SLC14A1 gene sequences, as were hemagglutination tests to determine the serologic phenotypes. RESULTS Nucleotide sequencing of the RHD gene in the index case, including relevant intron stretches, and cDNA identified an RHD-CE(4-9)-D hybrid allele. Nucleotide sequencing of his RHCE gene confirmed the presence of 2 RHCE*ce alleles despite expressing the C antigen. Sequencing of his SLC14A1 gene documented the JK*02N.01 null allele. In the other 8 samples, 5 previously known SLC14A1 nucleotide substitutions were identified. The JK*02N.17 allele was determined to be Jkb-positive. DISCUSSION We determined the 2 breakpoint regions of his RHD-CE(4-9)-D hybrid allele, which was likely distinct from the 2 previously published hybrid alleles due to the differences in the linked RHCE allele. His RHD variant was shown to express the C antigen. An SLC14A1 substitution was underlying his unexpected Jkb-negative phenotype. In a quality improvement project, we resolved 8 samples with similarly discrepant results between Jk serology and red cell genotyping.
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Affiliation(s)
- Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, United States of America
| | - Marina U Bueno
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, United States of America
| | - Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, United States of America
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Rophina M, Sinha A, Biswas D, Basu D, Datta SS, Scaria V. Molecular basis of DEL phenotype in the Indian population: Insights from next-generation sequencing analysis of two cases. Transfus Apher Sci 2024; 63:103872. [PMID: 38272782 DOI: 10.1016/j.transci.2024.103872] [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: 10/23/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/27/2024]
Abstract
The DEL phenotype represents an intriguing and challenging aspect of blood group serology. This condition is characterized by an extremely weak expression of the D antigen on red blood cells, to the extent that it often eludes detection through routine serological methods. Identifying the DEL phenotype necessitates more specialized techniques, such as adsorption and elution tests, to reveal the presence of the D antigen. This distinctive phenotype underscores the complexity and subtlety of blood group genetics and highlights the importance of using advanced methods to accurately classify individuals with this condition, as their ability to form anti-D antibodies can have clinical implications during transfusion and pregnancy scenarios. There is a paucity of data for the DEL phenotype in the Indian population, and the molecular basis has not been elucidated yet. Our investigation delves into the genetic underpinnings of two distinct DEL phenotype cases that pose challenges for resolution through conventional serological techniques. We employ next-generation amplicon sequencing to unravel the intricate genetic landscape underlying these cases. In the D-negative donor, the DEL phenotype was first identified serologically, which was subsequently confirmed by molecular analysis. In the second case, it was associated with an anti-D antibody in a D-positive patient. Initial data analysis unveiled a substantial reduction in coverage across the exonic segments of the RHD gene in both samples, suggesting the potential presence of RHD exon deletions. On both occasions, we identified a homozygous intronic RHD polymorphism that is well established to be linked to the RHD* 01EL.32/RHD*DEL32 variant.
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Affiliation(s)
- Mercy Rophina
- CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, Delhi 110025, India; Academy of Scientific and Innovative Research (AcSIR), CSIR-HRDC Campus, Sector 19, Kamla Nehru Nagar, Ghaziabad, Uttar Pradesh 201002, India
| | - Ayesha Sinha
- Department of Transfusion Medicine, Tata Medical Center, Newtown, Rajarhat, 700160, Kolkata, India
| | - Durba Biswas
- Department of Transfusion Medicine, Tata Medical Center, Newtown, Rajarhat, 700160, Kolkata, India
| | - Debapriya Basu
- Department of Transfusion Medicine, Tata Medical Center, Newtown, Rajarhat, 700160, Kolkata, India
| | - Suvro Sankha Datta
- Department of Transfusion Medicine, Tata Medical Center, Newtown, Rajarhat, 700160, Kolkata, India.
| | - Vinod Scaria
- CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, Delhi 110025, India; Academy of Scientific and Innovative Research (AcSIR), CSIR-HRDC Campus, Sector 19, Kamla Nehru Nagar, Ghaziabad, Uttar Pradesh 201002, India; Vishwanath Cancer Care Foundation, B 702, Neelkanth Business Park Kirol Village, Mumbai, 400 086, India
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Aburto A, Zapata D, Retamales E, Fernández J, Barra G, Peña F, Cárcamo S, Saavedra N, Sandoval C, Orellana J, Caamaño J. Genotype analysis to clarify RhD variants in discrepant samples of Chilean population. Front Immunol 2023; 14:1299639. [PMID: 38116010 PMCID: PMC10728993 DOI: 10.3389/fimmu.2023.1299639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction The D antigen variants are classified as weak, partial, and extremely weak (DEL) and can be differentiated using molecular tests. In Chile, the laboratories of local blood centers do not identify variants of the D antigen, referring them for study to the Reference Laboratory of the Public Health Institute of Chile. So, our aim was to talk about the results of the molecular analysis of variants of the D antigen in samples that had different results in the serological classification. Methods In the D antigen classification of the Rh system, 479 samples with serological discrepant results were sent for molecular analysis. The Rh phenotype was performed with monoclonal anti-C, anti-c, anti-E, and anti-e antisera by direct agglutination. To find the D antigen, researchers used direct agglutination with monoclonal antisera and indirect antiglobulin testing with the column (gel) agglutination method. Molecular analysis was performed with a polymerase chain reaction with sequence-specific primers (SSP-PCR) and sequencing. Results and discussion The presence of D antigen variants was confirmed in 332 samples (69.3%), with an initial discrepancy in serological classification. In this group of discrepant samples, the frequency of weak RhD variants was 66% (219/332), that of extremely weak RhD was 28% (93/332), and that of partial RhD was 6% (20/332). The weak variants type 2 (27.4%), type 3 (8.4%), type 48 (8.4%), and type 1 (8.1%) were the next most prevalent variants after RHD*DEL43 (28%). The ccEe (R2r) phenotype was the most frequently detected (38.4%) and is present in 87% of the RHD*DEL43 samples. The E antigen is associated with the presence of this variant. Our analyses give the first description of D antigen variants in Chile. The most common variants are DEL type (RHD*DEL43) and weak (weak type 2), which are linked to the ccDEe (R2r) phenotype. These findings allow us to characterize the variants of the D antigen in Chile and, according to the obtained data, to design strategies for the management of donors, patients, and pregnant women.
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Affiliation(s)
- Andrés Aburto
- Sección Hematología e Inmunohematología, Departamento Laboratorio Biomédico Nacional y de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Diego Zapata
- Sección Hematología e Inmunohematología, Departamento Laboratorio Biomédico Nacional y de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Eduardo Retamales
- Sección Hematología e Inmunohematología, Departamento Laboratorio Biomédico Nacional y de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Jorge Fernández
- Subdepartamento de Genética Molecular, Departamento Laboratorio Biomédico Nacional y de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Gisselle Barra
- Subdepartamento de Genética Molecular, Departamento Laboratorio Biomédico Nacional y de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Francisca Peña
- Laboratorio de Inmunohematología y Medicina Transfusional, Departamento de Medicina Interna, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
- Centro de Investigación en Medicina de Laboratorio – CeMLab, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - Sofía Cárcamo
- Laboratorio de Inmunohematología y Medicina Transfusional, Departamento de Medicina Interna, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - Nicolás Saavedra
- Centro de Investigación en Medicina de Laboratorio – CeMLab, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
- Departamento de Ciencias Básicas, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - Cristian Sandoval
- Escuela de Tecnología Médica, Facultad de Salud, Universidad Santo Tomás, Osorno, Chile
- Departamento de Ciencias Preclínicas, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - Juan Orellana
- Centro de Investigación en Medicina de Laboratorio – CeMLab, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
- Departamento de Salud Pública, CIGES (Capacitación, Investigación y Gestión para la Salud), Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - José Caamaño
- Laboratorio de Inmunohematología y Medicina Transfusional, Departamento de Medicina Interna, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
- Centro de Investigación en Medicina de Laboratorio – CeMLab, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
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Yin Q. DEL variants: review of molecular mechanisms, clinical consequences and molecular testing strategy. Funct Integr Genomics 2023; 23:318. [PMID: 37840046 DOI: 10.1007/s10142-023-01249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
Patients with DEL phenotype, a D variant with a low number of D antigens per red blood cell, are routinely typed as RhD-negative in serology testing and are detectable only by adsorption and elution techniques or molecular methods. DEL is of clinical importance worldwide, as indicated by its genotype-phenotype discrepancies among different populations and its potential to cause anti-D alloimmunization when DEL phenotype individuals are inadvertently managed as RhD-negative. This narrative review summarized the DEL alleles causing DEL phenotype and the underlying mechanisms. The clinical consequences and current molecular testing approach were discussed to manage the transfusion needs of patients and donors with DEL phenotype.
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Affiliation(s)
- Qinan Yin
- Henan Engineering Research Center of Digital Pathology and Artificial Intelligence Diagnosis, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
- Precision Medicine Laboratory, School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China.
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Ohto H, Ito S, Srivastava K, Ogiyama Y, Uchikawa M, Nollet KE, Flegel WA. Asian-type DEL (RHD*DEL1) with an allo-anti-D: A paradoxical observation in a healthy multiparous woman. Transfusion 2023; 63:1601-1611. [PMID: 37465939 PMCID: PMC10528739 DOI: 10.1111/trf.17465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The DEL phenotype is the D variant expressing the least amounts of D antigen per red cell. Asian-type DEL (RHD:c:1227G > A) is the most prevalent DEL in East Asia without any anti-D alloimmunization reported before. We investigated the first observation of an anti-D in any DEL phenotype, reported in the Japanese language at a 1987 conference, only 3 years after the discovery of DEL. METHODS We contacted the proband 35 years after the initial report. Standard hemagglutination, adsorption/elution, and flow cytometry tests were performed, as was nucleotide sequencing for the RHD, RHCE, and HLA class I and class II genes. RESULTS The healthy multiparous Japanese woman, a regular blood donor, still had the anti-D of titer 8 representing an alloantibody by standard serologic methods. Unexpectedly, she carried an Asian-type DEL without any additional RHD gene variation. All 12 HLA alleles identified were known in the Japanese population. Interestingly, one of her HLA-DRB1 and a variant of her HLA-DQB1 alleles had previously been associated with anti-D immunization. CONCLUSION We described an allo-anti-D, maintained for more than three decades, in an Asian-type DEL. The combination of two implicated HLA alleles were rare and could have contributed to the anti-D immunization. Continued monitoring of anti-D immunization events in patients with DEL is warranted, and we discuss possible mechanisms for further study. As only this single observation has been recognized in the last 35 years, the current recommendation is affirmed: Individuals with Asian-type DEL should be treated as Rh D-positive for transfusion and Rh immune prophylaxis purposes.
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Affiliation(s)
- Hitoshi Ohto
- Department of Mesenchymal Stem Cell Research, Fukushima Medical University, Fukushima, Japan
| | - Shoichi Ito
- Tohoku Block Blood Center, Japanese Red Cross Society, Sendai, Japan
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Yoshiko Ogiyama
- Tohoku Block Blood Center, Japanese Red Cross Society, Sendai, Japan
| | - Makoto Uchikawa
- Kanto-Koshinetsu Block Blood Center, Japanese Red Cross Society, Tokyo, Japan
| | - Kenneth Eric Nollet
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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7
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Wen J, Jia S, Wang Z, Chen J, Liang Q, Wei L, Richard G, Fichou Y, Luo G, Ji Y. Molecular and serological analysis of the D variant in the Chinese population and identification of seven novel RHD alleles. Transfusion 2023; 63:402-414. [PMID: 36382965 DOI: 10.1111/trf.17186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/30/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The molecular basis of the D variant phenotype in the Chinese differs greatly from that of the Caucasian. Adapting a specific D typing strategy to the spectrum of prevalent RHD variant alleles is necessary. STUDY DESIGN AND METHODS Blood samples with ambiguous D phenotypes were collected in the Southern Chinese population. A special three-step typing strategy was applied. First, the common DVI type 3 was identified from epitope profiles of D antigen. Then, another common weak D type 15 (RHD*845A) was identified by epitope profiles of D antigen and Sanger sequencing of RHD exon 6. Finally, the remaining D variants were genotyped mainly by Sanger sequencing. For the novel RHD alleles in the coding region and exon-intron junction, in vitro transfection and minigene splicing assays were performed, respectively. The anti-D investigation was performed. RESULTS DVI type 3 (65/253, 25.7%) and weak D type 15 (62/253, 24.5%) were common Chinese D variants, and RHD*960A, DFR, RHD*weak D type 25, 72, and 136 were frequent variant RHD alleles. Besides, twenty-two sporadic and seven novel RHD alleles (RHD*188A; RHD*688C; RHD*782 T; RHD*1181C; RHD*165 T, 993A; RHD*148 + 3G > T and RHD*1227 + 5G > C) were identified. The deleterious effect of the novel RHD alleles on D antigen or mRNA expression was confirmed. Anti-D was detected in two DVI type 3 pregnant women. DISCUSSION The three-step typing strategy provides an effective approach for Chinese D variant typing. It can be anticipated that commercially available RHD genotyping kits have limitations for testing Chinese D variants, as some of the frequent variants are not interrogated.
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Affiliation(s)
- Jizhi Wen
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.,The Key Medical Laboratory of Guangzhou, Guangzhou, People's Republic of China
| | - Shuangshuang Jia
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.,The Key Medical Laboratory of Guangzhou, Guangzhou, People's Republic of China
| | - Zhen Wang
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.,The Key Medical Laboratory of Guangzhou, Guangzhou, People's Republic of China
| | - Jingwang Chen
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.,The Key Medical Laboratory of Guangzhou, Guangzhou, People's Republic of China
| | - Qianni Liang
- Department of Blood Transfusion, Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China
| | - Ling Wei
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.,The Key Medical Laboratory of Guangzhou, Guangzhou, People's Republic of China
| | | | - Yann Fichou
- Univ Brest, Inserm, EFS, UMR 1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Guangping Luo
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.,The Key Medical Laboratory of Guangzhou, Guangzhou, People's Republic of China
| | - Yanli Ji
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.,The Key Medical Laboratory of Guangzhou, Guangzhou, People's Republic of China
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Yin Q, Ouchari M. Transfusion management of Africans with RHD variants in China. Transfus Clin Biol 2023; 30:287-293. [PMID: 36702201 DOI: 10.1016/j.tracli.2023.01.003] [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: 12/14/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
The presence of D variant among minorities could produce a higher rate of alloimmunization observed in patients from this group. This is partly due to the ethnic and racial specificity of RHD variants and the limited availability of Rh-matched blood donors. Approximately half a million African migrants in China carrying distinct Rh blood type composition have presented to the health care system with an imperative safety requirement of blood transfusion among 1.3 billion Chinese individuals. We depict the clinically significant RHD alleles among African migrants living in China and identify the genetic similarities and disparities to Chinese. We discussed practical strategies to manage the unique transfusion needs of African migrants in China.
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Affiliation(s)
- Qinan Yin
- School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, Henan, China
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9
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Ohto H, Albert Flegel W, Safic Stanic H. When should RhD-negative recipients be spared the transfusion of DEL red cells to avoid anti-D alloimmunization? Transfusion 2022; 62:2405-2408. [PMID: 36156264 PMCID: PMC9643616 DOI: 10.1111/trf.17122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hitoshi Ohto
- Department of Mesenchymal Stem Cell Research, and Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Hana Safic Stanic
- Department of Immunohematology, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
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10
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Five-Years Review of RHCE Alleles Detected after Weak and/or Discrepant C Results in Southern France. Genes (Basel) 2022; 13:genes13061058. [PMID: 35741820 PMCID: PMC9222276 DOI: 10.3390/genes13061058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 02/04/2023] Open
Abstract
Immunohematology laboratories are regularly facing transfusion issues due to serological weaknesses. Altered (partial) RH antigens account for most of them. In some situations, RHCE variant alleles are involved. Herein we present our three-step molecular exploration, with allele frequencies, that has efficiently untangled RH2 phenotype weaknesses and discrepancies in our 2017–2021 cohort. In the last 5 years, the PACA Corse EFS molecular platform received 265 samples from healthy blood donors or patients with C and C/e typing difficulties. The first-intention technique (DNA array and real time PCR for RHCE*CeRN research) detected RHCE variant alleles in 143 cases (54%). The RHCE alleles classically found in African populations were the most frequent, with RHCE*CeRN allele in 40 cases (15%) and (C)ces haplotype type 1 and 2 in 26 cases (10%). A “CE” effect haplotype was suspected in 56 cases, due to the uncommon DCE haplotype that may explain the low C expression. When there were no RHCE*Ce or RHCE*CE alleles, we then searched for RHD polymorphisms by DNA array. We detected the RHD*DAU5 and RHD*DIVa in 18 and 7 cases respectively, suggesting that C ambiguity is related to the presence of these alleles which has never been described with DAU5. If no variant RHCE and RHD alleles were detected, we finally sequenced the 10 exons of both RHCE and RHD genes according to the clinical context and found seven new RHCE alleles. Thus, this molecular strategy would improve the knowledge of RHCE variants’ expression and, thus, optimize the transfusion management.
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Simtong P, Phothi R, Puapairoj C, Leelayuwat C, Romphruk AV. RHD 1227 A and hybrid Rhesus box analysis in Thai RhD+ and RhD- blood donors: Prevalence, RHD zygosity, and molecular screening. Transfus Apher Sci 2022; 61:103496. [DOI: 10.1016/j.transci.2022.103496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/18/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
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12
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Secondary alloanti-D immunization post transfusion of “Asia type” DEL red blood cells. Transfus Apher Sci 2022; 61:103458. [DOI: 10.1016/j.transci.2022.103458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022]
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Zhang J, Zeng Y, Wang Y, Fan J, Chen H, Yang D, Shi X, Xu H, Fu Z, Sheng F, Xuan J, Pan X, Zhang Z, Ai L, Zhang Y, Pan J, Zhao J, Wang M. RHD Genotypes in a Chinese Cohort of Pregnant Women. Front Genet 2022; 12:752485. [PMID: 34970297 PMCID: PMC8712876 DOI: 10.3389/fgene.2021.752485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/18/2021] [Indexed: 12/03/2022] Open
Abstract
RHD variants in D¯ Chinese pregnant women arose difficulties in management during pregnancy. Therefore, this study aims to precisely manage D¯ pregnant women by evaluating the spectrum of RHD mutations in D¯ pregnant women and getting insight into the possible rare alleles of RHD. A total of 76 D¯ pregnant women were analyzed by performing polymerase chain reactions with sequence-specific primers (PCR-SSP), the 10 RHD exons Sanger sequencing, RHD zygosity detection, and mRNA sequencing (mRNA-seq). About 40% of alleles are variations of RHD, including RHD 1227A homozygous, RHD-CE(2-9)-D, et al. Therefore, we developed a molecular diagnostic strategy for Chinese women, and most D¯ pregnant women can be diagnosed with this simple decision tree. After RHD genotyping for D¯ pregnancy women, we eliminated at least 15% unnecessary ante- and postpartum injections of Rh immunoglobulin (RhIG). As the first pedigree study and the first functional analysis under physiological conditions, mRNA-seq revealed that c.336-1G>A mutation mainly led to the inclusion of the intron 2, which indirectly explained the D¯ phenotype in this family. We also developed a robust protocol for determining fetal RhD status from maternal plasma. All 31 fetuses were predicted as RhD positive and confirmed the RhD status after birth.
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Affiliation(s)
- Jianjun Zhang
- Department of Blood Transfusion, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Yan Zeng
- Genetics Department, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Yuefeng Wang
- Department of Blood Transfusion, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Jiaming Fan
- Genetics Department, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Haijiang Chen
- Department of Blood Transfusion, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Dan Yang
- Department of Blood Transfusion, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Xiaoliang Shi
- Department of Obstetrics and Gynecology, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Hualin Xu
- Department of Obstetrics and Gynecology, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Zimu Fu
- Department of Gynecological Protection, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Fang Sheng
- Department of Gynecological Protection, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Jie Xuan
- Department of Gynecological Protection, Shaoxing Maternal and Child Health Hospital, Shaoxing, China
| | - Xiaoxi Pan
- Tianjin Super Biotechnology Developing Co., Ltd., Tianjin, China
| | - Zhiming Zhang
- Tianjin Super Biotechnology Developing Co., Ltd., Tianjin, China
| | - Liping Ai
- Tianjin Super Biotechnology Developing Co., Ltd., Tianjin, China
| | - Yue Zhang
- Tianjin Super Biotechnology Developing Co., Ltd., Tianjin, China
| | - Jingjing Pan
- Zhejiang Biosan Biotechnology Co., Ltd., Hangzhou, China
| | - Jing Zhao
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Mingming Wang
- Zhejiang Biosan Biotechnology Co., Ltd., Hangzhou, China
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14
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Ito S, Ohto H, Ogiyama Y, Irino M, Omokawa S, Shibasaki I, Ogasawara K, Uchikawa M, Nollet KE, Flegel WA. A practical and effective strategy in East Asia to prevent anti-D alloimmunization in patients by C/c phenotyping of serologic RhD-negative blood donors. EJHAEM 2021; 2:750-756. [PMID: 35757680 PMCID: PMC9175983 DOI: 10.1002/jha2.292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Serologic RhD‐negative red cells can cause anti‐D alloimmunization if they carry the Asian‐type DEL or other DEL variants. RHD genotyping is a viable countermeasure if available, but inexpensive alternatives are worthy of consideration. RhD‐negative blood donors in Japan were studied by anti‐D adsorption‐elution and RHD genotyping. We collated published case reports of RhD‐negative red cell transfusions associated with inexplicable anti‐D immunization. Of 2754 serologic RhD‐negative donors, 378 were genotyped D/d. Anti‐D adsorption‐elution revealed 63.5% (240 of 378) to be DEL, of whom 96.7% (232 of 240) had the 1227G > A variant, diagnostic for the Asian‐type DEL. All 240 donors also carried at least one C antigen; none had a cc phenotype. The chance of transfusing DEL red cells to genuinely RhD‐negative Asian patients (based on a three‐unit transfusion) ranges from 16.7% in Korea to 69.4% in Taiwan, versus 0.6% in Germany. Among 22 RhD‐negative recipients of serologic RhD‐negative red cells, who produced new or increased anti‐D antibody titers, all 17 from East Asia were transfused with red cells with a C‐positive phenotype or known to be Asian‐type DEL or both. Serologic RhD‐negative East Asians with a cc phenotype can be red cell donors for RhD‐negative recipients, especially those of childbearing potential.
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Affiliation(s)
- Shoichi Ito
- Japanese Red Cross Tohoku Block Blood Center, Sendai, Japan
| | | | | | - Michiyo Irino
- Japanese Red Cross Tohoku Block Blood Center, Sendai, Japan
| | - Susumu Omokawa
- Japanese Red Cross Tohoku Block Blood Center, Sendai, Japan
| | | | | | - Makoto Uchikawa
- Japanese Red Cross Kanto-Koshinetsu Block Blood Center, Tokyo, Japan
| | - Kenneth E Nollet
- Department of Blood Transfusion and Transplantation Immunology Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Willy A Flegel
- National Institutes of Health NIH Clinical Center Department of Transfusion Medicine, Bethesda, Maryland, USA
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15
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Yin Q, Flegel WA. DEL in China: the D antigen among serologic RhD-negative individuals. J Transl Med 2021; 19:439. [PMID: 34670559 PMCID: PMC8527646 DOI: 10.1186/s12967-021-03116-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/21/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Providing RhD-negative red cell transfusions is a challenge in East Asia, represented by China, Korea, and Japan, where the frequency of RhD-negative is the lowest in the world. FINDINGS Among 56 ethnic groups in China, the RhD-negative frequency in Han, the prevalent ethnicity, is 0.5% or less, similar to most other ethnic groups. The Uyghur ethnic group has the highest reported RhD-negative frequency of up to 4.7%, as compared to 13.9% in the US. However, an estimated 7.15 million RhD-negative people live in China. The RhD-negative phenotype typically results from a loss of the entire RHD gene, causing the lack of the RhD protein and D antigen. The DEL phenotype carries a low amount of the D antigen and types as RhD-negative in routine serology. The DEL prevalence in RhD-negative individuals averages 23.3% in the Han, 17% in the Hui and 2.4% in the Uyghur ethnicities. The Asian type DEL, also known as RHD*DEL1 and RHD:c.1227G > A allele, is by far the most prevalent among the 13 DEL alleles observed in China. CONCLUSION The purpose of this review is to summarize the data on DEL and to provide a basis for practical strategy decisions in managing patients and donors with DEL alleles in East Asia using molecular assays.
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Affiliation(s)
- Qinan Yin
- Laboratory Services Section, Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
- Henan University of Science and Technology, Luoyang, Henan, China
| | - Willy Albert Flegel
- Laboratory Services Section, Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.
- Huazhong University of Science and Technology, Wuhan, Hubei, China.
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16
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Sadeghi-Bojd Y, Amirizadeh N, Oodi A. RHD Genotyping of Rh-Negative and Weak D Phenotype among Blood Donors in Southeast Iran. Int J Hematol Oncol Stem Cell Res 2021; 15:213-220. [PMID: 35291662 PMCID: PMC8888359 DOI: 10.18502/ijhoscr.v15i4.7476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/31/2020] [Indexed: 11/29/2022] Open
Abstract
Background: The D antigen is a subset of Rh blood group antigens involved in the hemolytic disease of the newborn [HDFN] and hemolytic transfusion reaction [HTR]. The hybrid Rhesus box that was created after RH gene deletion, was known as a mechanism of the Rh-negative phenotype. Hybrid marker identification is used to confirm the deletion of the RHD gene and to determine zygosity. This study aims to detect this marker in Rh-negative and weak D phenotype blood donors of the southeast of Iran. Materials and Methods: The molecular analysis of the hybrid Rhesus box was performed on the 200 Rh-negative blood donors in Sistan and Baluchestan province, southeast Iran. The presence of alleles responsible for the D variants was assessed by DNA sequencing in 26 weak D phenotype donors. Results: Of the 200 Rh-negative blood samples, 198 samples were homozygous (99%), and two samples were heterozygous (1%). Heterozygous samples had RHD*01N.73 allele and the RHD*01N.18 allele. Of the 26 samples with weak D phenotype, 16 partial DLO (61%), 4 partial DBT1 (15.3%), 2 partial DV type 2 (7.7%), 1 weak D type 1, 1 weak D type 4.2.3, 1weak D type 105 and 1 RHD (S103P) (4%) were determined. Conclusion: Since RHD gene deletion is the main mechanism of the Rh-negativity in Sistan and Baluchestan provinces, a hybrid Rhesus box marker can be used in resolving RhD typing discrepancies by RHD genotyping methods.
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Affiliation(s)
- Younes Sadeghi-Bojd
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Naser Amirizadeh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Arezoo Oodi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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17
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Flegel WA. Proceed with care: the "uncommon" serologic weak D phenotypes. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2021; 19:272-276. [PMID: 34704554 PMCID: PMC8297679 DOI: 10.2450/2021.0147-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, United States of America
- Huazhong University of Science and Technology, Wuhan, Hubei, China
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18
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Next-generation sequencing of 35 RHD variants in 16 253 serologically D- pregnant women in the Finnish population. Blood Adv 2021; 4:4994-5001. [PMID: 33057632 DOI: 10.1182/bloodadvances.2020001569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022] Open
Abstract
Fetal RHD screening for targeted routine antenatal anti-D prophylaxis has been implemented in many countries, including Finland, since the 2010s. Comprehensive knowledge of the RHD polymorphism in the population is essential for the performance and safety of the anti-D prophylaxis program. During the first 3 years of the national screening program in Finland, over 16 000 samples from RhD- women were screened for fetal RHD; among them, 79 samples (0.5%) containing a maternal variant allele were detected. Of the detected maternal variants, 35 cases remained inconclusive using the traditional genotyping methods and required further analysis by next-generation sequencing (NGS) of the whole RHD gene to uncover the variant allele. In addition to the 13 RHD variants that have been previously reported in different populations, 8 novel variants were also detected, indicating that there is more variation of RHD in the RhD- Finnish population than has been previously known. Three of the novel alleles were identified in multiple samples; thus, they are likely specific to the original Finnish population. National screening has thus provided new information about the diversity of RHD variants in the Finnish population. The results show that NGS is a powerful method for genotyping the highly polymorphic RHD gene compared with traditional methods that rely on the detection of specific nucleotides by polymerase chain reaction amplification.
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19
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Srivastava K, Albasri J, Alsuhaibani OM, Aljasem HA, Bueno MU, Antonacci T, Branch DR, Denomme GA, Flegel WA. SCAR: The high-prevalence antigen 013.008 in the Scianna blood group system. Transfusion 2021; 61:246-254. [PMID: 33098316 PMCID: PMC9067365 DOI: 10.1111/trf.16152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/31/2020] [Accepted: 09/24/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Scianna (SC) blood group system comprises seven antigens. They reside on the erythroblast membrane-associated glycoprotein (ERMAP). The ERMAP and RHCE genes are juxtaposed to each other on chromosome 1. We report a novel SC antigen. STUDY DESIGN AND METHODS Blood samples came from a patient and his two sisters in Saudi Arabia. To investigate the antibody specificity we used the column agglutination technique and soluble recombinant ERMAP protein. The significance of anti-SCAR was evaluated by the transfusion history and a monocyte monolayer assay. We determined the genomic sequence of ERMAP and RHCE genes. RESULTS The patient's serum showed an antibody of titer 8 against a high-prevalence antigen. The soluble recombinant ERMAP protein inhibited the antibody. The propositus genotyped homozygous for an ERMAP:c.424C>G variant, for which his sisters were heterozygous. The c.424C>G variant occurred in the SC*01 allele in one haplotype with the RHCE*03 (RHCE*cE) allele. No signs of hemolysis occurred following an incompatible blood transfusion. The monocyte monolayer assay was negative. CONCLUSIONS We characterized a high-prevalence antigen, with the proposed name "SCAR," which is the eighth antigen of the Scianna blood group system (proposed designation 013.008). Individuals homozygous for ERMAP:p.(Gln142Glu) protein variant can produce anti-SCAR. Although we did not observe any sign of hemolysis at this time, the anti-SCAR prompted a change of the treatment regimen. A review of the known reports indicated that all SC alloantibodies of sufficient titer should be considered capable of causing hemolysis.
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Affiliation(s)
- Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Jasem Albasri
- Blood Bank Laboratory, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Omar M. Alsuhaibani
- Blood Bank Laboratory, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hassan A. Aljasem
- Blood Bank Laboratory, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Marina U. Bueno
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Tania Antonacci
- Versiti Blood Research Institute and Diagnostic Laboratories, Versiti, Milwaukee, Wisconsin
| | - Donald R. Branch
- Department of Medicine, University of Toronto, and Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada
| | - Gregory A. Denomme
- Versiti Blood Research Institute and Diagnostic Laboratories, Versiti, Milwaukee, Wisconsin
| | - Willy A. Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
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20
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Deng D, Deng G, He Y, Yu Y. Identification of a novel c.94dupA mutation in RHD allele. Transfusion 2020; 60:E53-E54. [PMID: 33140446 DOI: 10.1111/trf.16173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/08/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Danfei Deng
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Gang Deng
- The Institute of Blood Transfusion of Ningbo Central Blood Station, Ningbo, China
| | - Yunlei He
- The Institute of Blood Transfusion of Ningbo Central Blood Station, Ningbo, China
| | - Yong Yu
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
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21
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Flegel WA, Srivastava K. Frameshift variations in the RHD coding sequence: Molecular mechanisms permitting protein expression. Transfusion 2020; 60:2737-2744. [PMID: 33037655 DOI: 10.1111/trf.16123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/08/2020] [Accepted: 07/17/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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22
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Safic Stanic H, Dogic V, Herceg I, Jagnjic S, Bingulac‐Popovic J, Babic I, Corusic A, Jukic I. D variants in the population of D‐negative blood donors in the north‐eastern region of Croatia. Transfus Med 2020; 31:43-47. [DOI: 10.1111/tme.12726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Hana Safic Stanic
- Department of Molecular Diagnostics Croatian Institute of Transfusion Medicine Zagreb Croatia
| | - Vesna Dogic
- Department of Molecular Diagnostics Croatian Institute of Transfusion Medicine Zagreb Croatia
| | - Ivona Herceg
- Department of Molecular Diagnostics Croatian Institute of Transfusion Medicine Zagreb Croatia
| | - Sandra Jagnjic
- Department of Immunohematology Croatian Institute of Transfusion Medicine Zagreb Croatia
| | - Jasna Bingulac‐Popovic
- Department of Molecular Diagnostics Croatian Institute of Transfusion Medicine Zagreb Croatia
| | - Ivana Babic
- Department of Molecular Diagnostics Croatian Institute of Transfusion Medicine Zagreb Croatia
| | - Ante Corusic
- Directory University Hospital Centre Zagreb Zagreb Croatia
- School of Medicine University of Zagreb Zagreb Croatia
| | - Irena Jukic
- Medical Department Croatian Institute of Transfusion Medicine Zagreb Croatia
- Faculty of Medicine Josip Juraj Strossmayer University of Osijek Osijek Croatia
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23
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Anani WQ, Gorlin J, Denomme GA. Anti-D selection for D assignment among pregnant women and blood donors: impact of the Crawford antigen. Transfusion 2020; 60:1378-1380. [PMID: 32472570 DOI: 10.1111/trf.15803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Waseem Q Anani
- Diagnostic Laboratories, Versiti, Wisconsin, USA
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jed Gorlin
- Innovative Blood Resources, Minneapolis, Minnesota, USA
| | - Gregory A Denomme
- Diagnostic Laboratories, Versiti, Wisconsin, USA
- Blood Research Institute, Versiti, Wisconsin, USA
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24
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25
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Serological Detection of Rh-Del Phenotype among Rh-Negative Blood Donors at National Blood Center, Yangon, Myanmar. Adv Hematol 2020; 2020:3482124. [PMID: 32148507 PMCID: PMC7049430 DOI: 10.1155/2020/3482124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/16/2020] [Indexed: 11/21/2022] Open
Abstract
Background Red cell Rhesus (Rh) antigen expression is influenced by the genetic polymorphism of RHD and RHCE genes and reveals serologically different reactions of RhD variants such as partial D, weak D, and Rh-Del. Serologically, Rh-Del type can only be detected by an adsorption-elution technique, and it might be mistyped as Rh-negative. The prevalence of Rh-Del has not been reported yet in Myanmar. Method A total of 222 Rh-negative blood donors in the National Blood Center were tested for weak D and Rh-Del by indirect antihuman globulin and adsorption-elution method, respectively. RhCE typing was performed among Rh-negative and Rh-Del. Results Of them, 75.2% (167/222) were Rh-negative, 15.8% (35/222) were Rh-Del, and 9% (20/222) were weak D. Of 202 blood donors (167 true Rh-negative and 35 Rh-Del), all of the Rh-Del positives were C-antigen-positive with 94.3% Ccee phenotype (33/35) and 5.7% CCee (2/35). Most of the Rh-negative donors (80.2%) were ccee phenotype (134/167). Conclusion About half of Rh-Del subjects were repeated donors, and attention was needed to avoid transfusion of truly Rh-negative patients to prevent alloimmunization. It is recommended to do Rh-Del typing of Rh-negative donors who are C-antigen-positive and consider moving them to the Rh-positive pool. Further study is needed to clarify the alloimmunization status for transfusion of Rh-Del blood to Rh-negative recipients. Molecular markers for RhD-negative and D variants should be established in the Myanmar population to improve selection of antisera for Rh typing and enhance safety of the transfusion services.
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26
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Fürst D, Tsamadou C, Neuchel C, Schrezenmeier H, Mytilineos J, Weinstock C. Next-Generation Sequencing Technologies in Blood Group Typing. Transfus Med Hemother 2019; 47:4-13. [PMID: 32110189 DOI: 10.1159/000504765] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/07/2019] [Indexed: 12/14/2022] Open
Abstract
Sequencing of the human genome has led to the definition of the genes for most of the relevant blood group systems, and the polymorphisms responsible for most of the clinically relevant blood group antigens are characterized. Molecular blood group typing is used in situations where erythrocytes are not available or where serological testing was inconclusive or not possible due to the lack of antisera. Also, molecular testing may be more cost-effective in certain situations. Molecular typing approaches are mostly based on either PCR with specific primers, DNA hybridization, or DNA sequencing. Particularly the transition of sequencing techniques from Sanger-based sequencing to next-generation sequencing (NGS) technologies has led to exciting new possibilities in blood group genotyping. We describe briefly the currently available NGS platforms and their specifications, depict the genetic background of blood group polymorphisms, and discuss applications for NGS approaches in immunohematology. As an example, we delineate a protocol for large-scale donor blood group screening established and in use at our institution. Furthermore, we discuss technical challenges and limitations as well as the prospect for future developments, including long-read sequencing technologies.
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Affiliation(s)
- Daniel Fürst
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg/Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Chrysanthi Tsamadou
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg/Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Christine Neuchel
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg/Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Hubert Schrezenmeier
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg/Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Joannis Mytilineos
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg/Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Christof Weinstock
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg/Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
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27
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de Paula Vendrame TA, Prisco Arnoni C, Guilhem Muniz J, de Medeiros Person R, Pereira Cortez AJ, Roche Moreira Latini F, Castilho L. Characterization of RHD alleles present in serologically RHD-negative donors determined by a sensitive microplate technique. Vox Sang 2019; 114:869-875. [PMID: 31587310 DOI: 10.1111/vox.12851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/15/2019] [Accepted: 09/08/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Weak D phenotypes with very low antigen densities and DEL phenotype may not be detected in RhD typing routine and could be typed as D-negative, leading to D alloimmunization of D-negative recipients. The present study aimed to investigate the presence of RHD-positive genotypes in blood donors typed as D-negative by an automated system using the solid-phase methodology as a confirmatory test. METHODS Two screenings were performed in different selected donor populations. For the first screening, we selected 1403 blood donor samples typed as D-negative regardless of the CE status, and in the second screening, we selected 517 donor samples typed as D-negative C+ and/or E+. RhD typing was performed by microplate in an automated equipment (Neo-Immucor®), and the confirmatory test was performed by solid-phase technique using Capture R® technology. A multiplex PCR specific to RHD and RHDψ was performed in a pool of 6 DNA samples. Sequencing of RHD exons was performed in all RHD-positive samples, and a specific PCR was used to identify the D-CE(4-7)-D hybrid gene. RESULTS AND CONCLUSION No weak D type was found in either screening populations. Additionally, 353 (18·4%) D-negative samples presented previously reported non-functional RHD genes, 2 samples had a DEL allele, and 6 samples demonstrated new alleles, including one novel DEL allele. Our study identified six new RHD alleles and showed that the inclusion of a confirmatory test using serological methodology with high sensitivity can reduce the frequency of weak D samples typed as D-negative.
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28
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Abstract
Red blood cell (RBC) antigen phenotyping is an essential component of transfusion compatibility testing. Serology has been the gold standard method, but its low throughput and risk of diagnostic interference in certain situations limits its applicability. Genotyping is useful for phenotyping in these cases, providing a high-throughput and reliable alternative to serology. Genotyping is indicated in several hematology and oncology patient populations. Because genotyping requires a complex testing environment and bears an additional risk of genotype-phenotype discrepancy, its use is currently limited, but it serves as a useful adjunct and may eventually supplant serology as a new gold standard.
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Affiliation(s)
- Ronald Jackups
- Department of Pathology & Immunology, Washington University School of Medicine, 660 South Euclid Avenue #8118, St Louis, MO 63110, USA.
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29
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Kim TY, Hong YJ, Kim MJ, Kim H, Kim TS, Park JS, Park KU, Han KS. Recommendations Regarding Practical DEL Typing Strategies for Serologically D-Negative Asian Donors. Transfus Med Hemother 2019; 47:88-93. [PMID: 32110199 DOI: 10.1159/000500098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/31/2019] [Indexed: 12/25/2022] Open
Abstract
Background DEL, the weakest D variant, is mistyped as D-negative by routine serological assays. Transfusion of red blood cells expressing the DEL phenotype has the potential to elicit anti-D alloimmunization in D-negative recipients. The goal of this study was to recommend DEL typing strategies for serologically D-negative Asian donors. Methods RhCE phenotyping and the adsorption-elution test were performed on 674 serologically D-negative samples. RHD genotyping using real-time polymerase chain reaction and melting curve analysis were also undertaken to identify DEL alleles. Costs and turnaround time of RhCE phenotyping, the adsorption-elution test, and RHD genotyping were estimated. Results Sensitivity and specificity of the adsorption-elution test for serologically D-negative samples were 94.9% (93/98) and 91.5% (527/576), respectively. C+ phenotypes were detected in all 98 samples with DEL alleles. Despite comparable costs, RHD genotyping was more accurate and rapid than the adsorption-elution test. Conclusions Two practical DEL typing strategies using RhCE phenotyping as an initial screening method were recommended for serologically D-negative Asian donors. Compared with DEL typing using RHD genotyping, serological DEL typing using adsorption-elution test is predicted to increase the incidence of anti-D alloimmunization and decrease the D-negative donor pool without having any cost-competitiveness but can be used in laboratories where molecular methods are not applicable.
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Affiliation(s)
- Tae Yeul Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yun Ji Hong
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Mi Jung Kim
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyungsuk Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Su Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyou-Sup Han
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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30
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Perez‐Alvarez I, Hayes C, Hailemariam T, Shin E, Hutchinson T, Klapper E. RHDgenotyping of serologic RhD‐negative blood donors in a hospital‐based blood donor center. Transfusion 2019; 59:2422-2428. [DOI: 10.1111/trf.15325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 03/10/2019] [Accepted: 03/20/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ingrid Perez‐Alvarez
- Department of Pathology, Division of Transfusion MedicineUniversity of California Irvine Medical Center Irvine California
| | - Chelsea Hayes
- Department of Pathology, Division of Transfusion MedicineCedars‐Sinai Medical Center Los Angeles California
| | | | | | | | - Ellen Klapper
- Department of Pathology, Division of Transfusion MedicineCedars‐Sinai Medical Center Los Angeles California
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Sandler SG, Flegel WA. Does transfusion of Asian-type DEL red blood cells to D- recipients cause D alloimmunization? Transfusion 2019; 59:2455-2458. [PMID: 31008519 DOI: 10.1111/trf.15323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/20/2019] [Accepted: 03/01/2019] [Indexed: 12/17/2022]
Affiliation(s)
- S Gerald Sandler
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Willy A Flegel
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC.,Department of Laboratory Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
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Abstract
Genomics is affecting all areas of medicine. In transfusion medicine, DNA-based genotyping is being used as an alternative to serological antibody-based methods to determine blood groups for matching donor to recipient. Most antigenic polymorphisms are due to single nucleotide polymorphism changes in the respective genes, and DNA arrays that target these changes have been validated by comparison with antibody-based typing. Importantly, the ability to test for antigens for which there are no serologic reagents is a major medical advance to identify antibodies and find compatible donor units, and can be life-saving. This review summarizes the evolving use and applications of genotyping for red cell and platelet blood group antigens affecting several areas of medicine. These include prenatal medicine for evaluating risk of fetal or neonatal disease and candidates for Rh-immune globulin; transplantation for bone marrow donor selection and transfusion support for highly alloimmunized patients and for confirmation of A2 status of kidney donors; hematology for comprehensive typing for patients with anemia requiring chronic transfusion; and oncology for patients receiving monoclonal antibody therapies that interfere with pretransfusion testing. A genomics approach allows, for the first time, the ability to routinely select donor units antigen matched to recipients for more than ABO/RhD to reduce complications. Of relevance, the growth of whole-genome sequencing in chronic disease and for general health will provide patients' comprehensive extended blood group profile as part of their medical record to be used to inform selection of the optimal transfusion therapy.
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Choi S, Chun S, Lee HT, Yu H, Seo JY, Cho D. Weak D Testing is not Required for D- Patients With C-E- Phenotype. Ann Lab Med 2018; 38:585-590. [PMID: 30027703 PMCID: PMC6056382 DOI: 10.3343/alm.2018.38.6.585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/27/2017] [Accepted: 05/30/2018] [Indexed: 12/05/2022] Open
Abstract
Background Although testing to detect weak D antigens using the antihuman globulin reagent is not required for D− patients in many countries, it is routinely performed in Korea. However, weak D testing can be omitted in D− patients with a C−E− phenotype as this indicates complete deletion of the RHD gene, except in rare cases. We designed a new algorithm for weak D testing, which consisted of RhCE phenotyping followed by weak D testing in C+ or E+ samples, and compared it with the current algorithm with respect to time and cost-effectiveness. Methods In this retrospective study, 74,889 test results from January to July 2017 in a tertiary hospital in Korea were analyzed. Agreement between the current and proposed algorithms was evaluated, and total number of tests, time required for testing, and test costs were compared. With both algorithms, RHD genotyping was conducted for samples that were C+ or E+ and negative for weak D testing. Results The algorithms showed perfect agreement (agreement=100%; κ=1.00). By applying the proposed algorithm, 29.56% (115/389 tests/yr) of tests could be omitted, time required for testing could be reduced by 36% (8,672/24,084 min/yr), and the test cost could be reduced by 16.53% (536.11/3,241.08 USD/yr). Conclusions Our algorithm omitting weak D testing in D− patients with C−E− phenotype may be a cost-effective testing strategy in Korea.
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Affiliation(s)
- Sooin Choi
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sejong Chun
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hwan Tae Lee
- Department of Laboratory Medicine Gachon University Gil Medical Center, Incheon, Korea
| | - HongBi Yu
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Ji Young Seo
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duck Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea.
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34
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Khosroshahi BN, Oodi A, Namjou S, Gholamali T, Amirizadeh N. RHD Genotyping by Molecular Analysis of Hybrid Rhesus box in RhD-Negative Blood Donors from Iran. Indian J Hematol Blood Transfus 2018; 35:119-124. [PMID: 30828158 PMCID: PMC6369079 DOI: 10.1007/s12288-018-0992-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/19/2018] [Indexed: 01/05/2023] Open
Abstract
D antigen is the most important and immunogenic antigen of the Rh blood group. The RhD-negative phenotype has different genetic backgrounds with variable distribution in different populations. Hybrid Rhesus box, resulting from RHD gene deletion, is used in genotyping studies of the Rh blood group as a marker to identify the RHD gene deletion. This study for the first time identified genetic mechanisms for the occurrence of RhD-negative phenotype among the Iranian population. 200 RhD-negative blood donors were randomly selected from Tehran Blood Transfusion Center. The phenotype of D, C, Ε, e and c antigens was serologically identified, and DNA was extracted from buffy coat. The molecular analysis of hybrid Rhesus box was performed by PCR-SSP and PCR-RFLP. Moreover, the presence of different exons of RHD gene was investigated by real-time PCR on extracted DNA. Hybrid Rhesus box was detected in all samples, and PCR-RFLP confirmed that 198 (99%) were homozygous for an RHD gene deletion and 2 were heterozygous for hybrid Rhesus box in which one (0.5%) had a weak D type 11 and the other one (0.5%) had a RHD-CE (2-9)-D2 hybrid allele. Similar to Caucasians, the frequency of RHD gene deletion was high among the Iranian population studied in this investigation, so hybrid Rhesus box can be used as an efficient marker to detect RHD gene deletion in our population.
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Affiliation(s)
- Behzad Nazel Khosroshahi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Hemmat Highway, Next to the Milad Tower, Tehran, Iran
| | - Arezoo Oodi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Hemmat Highway, Next to the Milad Tower, Tehran, Iran
| | - Saba Namjou
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Hemmat Highway, Next to the Milad Tower, Tehran, Iran
| | - Tahereh Gholamali
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Hemmat Highway, Next to the Milad Tower, Tehran, Iran
| | - Naser Amirizadeh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Hemmat Highway, Next to the Milad Tower, Tehran, Iran
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Dezan MR, Oliveira VB, Gomes ÇN, Luz F, Gallucci AJ, Bonifácio SL, Alencar CS, Sabino EC, Pereira AC, Krieger JE, Rocha V, Mendrone-Junior A, Dinardo CL. High frequency of variant RHD genotypes among donors and patients of mixed origin with serologic weak-D phenotype. J Clin Lab Anal 2018; 32:e22596. [PMID: 29943480 DOI: 10.1002/jcla.22596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/31/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The current transfusion policy recommended for individuals with serologic weak-D phenotype is based on data derived from European-descent populations. Data referring to the distribution of RH alleles underlying weak-D phenotype among people of mixed origin are yet incomplete, and the applicability of European-based transfusion guidelines to this specific population is questionable. GOAL To evaluate the distribution of RHD variant genotype among individuals with serologic weak-D phenotype of both African and European descent. METHODS Donors and patients of mixed origin and with serologic weak-D phenotype were selected for the study. They were investigated using conventional RHD-PCR assays and RHD whole-coding region direct sequencing. RESULTS One hundred and six donors and 58 patients were included. There were 47 donors and 29 patients with partial-D genotype (47/106, 44.3%, and 29/58, 50%, respectively). RHD*DAR and RHD*weak D type 38 represented the most common altered RHD alleles among donors (joint frequency of 39.6%), while weak D types 1-3 accounted for 10.4% of the total D variant samples. RHD*DAR was the most common allele identified in the patient group (frequency of 31%), and weak D types 1-3 represented 29.3% of the total. CONCLUSION The frequency of partial D among mixed individuals with serologic weak-D phenotype is high. They should be managed as D-negative patients until molecular tests are complete.
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Affiliation(s)
- Marcia Regina Dezan
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil
| | - Valéria B Oliveira
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil
| | - Çarolina Nunes Gomes
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil
| | - Fabio Luz
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil
| | - Antônio J Gallucci
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil
| | - Silvia L Bonifácio
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil
| | - Cecília Salete Alencar
- Laboratório de Medicina Laboratorial, Divisão de Laboratório Central Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ester C Sabino
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), São Paulo, Brazil
| | - Jose E Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), São Paulo, Brazil
| | - Vanderson Rocha
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil.,Discipline of Hematology, University of São Paulo School of Medicine, São Paulo, Brazil.,Churchill Hospital, NHSBT, Oxford University, Oxford, UK
| | | | - Carla L Dinardo
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil.,Laboratório de Medicina Laboratorial, Divisão de Laboratório Central Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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36
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Kulkarni SS, Gogri H, Parchure D, Mishra G, Ghosh K, Rajadhyaksha S, Madkaikar M, Férec C, Fichou Y. RHD-Positive Alleles among D- C/E+ Individuals from India. Transfus Med Hemother 2018; 45:173-177. [PMID: 29928172 DOI: 10.1159/000479239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/05/2017] [Indexed: 01/06/2023] Open
Abstract
Background Molecular bases of blood group systems, including Rh blood group, have been poorly studied in the Indian population so far, while specificities of Europeans, East Asians and Africans have been well known for years. In order to gain insights into the molecular bases of this population, we sought to characterize the RHD allele in D- Indian donors expressing C and/or E antigen(s). Methods RHD gene was analyzed in 171 serologically D-, C/E+ samples by standard molecular methods such as quantitative, multiplex PCR of short fluorescent fragments (QMPSF) and direct sequencing when necessary. Results RHD whole gene deletion at the homozygous state was found to be the most common genotype associated with D- phenotype (118/171, 69.0%). Nonfunctional, negative hybrid genes with reported molecular backgrounds were observed in approximately one-third of the samples, while only four samples carry single-nucleotide variations, including one novel nonsense (RHD(Y243X)), one novel frameshift (RHD(c.701delG)), and two missense (RHD(T148R) and RHD(T148R, T195M)) alleles. Conclusion Overall we report for the first time the molecular bases of D antigen negativity in the D-, C/E+ Indian population, which appears to be qualitatively similar to other populations, but with a population-specific, quantitative distribution of D-- alleles.
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Affiliation(s)
- Swati S Kulkarni
- National Institute of Immunohematology, Indian Council of Medical Research (NIIH-ICMR), Mumbai, India
| | - Harita Gogri
- National Institute of Immunohematology, Indian Council of Medical Research (NIIH-ICMR), Mumbai, India
| | - Disha Parchure
- National Institute of Immunohematology, Indian Council of Medical Research (NIIH-ICMR), Mumbai, India
| | - Garima Mishra
- National Institute of Immunohematology, Indian Council of Medical Research (NIIH-ICMR), Mumbai, India
| | - Kanjaksha Ghosh
- National Institute of Immunohematology, Indian Council of Medical Research (NIIH-ICMR), Mumbai, India
| | - Sunil Rajadhyaksha
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, India
| | - Manisha Madkaikar
- National Institute of Immunohematology, Indian Council of Medical Research (NIIH-ICMR), Mumbai, India
| | - Claude Férec
- Institut National de la Santé et de la Recherche Médicale (Inserm), UMR1078, Brest, France.,Etablissement français du sang Bretagne, Brest, France.,Laboratoire de Génétique Moléculaire et d'Histocompatibilité, Centre Hospitalier Régional Universitaire (CHRU), Hôpital Morvan, Brest, France.,Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale (UBO), Brest, France
| | - Yann Fichou
- Institut National de la Santé et de la Recherche Médicale (Inserm), UMR1078, Brest, France.,Etablissement français du sang Bretagne, Brest, France
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37
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Srivastava K, Stiles DA, Wagner FF, Flegel WA. Two large deletions extending beyond either end of the RHD gene and their red cell phenotypes. J Hum Genet 2018; 63:27-35. [PMID: 29215093 PMCID: PMC5764804 DOI: 10.1038/s10038-017-0345-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 01/22/2023]
Abstract
Only two partial deletions longer than 655 nucleotides had been reported for the RHD gene, constrained within the gene and causing DEL phenotypes. Using a combination of quantitative PCR and long-range PCR, we examined three distinct deletions affecting parts of the RHD gene in three blood donors. Their RHD nucleotide sequences and exact boundaries of the breakpoint regions were determined. DEL phenotypes were caused by a novel 18.4 kb deletion and a previously published 5.4 kb deletion of the RHD gene; a D-negative phenotype was caused by a novel 7.6 kb deletion. Examination of the deletion-flanking regions suggested microhomology-mediated end-joining, replication slippage, and non-homologous end-joining, respectively, as the most likely mechanisms for the three distinct deletions. We described two new deletions affecting parts of the RHD gene, much longer than any previously reported partial deletion: one was the first deletion observed at the 5' end of the RHD gene extending into the intergenic region, and the other the second deletion observed at its 3' end. Large deletions present at either end are a mechanism for a much reduced RhD protein expression or its complete loss. Exact molecular characterization of such deletions is instrumental for accurate RHD genotyping.
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Affiliation(s)
- Kshitij Srivastava
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, MSC 1184, 10 Center Drive, Bethesda, 20892, MD, USA
| | - David Alan Stiles
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, MSC 1184, 10 Center Drive, Bethesda, 20892, MD, USA
| | - Franz Friedrich Wagner
- Red Cross Blood Service NSTOB, Institute Springe, Eldagsener Strasse 38, 31830, Springe, Germany
| | - Willy Albert Flegel
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, MSC 1184, 10 Center Drive, Bethesda, 20892, MD, USA.
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38
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Lopez GH, Turner RM, McGowan EC, Schoeman EM, Scott SA, O'Brien H, Millard GM, Roulis EV, Allen AJ, Liew YW, Flower RL, Hyland CA. A DEL phenotype attributed to RHD Exon 9 sequence deletion: slipped-strand mispairing and blood group polymorphisms. Transfusion 2017; 58:685-691. [PMID: 29214630 DOI: 10.1111/trf.14439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The RhD blood group antigen is extremely polymorphic and the DEL phenotype represents one such class of polymorphisms. The DEL phenotype prevalent in East Asian populations arises from a synonymous substitution defined as RHD*1227A. However, initially, based on genomic and cDNA studies, the genetic basis for a DEL phenotype in Taiwan was attributed to a deletion of RHD Exon 9 that was never verified at the genomic level by any other independent group. Here we investigate the genetic basis for a Caucasian donor with a DEL partial D phenotype and compare the genomic findings to those initial molecular studies. STUDY DESIGN AND METHODS The 3'-region of the RHD gene was amplified by long-range polymerase chain reaction (PCR) for massively parallel sequencing. Primers were designed to encompass a deletion, flanking Exon 9, by standard PCR for Sanger sequencing. Targeted sequencing of exons and flanking introns was also performed. RESULTS Genomic DNA exhibited a 1012-bp deletion spanning from Intron 8, across Exon 9 into Intron 9. The deletion breakpoints occurred between two 25-bp repeat motifs flanking Exon 9 such that one repeat sequence remained. CONCLUSION Deletion mutations bordered by repeat sequences are a hallmark of slipped-strand mispairing (SSM) event. We propose this genetic mechanism generated the germline deletion in the Caucasian donor. Extensive studies show that the RHD*1227A is the most prevalent DEL allele in East Asian populations and may have confounded the initial molecular studies. Review of the literature revealed that the SSM model explains some of the extreme polymorphisms observed in the clinically significant RhD blood group antigen.
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Affiliation(s)
- Genghis H Lopez
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Robyn M Turner
- Red Cell Reference Laboratory, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Eunike C McGowan
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Elizna M Schoeman
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Stacy A Scott
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Helen O'Brien
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Glenda M Millard
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Eileen V Roulis
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Amanda J Allen
- Medical Services, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Yew-Wah Liew
- Red Cell Reference Laboratory, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Robert L Flower
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Catherine A Hyland
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
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39
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Dezan MR, Guardalini LGO, Pessoa E, Ribeiro IH, Oliveira VB, Luz F, Novac DR, Gallucci A, Bonifácio S, Gomes F, Levi JE, Pereira AC, Krieger JE, Mendrone-Junior A, Rocha V, Dinardo CL. Evaluation of the applicability and effectiveness of a molecular strategy for identifying weak D and DEL phenotype among D- blood donors of mixed origin exhibiting high frequency ofRHD*Ψ. Transfusion 2017; 58:317-322. [DOI: 10.1111/trf.14425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/01/2017] [Accepted: 10/22/2017] [Indexed: 01/28/2023]
Affiliation(s)
| | | | - Elaine Pessoa
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
| | | | | | - Fabio Luz
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
| | | | - António Gallucci
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
| | - Silvia Bonifácio
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
| | - Francisco Gomes
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
| | - José E. Levi
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
| | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology; Heart Institute (InCor), University of São Paulo School of Medicine
| | - Jose E. Krieger
- Laboratory of Genetics and Molecular Cardiology; Heart Institute (InCor), University of São Paulo School of Medicine
| | | | - Vanderson Rocha
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
- Discipline of Hematology; University of São Paulo School of Medicine; São Paulo Brazil
| | - Carla Luana Dinardo
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
- Laboratory of Genetics and Molecular Cardiology; Heart Institute (InCor), University of São Paulo School of Medicine
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40
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Flegel WA, Gottschall JL, Denomme GA. Integration of red cell genotyping into the blood supply chain: a population-based study. LANCET HAEMATOLOGY 2017. [PMID: 26207259 DOI: 10.1016/s2352-3026(15)00090-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND When problems with compatibility arise, transfusion services often use time-consuming serological tests to identify antigen-negative red cell units for safe transfusion. New methods have made red cell genotyping possible for all clinically relevant blood group antigens. We did mass-scale genotyping of donor blood and provided hospitals with access to a large red cell database to meet the demand for antigen-negative red cell units beyond ABO and Rh blood typing. METHODS We established a red cell genotype database at the BloodCenter of Wisconsin on July 17, 2010. All self-declared African American, Asian, Hispanic, and Native American blood donors were eligible irrespective of their ABO and Rh type or history of donation. Additionally, blood donors who were groups O, A, and B, irrespective of their Rh phenotype, were eligible for inclusion only if they had a history of at least three donations in the previous 3 years, with one donation in the previous 12 months at the BloodCenter of Wisconsin. We did red cell genotyping with a nanofluidic microarray system, using 32 single nucleotide polymorphisms to predict 42 blood group antigens. An additional 14 antigens were identified via serological phenotype. We monitored the ability of the red cell genotype database to meet demand for compatible blood during 3 years. In addition to the central database at the BloodCenter of Wisconsin, we gave seven hospitals online access to a web-based antigen query portal on May 1, 2013, to help them to locate antigen-negative red cell units in their own inventories. FINDINGS We analysed genotype data for 43,066 blood donors. Requests were filled for 5661 (99.8%) of 5672 patient encounters in which antigen-negative red cell units were needed. Red cell genotyping met the demand for antigen-negative blood in 5339 (94.1%) of 5672 patient encounters, and the remaining 333 (5.9%) requests were filled by use of serological data. Using the 42 antigens represented in our red cell genotype database, we were able to fill 14,357 (94.8%) of 15,140 requests for antigen-negative red cell units from hospitals served by the BloodCenter of Wisconsin. In the pilot phase, the seven hospitals identified 71 units from 52 antigen-negative red cell unit requests. INTERPRETATION Red cell genotyping has the potential to transform the way antigen-negative red cell units are provided. An antigen query portal could reduce the need for transportation of blood and serological screening. If this wealth of genotype data can be made easily accessible online, it will help with the supply of affordable antigen-negative red cell units to ensure patient safety. FUNDING BloodCenter of Wisconsin Diagnostic Laboratories Strategic Initiative and the NIH Clinical Center Intramural Research Program.
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41
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Sandler SG, Chen L, Flegel WA. Serological weak D phenotypes: a review and guidance for interpreting the RhD blood type using the RHD genotype. Br J Haematol 2017; 179:10-19. [PMID: 28508413 PMCID: PMC5612847 DOI: 10.1111/bjh.14757] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Approximately 0·2-1% of routine RhD blood typings result in a "serological weak D phenotype." For more than 50 years, serological weak D phenotypes have been managed by policies to protect RhD-negative women of child-bearing potential from exposure to weak D antigens. Typically, blood donors with a serological weak D phenotype have been managed as RhD-positive, in contrast to transfusion recipients and pregnant women, who have been managed as RhD-negative. Most serological weak D phenotypes in Caucasians express molecularly defined weak D types 1, 2 or 3 and can be managed safely as RhD-positive, eliminating unnecessary injections of Rh immune globulin and conserving limited supplies of RhD-negative RBCs. If laboratories in the UK, Ireland and other European countries validated the use of potent anti-D reagents to result in weak D types 1, 2 and 3 typing initially as RhD-positive, such laboratory results would not require further testing. When serological weak D phenotypes are detected, laboratories should complete RhD testing by determining RHD genotypes (internally or by referral). Individuals with a serological weak D phenotype should be managed as RhD-positive or RhD-negative, according to their RHD genotype.
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Affiliation(s)
- S. Gerald Sandler
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Leonard Chen
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Willy A. Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, United States
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42
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Kulkarni S, Parchure DS, Gopalkrishnan V, Madkaikar M. Screening for DEL phenotype in RhD negative Indians. J Clin Lab Anal 2017. [PMID: 28643361 DOI: 10.1002/jcla.22288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND DEL phenotype represents a very weak form of D variant detected only by adsorption and elution technique. DEL phenotype individuals mistyped as RhD-negative can lead to alloimmunization after transfusion or pregnancy. Molecular techniques have now been used to identify DEL variants. They are commonly encountered in the East Asian population with RHD(K409K) being the most frequent allele. RHD(M295I) is the most common DEL allele in Caucasians. As there is a paucity of data on DEL phenotype in the Indian population, the study aims to screen RhD negative individuals for two most common DEL mutations. MATERIAL AND METHODS EDTA blood was collected from 900 RhD negative individuals. Serological analysis included testing for the five major Rh antigens- C, c, D, E, and e by tube technique. Samples showing negative reaction for the presence of D antigen by Indirect Antiglobulin test were further tested for DEL phenotype by adsorption and elution technique. Molecular analysis involved DNA extraction and testing by PCR-SSP for RHD(K409K) and RHD(M295I) DEL alleles. RESULTS Rh phenotyping showed 153 Rh negative individuals with r'r, ten with r''r and 737 with rr phenotype. All the samples tested negative for RhD antigen by adsorption and elution method. The two common DEL mutations RHD(K409K) and RHD(M295I) were also not detected in the study population. CONCLUSION The study population showed the absence of the two common DEL alleles, concluding the variant to be rare. A comprehensive study with a larger sample size to look for other DEL mutations should be performed.
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Affiliation(s)
- Swati Kulkarni
- Department of Transfusion Medicine, National Institute of Immunohaematology, Mumbai, India
| | - Disha S Parchure
- Department of Transfusion Medicine, National Institute of Immunohaematology, Mumbai, India
| | - Vidya Gopalkrishnan
- Department of Transfusion Medicine, National Institute of Immunohaematology, Mumbai, India
| | - Manisha Madkaikar
- Department of Transfusion Medicine, National Institute of Immunohaematology, Mumbai, India
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43
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Granier T, Chiaroni J, Bailly P, Silvy M. First description of a D-CE-D hybrid gene on a weak D Type 2 molecular background. Transfusion 2017; 57:1248-1253. [PMID: 28164316 DOI: 10.1111/trf.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/12/2016] [Accepted: 12/16/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND RhD phenotypes that express a significantly reduced amount of RhD antigen per red blood cell may be mistyped as RhD-negative by standard serologic methods. The molecular identification of weak D Type 1, 2, or 3 carriers allows managing them as RhD-positive and, thus, rationalizes the use of RhD-negative stock units and the administration of Rh-immunoglobulin prophylaxis, avoiding unnecessary costs and possible side effects. STUDY DESIGN AND METHODS One sample was investigated for confirming a D-C-E+c+e- phenotype. Rh phenotyping was performed with the microplate direct hemagglutination test. DNA array analysis was performed using the BeadChip wRhD kit, and the RHD gene was explored by sequencing to determine the molecular background associated with RhD-negative phenotype. RESULTS Molecular investigations showed a lack of amplification of Exons 3 through 7 and c.1154G>T transversion in Exon 9, suggesting an RHD-CE-D composite on a weak D Type 2 background. We attempted to precisely identify the two recombination sites generating this hybrid allele. The 5' and 3' breakpoints were located in Introns 2 and 7, which showed concentration of mobile Alu sequences most likely involved in the RHD-cE(3-7)-weak D Type 2 allele. CONCLUSION Altogether, we identified the first example of an RHD-CE-D large hybrid allele on a weak D Type 2 background associated with an RhD-negative phenotype. By investigating the RHCE-D breakpoint zones, we suggest a mobile element-mediated recombination.
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Affiliation(s)
- Thomas Granier
- Etablissement Français du Sang Alpes Méditerranée.,Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguin,", Marseille, France
| | - Jacques Chiaroni
- Etablissement Français du Sang Alpes Méditerranée.,Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguin,", Marseille, France
| | - Pascal Bailly
- Etablissement Français du Sang Alpes Méditerranée.,Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguin,", Marseille, France
| | - Monique Silvy
- Etablissement Français du Sang Alpes Méditerranée.,Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguin,", Marseille, France
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44
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Abstract
Abstract
Background: RH genotyping studies have been conducted mainly in people of Caucasian and African descent. There is limited information regarding the molecular basis for RH genotypes in Malaysia.
Objectives: To investigate the prevalence and characteristics of RHCE genotypes among different ethnic groups in Malaysia.
Methods: A total of 1014 whole blood samples were obtained from donors from 4 different ethnic groups (360 Malays, 434 Chinese, 164 Indians, and 56 others). All samples were phenotyped for C, c, D, E, and e using standard serologic methods and genotyped using polymerase chain reaction (PCR)-based analysis.
Results: In the blood samples that we analyzed, the distribution of RH genotype antigens was significantly different among the various ethnic groups. Our findings showed that CCDee is the most common in Malaysian blood donors; 18.4% (187/1014) compared with other genotypes. The ccDEE genotype is more prevalent in the Chinese: 65.6% (82/125), and the ccee genotype is more prevalent in Indians: 47.1% (65/138). There were discrepancies between phenotypes and genotypes. There were 17 (1.7%) discrepancies in RH C/c genotyping results and of these 47% (8/17) occurred in Malays. Discrepancies in RH E/e results occurred in 3 samples (0.3%).
Conclusions: Our study provides a database for the distribution of RH genotypes of donors from the major ethnic groups in Malaysia. Methods used in this study are useful for comparing the phenotypes and genotypes. Further investigation should be conducted to study the causes of these discrepancies using other molecular based techniques.
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Affiliation(s)
- Rozi Hanisa Musa
- Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia, Bertam, Penang, Malaysia
| | | | - Yasmin Ayob
- National Blood Centre, Kuala Lumpur, Malaysia
| | - Narazah Mohd Yusoff
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Penang, Malaysia
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45
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Yang HS, Lee MY, Park TS, Cho SY, Lee HJ, Lim G, Lee DD, Oh SH, Cho D, Park KU. Primary anti-D alloimmunization induced by "Asian type" RHD (c.1227G>A) DEL red cell transfusion. Ann Lab Med 2016. [PMID: 26206698 PMCID: PMC4510514 DOI: 10.3343/alm.2015.35.5.554] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hyung Seok Yang
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Min Young Lee
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Tae Sung Park
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
| | - Sun Young Cho
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hee Joo Lee
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Gayoung Lim
- Blood Laboratory Center, Central, Korean Red Cross, Seoul, Korea
| | - Dae Dong Lee
- Blood Laboratory Center, Nambu, Korean Red Cross, Busan, Korea
| | - Seung Hwan Oh
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea
| | - Duck Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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46
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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.
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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
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47
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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.
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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
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48
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DEL phenotype is more common in some parts of European population than initially thought. Transfus Clin Biol 2016; 23:110-1. [DOI: 10.1016/j.tracli.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/07/2016] [Indexed: 11/22/2022]
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49
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Stegmann TC, Veldhuisen B, Bijman R, Thurik FF, Bossers B, Cheroutre G, Jonkers R, Ligthart P, de Haas M, Haer-Wigman L, van der Schoot CE. Frequency and characterization of known and novel RHD variant alleles in 37 782 Dutch D-negative pregnant women. Br J Haematol 2016; 173:469-79. [PMID: 27018217 DOI: 10.1111/bjh.13960] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/14/2015] [Indexed: 11/30/2022]
Abstract
To guide anti-D prophylaxis, Dutch D- pregnant women are offered a quantitative fetal-RHD-genotyping assay to determine the RHD status of their fetus. This allowed us to determine the frequency of different maternal RHD variants in 37 782 serologically D- pregnant women. A variant allele is present in at least 0·96% of Dutch D- pregnant women The D- serology could be confirmed after further serological testing in only 54% of these women, which emphasizes the potential relevance of genotyping of blood donors. 43 different RHD variant alleles were detected, including 15 novel alleles (11 null-, 2 partial D- and 2 DEL-alleles). Of those novel null alleles, one allele contained a single missense mutation (RHD*443C>G) and one allele had a single amino acid deletion (RHD*424_426del). The D- phenotype was confirmed by transduction of human D- erythroblasts, consolidating that, for the first time, a single amino acid change or deletion causes the D- phenotype. Transduction also confirmed the phenotypes for the two new variant DEL-alleles (RHD*721A>C and RHD*884T>C) and the novel partial RHD*492C>A allele. Notably, in three additional cases the DEL phenotype was observed but sequencing of the coding sequence, flanking introns and promoter region revealed an apparently wild-type RHD allele without mutations.
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Affiliation(s)
- Tamara C Stegmann
- Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Barbera Veldhuisen
- Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Renate Bijman
- Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Florentine F Thurik
- Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Remco Jonkers
- Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | | | - Masja de Haas
- Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Lonneke Haer-Wigman
- Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - C Ellen van der Schoot
- Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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50
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Abstract
The clinical importance of blood group antigens relates to their ability to evoke immune antibodies that are capable of causing hemolysis. The most important antigens for safe transfusion are ABO and D (Rh), and typing for these antigens is routinely performed for patients awaiting transfusion, prenatal patients, and blood donors. Typing for other blood group antigens, typically of the Kell, Duffy, Kidd, and MNS blood groups, is sometimes necessary, for patients who have, or are likely to develop antibodies to these antigens. The most commonly used typing method is serological typing, based on hemagglutination reactions against specific antisera. This method is generally reliable and practical for routine use, but it has certain drawbacks. In recent years, molecular typing has emerged as an alternative or supplemental typing method. It is based on detecting the polymorphisms and mutations that control the expression of blood group antigens, and using this information to predict the probable antigen type. Molecular typing methods are useful when traditional serological typing methods cannot be used, as when a patient has been transfused and the sample is contaminated with red blood cells from the transfused blood component. Moreover, molecular typing methods can precisely identify clinically significant variant antigens that cannot be distinguished by serological typing; this capability has been exploited for the resolution of typing discrepancies and shows promise for the improved transfusion management of patients with sickle cell anemia. Despite its advantages, molecular typing has certain limitations, and it should be used in conjunction with serological methods.
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