1
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van de Weem RHG, Wemelsfelder ML, Luken JS, de Haas M, Niessen RWLM, van der Schoot CE, Hoogeveen H, Janssen MP. Preventing alloimmunization using a new model for matching extensively typed red blood cells. Vox Sang 2021; 117:580-586. [PMID: 34725840 DOI: 10.1111/vox.13217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Alloimmunization is a well-known adverse event associated with red blood cell (RBC) transfusions, caused by phenotype incompatibilities between donor and patient RBCs that may lead to haemolytic transfusion reactions on subsequent transfusions. Alloimmunization can be prevented by transfusing fully matched RBC units. Advances in RBC genotyping render the extensive typing of both donors and patients affordable in the foreseeable future. However, the exponential increase in the variety of extensively typed RBCs asks for a software-driven selection to determine the 'best product for a given patient'. MATERIALS AND METHODS We propose the MINimize Relative Alloimmunization Risks (MINRAR) model for matching extensively typed RBC units to extensively typed patients to minimize the risk of alloimmunization. The key idea behind this model is to use antigen immunogenicity to represent the clinical implication of a mismatch. Using simulations of non-elective transfusions in Caucasian donor and patient populations, the effect on the alloimmunization rate of the MINRAR model is compared with that of a baseline model that matches antigens A, B and RhD only. RESULTS Our simulations show that with the MINRAR model, even for small inventories, the expected number of alloimmunizations can be reduced by 78.3% compared with a policy of only matching on antigens A, B and RhD. Furthermore, a reduction of 93.7% can be achieved when blood is issued from larger inventories. CONCLUSION Despite an exponential increase in phenotype variety, matching of extensively typed RBCs can be effectively implemented using our MINRAR model, effectuating a substantial reduction in alloimmunization risk without introducing additional outdating or shortages.
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Affiliation(s)
- Ronald H G van de Weem
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
| | - Merel L Wemelsfelder
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
| | | | | | | | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
| | | | - Mart P Janssen
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
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2
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Stack G. Post-transfusion detection of RBC alloimmunization: Timing is everything. Transfusion 2021; 61:2219-2222. [PMID: 34289127 DOI: 10.1111/trf.16593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Gary Stack
- Pathology and Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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3
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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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4
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Chonat S, Arthur CM, Zerra PE, Maier CL, Jajosky RP, Yee MEM, Miller MJ, Josephson CD, Roback JD, Fasano R, Stowell SR. Challenges in preventing and treating hemolytic complications associated with red blood cell transfusion. Transfus Clin Biol 2019; 26:130-134. [PMID: 30979566 DOI: 10.1016/j.tracli.2019.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Red blood cell (RBC) transfusion support represents a critical component of sickle cell disease (SCD) management. However, as with any therapeutic intervention, RBC transfusion is not without risk. Repeat exposure to allogeneic RBCs can result in the development of RBC alloantibodies that can make it difficult to find compatible RBCs for future transfusions and can directly increase the risk of developing acute or delayed hemolytic transfusion reactions, which can be further complicated by hyperhemolysis. Several prophylactic and treatment strategies have been employed in an effort to reduce or prevent hemolytic transfusion reactions. However, conflicting data exist regarding the efficacy of many of these approaches. We will explore the challenges associated with predicting, preventing and treating different types of hemolytic transfusion reactions in patients with SCD in addition to describing future strategies that may aid in the management of the complex transfusion requirements of SCD patients.
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Affiliation(s)
- Satheesh Chonat
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Connie M Arthur
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA
| | - Patricia E Zerra
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA
| | - Cheryl L Maier
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA
| | - Ryan P Jajosky
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA
| | - Marianne E M Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Maureen J Miller
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA
| | - Cassandra D Josephson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA
| | - John D Roback
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA
| | - Ross Fasano
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA.
| | - Sean R Stowell
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA.
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5
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Floch A, Gien D, Tournamille C, Chami B, Habibi A, Galactéros F, Bierling P, Djoudi R, Pondarré C, Peyrard T, Pirenne F. High immunogenicity of red blood cell antigens restricted to the population of African descent in a cohort of sickle cell disease patients. Transfusion 2018; 58:1527-1535. [PMID: 29707783 DOI: 10.1111/trf.14633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/12/2018] [Accepted: 01/29/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) patients undergo multiple red blood cell (RBC) transfusions and are regularly exposed to low-prevalence (LP) antigens specific to individuals of African descent. This study evaluated the prevalence of antibodies against LP antigens in SCD patients and the need to identify these antibodies in everyday practice. STUDY DESIGN AND METHODS Plasma from 211 SCD patients was tested with RBCs expressing the following LP antigens: RH10 (V), RH20 (VS), RH23 (DW ), RH30 (Goa ), KEL6 (Jsa ), and MNS6 (He). RESULTS Nine LP antibodies were found in eight patients (3.8%): five anti-RH23, two anti-RH30, and two anti-MNS6. The exposure risk, calculated for each LP antigen, was below 3% per RBC unit, for all antigens tested. Thus, in this cohort of transfused SCD patients, the prevalence of LP antibodies was similar to that of antibodies against antigens of the FY, JK, and MNS blood group systems. These findings also reveal the occurrence of anti-RH23 in SCD patients. No anti-RH20 or anti-KEL6 were found, despite the high frequency of mismatch situations. CONCLUSION These results highlight the immunogenicity of these LP antigens, and the evanescence of antibodies against LP antigens. They also highlight the importance of appropriate pretransfusion testing for patients frequently transfused, who are likely to be exposed to multiple types of blood group antigens.
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Affiliation(s)
- Aline Floch
- Etablissement Français du Sang (EFS)-Ile de France, Créteil.,INSERM U955, Equipe 2 "Transfusion et maladies du globule rouge", Créteil.,Laboratory of Excellence GR-Ex, Créteil, France.,Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est-Créteil (UPEC), Faculté de Médecine, Créteil
| | - Dominique Gien
- Laboratory of Excellence GR-Ex, Créteil, France.,Département Centre National de Référence pour les Groupes Sanguins, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - Christophe Tournamille
- Etablissement Français du Sang (EFS)-Ile de France, Créteil.,INSERM U955, Equipe 2 "Transfusion et maladies du globule rouge", Créteil.,Laboratory of Excellence GR-Ex, Créteil, France
| | - Btissam Chami
- Etablissement Français du Sang (EFS)-Ile de France, Créteil
| | - Anoosha Habibi
- INSERM U955, Equipe 2 "Transfusion et maladies du globule rouge", Créteil.,Centre de Référence de la Drépanocytose, Unité des Maladies du Globule Rouge, Hôpitaux Universitaires Henri Mondor, Créteil
| | - Frédéric Galactéros
- INSERM U955, Equipe 2 "Transfusion et maladies du globule rouge", Créteil.,Centre de Référence de la Drépanocytose, Unité des Maladies du Globule Rouge, Hôpitaux Universitaires Henri Mondor, Créteil
| | - Philippe Bierling
- Etablissement Français du Sang (EFS)-Ile de France, Créteil.,INSERM U955, Equipe 2 "Transfusion et maladies du globule rouge", Créteil.,Laboratory of Excellence GR-Ex, Créteil, France.,Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est-Créteil (UPEC), Faculté de Médecine, Créteil.,Service de Pédiatrie et Drépanocytose, Centre Intercommunal de Créteil, Créteil, France
| | - Rachid Djoudi
- Etablissement Français du Sang (EFS)-Ile de France, Créteil
| | - Corinne Pondarré
- INSERM U955, Equipe 2 "Transfusion et maladies du globule rouge", Créteil.,Service de Pédiatrie et Drépanocytose, Centre Intercommunal de Créteil, Créteil, France
| | - Thierry Peyrard
- Laboratory of Excellence GR-Ex, Créteil, France.,Département Centre National de Référence pour les Groupes Sanguins, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - France Pirenne
- Etablissement Français du Sang (EFS)-Ile de France, Créteil.,INSERM U955, Equipe 2 "Transfusion et maladies du globule rouge", Créteil.,Laboratory of Excellence GR-Ex, Créteil, France.,Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est-Créteil (UPEC), Faculté de Médecine, Créteil
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6
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Abstract
PURPOSE OF REVIEW Thalassemia is the most common form of inherited anemia, characterized by variable clinical phenotypes. The purpose of this review is to summarize the transfusion support in thalassemia patients and the management of transfusion-related iron overload. RECENT FINDINGS The most recent evidence on transfusion strategy and iron chelation therapy in thalassemia arising from clinical trials as well as from recommendation guidelines are critically discussed. SUMMARY Enhancements in the global care of thalassemia, resulting from the combination of an appropriate transfusion approach and iron chelation therapy, have produced a significant improvement in the quality of life and, finally, in the prognosis of patients affected by this inherited hematologic disorder.
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7
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Caesar A, Meyer S, Trost N, Neuenschwander K, Geisen C, Frey BM, Gassner C, Schwind P. A uniform method for the simultaneous blood group phenotyping of Fya
, Fyb
, Jka
, Jkb
, S, s̅, P1, k applying lateral-flow technique. Vox Sang 2017; 113:177-184. [DOI: 10.1111/vox.12603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A. Caesar
- Medion Grifols Diagnostics AG; Duedingen Switzerland
| | - S. Meyer
- Blood Transfusion Service Zurich; Swiss Red Cross; Schlieren Switzerland
| | - N. Trost
- Blood Transfusion Service Zurich; Swiss Red Cross; Schlieren Switzerland
| | - K. Neuenschwander
- Blood Transfusion Service Zurich; Swiss Red Cross; Schlieren Switzerland
| | - C. Geisen
- Institute for Transfusion Medicine and Immunohaematology; German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH; Goethe University Hospital; Frankfurt am Main Germany
| | - B. M. Frey
- Blood Transfusion Service Zurich; Swiss Red Cross; Schlieren Switzerland
| | - C. Gassner
- Blood Transfusion Service Zurich; Swiss Red Cross; Schlieren Switzerland
| | - P. Schwind
- Medion Grifols Diagnostics AG; Duedingen Switzerland
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8
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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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9
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Rossmann SN. Donors and data-increasing deficits. Transfusion 2017; 57:1635-1638. [PMID: 28675528 DOI: 10.1111/trf.14180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Susan N Rossmann
- Medical Services, Gulf Coast Regional Blood Center, Houston, Texas
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10
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Bachegowda LS, Timm B, Dasgupta P, Hillyer CD, Kessler D, Rebosa M, France CR, Shaz BH. Impact of predictive scoring model and e-mail messages on African American blood donors. Transfusion 2017; 57:1515-1521. [DOI: 10.1111/trf.14113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 02/04/2017] [Accepted: 02/04/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Brad Timm
- Hindsait, Inc.; Hackensack New Jersey
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11
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Yazer MH, Vassallo R, Delaney M, Germain M, Karafin MS, Sayers M, van de Watering L, Shaz BH. Trends in age and red blood cell donation habits among several racial/ethnic minority groups in the United States. Transfusion 2017; 57:1644-1655. [DOI: 10.1111/trf.14108] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Mark H. Yazer
- The Institute for Transfusion Medicine; Pittsburgh Pennsylvania
| | | | | | | | | | - Merlyn Sayers
- Carter BloodCare and the University of Texas Southwestern; Dallas Texas
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12
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Fasano RM, Sullivan HC, Bray RA, Gebel HM, Meyer EK, Winkler AM, Josephson CD, Stowell SR, Sandy Duncan A, Roback JD. Genotyping Applications for Transplantation and Transfusion Management: The Emory Experience. Arch Pathol Lab Med 2017; 141:329-340. [PMID: 28234571 DOI: 10.5858/arpa.2016-0277-sa] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Current genotyping methodologies for transplantation and transfusion management employ multiplex systems that allow for simultaneous detection of multiple HLA antigens, human platelet antigens, and red blood cell (RBC) antigens. The development of high-resolution, molecular HLA typing has led to improved outcomes in unrelated hematopoietic stem cell transplants by better identifying compatible alleles of the HLA-A, B, C, DRB1, and DQB1 antigens. In solid organ transplantation, the combination of high-resolution HLA typing with solid-phase antibody identification has proven of value for highly sensitized patients and has significantly reduced incompatible crossmatches at the time of organ allocation. This database-driven, combined HLA antigen/antibody testing has enabled routine implementation of "virtual crossmatching" and may even obviate the need for physical crossmatching. In addition, DNA-based testing for RBC antigens provides an alternative typing method that mitigates many of the limitations of hemagglutination-based phenotyping. Although RBC genotyping has utility in various transfusion settings, it has arguably been most useful for minimizing alloimmunization in the management of transfusion-dependent patients with sickle cell disease or thalassemia. The availability of high-throughput RBC genotyping for both individuals and large populations of donors, along with coordinated informatics systems to compare patients' antigen profiles with available antigen-negative and/or rare blood-typed donors, holds promise for improving the efficiency, reliability, and extent of RBC matching for this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - John D Roback
- From the Center for Transfusion and Cellular Therapies (Drs Fasano, Sullivan, Meyer, Winkler, Josephson, Stowell, Duncan, and Roback) and the Department of Pathology and Laboratory Medicine (Drs Fasano, Sullivan, Bray, Gebel, Meyer, Winkler, Josephson, Stowell, Duncan, and Roback), Emory University School of Medicine, Atlanta, Georgia; and the Department of Transfusion, Tissue, and Apheresis, Children's Healthcare of Atlanta, Atlanta (Drs Fasano, Meyer, and Josephson). Dr Meyer is now with the Department of Pathology, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus
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13
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Belsito A, Magnussen K, Napoli C. Emerging strategies of blood group genotyping for patients with hemoglobinopathies. Transfus Apher Sci 2016; 56:206-213. [PMID: 28040400 DOI: 10.1016/j.transci.2016.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 02/06/2023]
Abstract
Red cell alloimmunization is a serious problem in chronically transfused patients. A number of high-throughput DNA assays have been developed to extend or replace traditional serologic antigen typing. DNA-based typing methods may be easily automated and multiplexed, and provide reliable information on a patient. Molecular genotyping promises to become cheaper, being not dependent on serologic immunoglobulin reagents. Patients with hemoglobinopathies could benefit from receiving extended genomic typing. This could limit post transfusional complications depending on subtle antigenic differences between donors and patients. Patient/donor compatibility extended beyond the phenotype Rh/Kell may allows improved survival of transfused units of red blood cells (RBC) and lead to reduced need for blood transfusion and leading to less iron overload and reduced risk of alloimmunization. Here we discuss the advantages and limitations of current techniques, that detect only predefined genetic variants. In contrast, target enrichment next-generation sequencing (NGS) has been used to detect both known and de novo genetic polymorphisms, including single-nucleotide polymorphisms, indels (insertions/deletions), and structural variations. NGS approaches can be used to develop an extended blood group genotyping assay system.
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Affiliation(s)
- A Belsito
- Department of Internal Medicine and Specialistic Units Clinical Immunoematology Immunohematology U.O.C. Immunohematology, Transfusion Medicine and Organ Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Department of Internal Medicine and Specialist Units, Azienda Universitaria Policlinico (AOU), Second University of Naples (SUN), Naples, Italy.
| | - K Magnussen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - C Napoli
- Department of Internal Medicine and Specialistic Units Clinical Immunoematology Immunohematology U.O.C. Immunohematology, Transfusion Medicine and Organ Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Department of Internal Medicine and Specialist Units, Azienda Universitaria Policlinico (AOU), Second University of Naples (SUN), Naples, Italy
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14
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Complications chirurgicales de la transplantation rénale. Prog Urol 2016; 26:1066-1082. [DOI: 10.1016/j.purol.2016.09.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 12/13/2022]
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15
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Fasano RM, Chou ST. Red Blood Cell Antigen Genotyping for Sickle Cell Disease, Thalassemia, and Other Transfusion Complications. Transfus Med Rev 2016; 30:197-201. [DOI: 10.1016/j.tmrv.2016.05.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 01/19/2023]
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16
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Molecular immunohaematology round table discussions at the AABB Annual Meeting, Anaheim 2015. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 14:557-565. [PMID: 27483480 DOI: 10.2450/2016.0063-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/17/2016] [Indexed: 12/16/2022]
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17
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Gogri H, Kulkarni S, Vasantha K, Jadhav S, Ghosh K, Gorakshakar A. Partial matching of blood group antigens to reduce alloimmunization in Western India. Transfus Apher Sci 2016; 54:390-5. [PMID: 27020262 DOI: 10.1016/j.transci.2016.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/01/2016] [Accepted: 02/21/2016] [Indexed: 12/01/2022]
Abstract
Red blood cell alloimmunization occurs due to the genetic disparity of red cell antigens between donor and recipient. In the present study, we report a spectrum of red cell alloantibodies characterized in patients with different clinical conditions in a reference center in India. Majority of the antibodies identified were against the blood group antigens c, D, E, M, N, S, s and Jka. Hence, apart from ABO and RhD, we recommend partial antigen matching between donor and patients for other Rh (C, c, E, e) and MNS blood group antigens to potentially reduce the risk of alloimmunization by 75%. Matching of Kell antigen is not recommended in Western India.
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Affiliation(s)
- Harita Gogri
- National Institute of Immunohaematology, 13th Floor New Multistoreyed Building, K. E. M. Hospital, Parel, Mumbai, Maharashtra 400091, India
| | - Swati Kulkarni
- National Institute of Immunohaematology, 13th Floor New Multistoreyed Building, K. E. M. Hospital, Parel, Mumbai, Maharashtra 400091, India.
| | - K Vasantha
- National Institute of Immunohaematology, 13th Floor New Multistoreyed Building, K. E. M. Hospital, Parel, Mumbai, Maharashtra 400091, India
| | - Seema Jadhav
- National Institute of Immunohaematology, 13th Floor New Multistoreyed Building, K. E. M. Hospital, Parel, Mumbai, Maharashtra 400091, India
| | - Kanjaksha Ghosh
- National Institute of Immunohaematology, 13th Floor New Multistoreyed Building, K. E. M. Hospital, Parel, Mumbai, Maharashtra 400091, India
| | - Ajit Gorakshakar
- National Institute of Immunohaematology, 13th Floor New Multistoreyed Building, K. E. M. Hospital, Parel, Mumbai, Maharashtra 400091, India
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18
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Davari K, Soltanpour MS. Study of alloimmunization and autoimmunization in Iranian β-thalassemia major patients. Asian J Transfus Sci 2016; 10:88-92. [PMID: 27011679 PMCID: PMC4782503 DOI: 10.4103/0973-6247.172179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Thalassemia is one of the most common monogenic disorders characterized by reduced production of globin chains. Although regular red blood cell (RBC) transfusion support is the main treatment for these patients, it may be associated with complications such as RBC alloimmunization. Aim: The study aimed to determine the incidence of alloimmunization and autoimmunization to RBC antigens in β-thalassemia major patients from Zanjan, Zanjan Province, Iran. Materials and Methods: A total of 49 β-thalassemia major patients comprising 24 females and 25 males (mean age: 18.59 ± 8.16 years; range: 2-40 years) from Northwest Iran were included in a cross-sectional study. Alloantibody screening and identification were done using 3-cell and 10-cell reagent red blood cells, respectively. Autoantibody detection was performed using direct Coomb's test. Results: The incidence of alloimmunization was 16.32% with 10 alloantibodies identified in 8 patients. The most common clinically significant alloantibody identified in alloimmunized patients was anti-Kell (K-antigen) (60%) followed by anti-Rhesus (Rh) (E, c-antigens). The rate of alloimmunization was significantly lower in patients transfused with leukoreduced RBCs compared with those transfused with nonleukoreduced RBCs (9.53% vs 57.14%, P = 0.001). There was no significant correlation between alloantibody formation and the age, gender, hemoglobin levels, number of transfused units, and splenectomy. Conclusion: Transfusion of leukoreduced and phenotypically matched red blood cells for Kell (K) and Rh (E, c) antigens may help reduce the alloimmunization rate in Iranian β-thalassemia major patients. Moreover, autoimmunization to RBC antigens was rare in our patients.
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Affiliation(s)
- Kambiz Davari
- Department of Pediatrics, School of Medical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohammad Soleiman Soltanpour
- Department of Laboratory Sciences, School of Paramedical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran
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A model for integrating molecular-based testing in transfusion services. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 14:566-572. [PMID: 26509823 DOI: 10.2450/2015.0070-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/22/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Molecular-based laboratory tests can predict blood group antigens and supplement serological methods, adding a unique technology to assist in resolving discrepant or incomplete blood group typing or antibody identification. Hospital transfusion services have options for integrating molecular-based methods in their routine operations. We describe here the model of a hospital-reference laboratory partnership. MATERIALS AND METHODS Blood samples for compatibility testing were obtained from patients in a 609-bed hospital serving an urban multiethnic and multiracial population. When results of blood group phenotyping by serological methods were inconclusive, samples were referred for molecular-based testing. The reference laboratory used several methods for genotyping, including polymerase chain reaction followed by restriction enzyme-linked polymorphism analysis, sequence-specific primer polymerase chain reaction and array-based approaches. Human erythrocyte antigen, RHCE and RHD single nucleotide polymorphism arrays were integrated into the laboratory as they became commercially available. RESULTS The hospital-reference laboratory model made it possible to integrate blood group genotyping promptly by current technology without the expense of new laboratory equipment or adding personnel with technical expertise. We describe ten cases that illustrate the categories of serological problems that were resolved by molecular methods. DISCUSSION In-hospital molecular testing for transfusion services has logistical advantages, but is financially impractical for most hospitals. Our model demonstrates the advantages of a hospital-reference laboratory partnership. In conclusion, hospital transfusion services can integrate molecular-based testing in their routine services without delay by establishing a partnership with a molecular blood group reference laboratory. The hospital reference-laboratory model promotes genomic medicine without the expense of new equipment and skilled personnel, while supporting the economy of centralised large-scale laboratory operations.
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Tormey CA, Hendrickson JE. Routine non-ABO blood group antigen genotyping in sickle cell disease: the new frontier in pretransfusion testing? Transfusion 2015; 55:1374-7. [DOI: 10.1111/trf.13065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/02/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Christopher A. Tormey
- Pathology & Laboratory Medicine Service; VA Connecticut Healthcare System; West Haven CT
- Department of Laboratory Medicine
| | - Jeanne E. Hendrickson
- Department of Laboratory Medicine
- Department of Pediatrics; Yale University School of Medicine; New Haven CT
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Delaney M, Harris S, Haile A, Johnsen J, Teramura G, Nelson K. Red blood cell antigen genotype analysis for 9087 Asian, Asian American, and Native American blood donors. Transfusion 2015; 55:2369-75. [DOI: 10.1111/trf.13163] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 03/14/2015] [Accepted: 04/10/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Meghan Delaney
- Specialty Diagnostics; Red Cell Genomics Laboratory; Puget Sound Blood Center
- Department of Laboratory Medicine; University of Washington
| | - Samantha Harris
- Specialty Diagnostics; Red Cell Genomics Laboratory; Puget Sound Blood Center
| | - Askale Haile
- Red Cell Reference Laboratory; Puget Sound Blood Center
| | - Jill Johnsen
- Department of Medicine; Division of Hematology; University of Washington
- Puget Sound Blood Center Research Institute; Seattle Washington
| | - Gayle Teramura
- Specialty Diagnostics; Red Cell Genomics Laboratory; Puget Sound Blood Center
| | - Karen Nelson
- Specialty Diagnostics; Red Cell Genomics Laboratory; Puget Sound Blood Center
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Belsito A, Costa D, Fiorito C, De Iorio G, Casamassimi A, Perrotta S, Napoli C. Erythrocyte genotyping for transfusion-dependent patients at the Azienda Universitaria Policlinico of Naples. Transfus Apher Sci 2015; 52:72-7. [PMID: 25582271 DOI: 10.1016/j.transci.2014.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 11/17/2014] [Accepted: 12/15/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Although minor erythrocyte antigens are not considered clinically significant in sporadic transfusions, they may be relevant for multi-transfusion patients. When serological assay is not conceivable, molecular genotyping allows predicting the red blood cell phenotype, extending the typing until minor blood groups. The aim of this study was to evaluate the utility of blood group genotyping and compare the molecular typing of erythrocyte antigens with the established serological methods. MATERIALS AND METHODS We selected 225 blood donors and 50 transfusion-dependent patients at the Division of Immunohematology of the Second University of Naples. Blood samples were analyzed with NEO Immucor automated system and genotyped for 38 red blood cell antigens and phenotypic variants with the kit HEA BeadChip™. The comparative study was conducted for RhCE and Kell antigens whose typing is available with both methods. RESULTS We observed a good correlation between serological and molecular methods for donors that were concordant for 99.5% (224/225) and discordant for 0.5% (1/225). Patients resulted concordant only for 46.0% (23/50) and discordant for 54.0% (27/50); discrepancies were 46.0% (23/50) and 8.0% (4/50) for RhCE and Kell systems respectively. Through molecular genotyping we also identified polymorphisms in RhCE, Kell, Duffy, Colton, Lutheran and Scianna loci in donors and patients. CONCLUSIONS Blood group genotyping is particularly useful for poly-transfused patients. Molecular analysis confirms and extends serological test data and then allows us to obtain a better match. This molecular assay can be used in the future to prevent alloimmunization in transfusion-dependent patients.
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Affiliation(s)
- Angela Belsito
- U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Azienda Universitaria Policlinico (AOU), Second University of Naples (SUN), Italy; Department of Biochemistry, Biophysics and General Pathology, Second University of Naples (SUN), Italy.
| | - Dario Costa
- U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Azienda Universitaria Policlinico (AOU), Second University of Naples (SUN), Italy
| | - Carmela Fiorito
- U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Azienda Universitaria Policlinico (AOU), Second University of Naples (SUN), Italy
| | - Gustavo De Iorio
- U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Azienda Universitaria Policlinico (AOU), Second University of Naples (SUN), Italy
| | - Amelia Casamassimi
- Department of Biochemistry, Biophysics and General Pathology, Second University of Naples (SUN), Italy
| | - Silverio Perrotta
- Department of Women, Child and General and Specialistic Surgery, Second University of Naples (SUN), Italy
| | - Claudio Napoli
- U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Azienda Universitaria Policlinico (AOU), Second University of Naples (SUN), Italy; Department of Biochemistry, Biophysics and General Pathology, Second University of Naples (SUN), Italy
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Remeikiene D, Ugenskiene R, Inciura A, Savukaityte A, Raulinaityte D, Skrodeniene E, Simoliuniene R, Juozaityte E. Duffy and kidd genotyping facilitates pretransfusion testing in patients undergoing long-term transfusion therapy. Turk J Haematol 2014; 31:367-73. [PMID: 25541653 PMCID: PMC4454051 DOI: 10.4274/tjh.2013.0075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Conventional serologic typing of red blood cell systems other than ABO and RhD can be inaccurate and difficult to interpret in patients who have recently undergone blood transfusion. While molecular-based assays are not used routinely, the usefulness of genotyping was investigated in order to determine patients who may benefit from this procedure. Materials and Methods: Blood samples were taken from 101 patients with haemato-oncological, chronic renal, or gastroenterological diseases and from 50 donor controls; the samples were tested for Fya and Fyb by applying serologic and genetic methods. All patients had received 3 or more units of RBCs during the last 3 months. An average of 6.1 RBC units were transfused per patient. The average length of time from transfusion until blood sampling was 24.4 days. The haemagglutination test was applied for serological analysis, and the restriction length polymorphism assay was used for genotyping. Results: In total, 33 (32.7%) patients showed positive reactions with anti-Fya or anti-Fyb while being negative genetically. False-positive Fya results were found in 23 samples, and false-positive Fyb in 10 specimens. During the last 3 months, significantly more RBC units were transfused to patients with discrepant results than to those with accurate phenotyping/genotyping results: median of 5 (mean ± SE: 6.85±0.69) versus median of 4 (mean: 5.71±0.51), respectively (p=0.025). The median length of time after the last transfusion was 25 days (mean: 28.72±2.23 days) in the group with accurate phenotyping/genotyping results versus a median of 14 days (mean: 15.52±1.95 days) in the group with discrepant results (p=0.001). Phenotypes and genotypes coincided in all donor samples. Conclusion: Genotyping assays for the Duffy system should be considered if the patient underwent blood transfusion less than 3 or 4 weeks before the sample collection. If the time frame from RBC transfusion exceeds 6 weeks, Duffy phenotyping can provide accurate results.
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Affiliation(s)
- Diana Remeikiene
- Lithuanian University of Health Sciences, Institute of Oncology, Department of Haematology, Kaunas, Lithuania. E-ma-il:
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Liu Z, Liu M, Mercado T, Illoh O, Davey R. Extended blood group molecular typing and next-generation sequencing. Transfus Med Rev 2014; 28:177-86. [PMID: 25280589 DOI: 10.1016/j.tmrv.2014.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 08/11/2014] [Accepted: 08/25/2014] [Indexed: 02/09/2023]
Abstract
Several high-throughput multiplex blood group molecular typing platforms have been developed to predict blood group antigen phenotypes. These molecular systems support extended donor/patient matching by detecting commonly encountered blood group polymorphisms as well as rare alleles that determine the expression of blood group antigens. Extended molecular typing of a large number of blood donors by high-throughput platforms can increase the likelihood of identifying donor red blood cells that match those of recipients. This is especially important in the management of multiply-transfused patients who may have developed several alloantibodies. Nevertheless, current molecular techniques have limitations. For example, they detect only predefined genetic variants. In contrast, target enrichment next-generation sequencing (NGS) is an emerging technology that provides comprehensive sequence information, focusing on specified genomic regions. Target enrichment NGS is able to assess genetic variations that cannot be achieved by traditional Sanger sequencing or other genotyping platforms. Target enrichment NGS has been used to detect both known and de novo genetic polymorphisms, including single-nucleotide polymorphisms, indels (insertions/deletions), and structural variations. This review discusses the methodology, advantages, and limitations of the current blood group genotyping techniques and describes various target enrichment NGS approaches that can be used to develop an extended blood group genotyping assay system.
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Affiliation(s)
- Zhugong Liu
- Division of Blood Components and Devices, Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD.
| | - Meihong Liu
- Division of Blood Components and Devices, Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Teresita Mercado
- Division of Blood Components and Devices, Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Orieji Illoh
- Division of Blood Components and Devices, Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Richard Davey
- Division of Blood Components and Devices, Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD
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Belsito A, Costa D, Napoli C. Blood group genotyping for patients with autoimmune hemolytic anemia. Transl Res 2014; 164:177-8. [PMID: 24746869 DOI: 10.1016/j.trsl.2014.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 03/14/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Angela Belsito
- U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Azienda Universitaria Policlinico (AOU), Second University of Naples, Naples, Italy.
| | - Dario Costa
- U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Azienda Universitaria Policlinico (AOU), Second University of Naples, Naples, Italy
| | - Claudio Napoli
- U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Azienda Universitaria Policlinico (AOU), Second University of Naples, Naples, Italy; Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, Naples, Italy
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26
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Paris S, Rigal D, Barlet V, Verdier M, Coudurier N, Bailly P, Brès JC. Flexible automated platform for blood group genotyping on DNA microarrays. J Mol Diagn 2014; 16:335-42. [PMID: 24726279 DOI: 10.1016/j.jmoldx.2014.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 02/06/2014] [Accepted: 02/12/2014] [Indexed: 11/17/2022] Open
Abstract
The poor suitability of standard hemagglutination-based assay techniques for large-scale automated screening of red blood cell antigens severely limits the ability of blood banks to supply extensively phenotype-matched blood. With better understanding of the molecular basis of blood antigens, it is now possible to predict blood group phenotype by identifying single-nucleotide polymorphisms in genomic DNA. Development of DNA-typing assays for antigen screening in blood donation qualification laboratories promises to enable blood banks to provide optimally matched donations. We have designed an automated genotyping system using 96-well DNA microarrays for blood donation screening and a first panel of eight single-nucleotide polymorphisms to identify 16 alleles in four blood group systems (KEL, KIDD, DUFFY, and MNS). Our aim was to evaluate this system on 960 blood donor samples with known phenotype. Study data revealed a high concordance rate (99.92%; 95% CI, 99.77%-99.97%) between predicted and serologic phenotypes. These findings demonstrate that our assay using a simple protocol allows accurate, relatively low-cost phenotype prediction at the DNA level. This system could easily be configured with other blood group markers for identification of donors with rare blood types or blood units for IH panels or antigens from other systems.
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Affiliation(s)
- Sandra Paris
- Établissement Français du Sang Rhône Alpes, Lyon, France
| | | | - Valérie Barlet
- Établissement Français du Sang Rhône Alpes, Lyon, France
| | | | | | - Pascal Bailly
- Établissement Français du Sang Alpes Méditerranée, Marseille, France
| | - Jean-Charles Brès
- Établissement Français du Sang Rhône Alpes, Lyon, France; Établissement Français du Sang Pyrénées Méditerranée, Montpellier, France.
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Sapatnekar S, Figueroa PI. How do we use molecular red blood cell antigen typing to supplement pretransfusion testing? Transfusion 2014; 54:1452-8. [PMID: 24654601 DOI: 10.1111/trf.12623] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/16/2014] [Accepted: 01/16/2014] [Indexed: 11/28/2022]
Abstract
The molecular basis of many blood group antigens is known, and it provides a means for predicting the red blood cell phenotype. Molecular typing methods are useful when serologic typing cannot be performed, due to sample or reagent limitations. We discuss the implementation of a commercial molecular typing assay at our Transfusion Service, the indications for testing, and the advantages and drawbacks of the assay. We also present our algorithm for selecting candidates for testing.
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Affiliation(s)
- Suneeti Sapatnekar
- Section of Transfusion Medicine, Department of Clinical Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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Shafi H, Abumuhor I, Klapper E. How we incorporate molecular typing of donors and patients into our hospital transfusion service. Transfusion 2014; 54:1212-9. [DOI: 10.1111/trf.12582] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 11/13/2013] [Accepted: 12/19/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Hedyeh Shafi
- Division of Transfusion Medicine, Department of Pathology and Lab Medicine; Cedars-Sinai Medical Center; Los Angeles California
| | - Ihab Abumuhor
- Division of Transfusion Medicine, Department of Pathology and Lab Medicine; Cedars-Sinai Medical Center; Los Angeles California
| | - Ellen Klapper
- Division of Transfusion Medicine, Department of Pathology and Lab Medicine; Cedars-Sinai Medical Center; Los Angeles California
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Molecular immunohaematology round table discussions at the AABB Annual Meeting, Boston 2012. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12:280-6. [PMID: 24333058 DOI: 10.2450/2013.0022-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Sood R, Makroo RN, Riana V, Rosamma NL. Detection of alloimmunization to ensure safer transfusion practice. Asian J Transfus Sci 2013; 7:135-9. [PMID: 24014944 PMCID: PMC3757774 DOI: 10.4103/0973-6247.115577] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Serological safety is an integral part of overall safety for blood banks. Emphasis is on the use of routinue Red Blood Cell (RBC) antibody screen test, at set time intervals, to reduce risks related to alloantibodies. Also emphasis is on importance of issuing antigen negative blood to alloantibody positive patients. Effect of using leucodepleted blood on the rate of alloimmunization is highlighted. The concept of provision of phenotypically matched blood is suggested. MATERIALS AND METHODS Antibody screen test is important to select appropriate blood for transfusion. Repeat antibody screen testing, except if time interval between the earlier and subsequent transfusion was less than 72 hours, followed by antibody identification, if required, was performed in patients being treated with repeat multiple blood transfusions. Between February 2008 and June 2009, repeat samples of 306 multi-transfused patients were analyzed. Search for irregular antibodies and reading of results was conducted using RBC panels (three-cell panel of Column Agglutination Technology (CAT) and two cell panel of the Solid Phase Red Cell Adherence Technology (SPRCAT). Specificities of antibodies were investigated using appropriate panels, 11 cell panel of CAT and 16 cell panel of SPRCA. These technologies, detecting agglutination in columns and reactions in solid phase, evaluate the attachment of irregular incomplete antibody to antigen in the first phase of immunological reaction more directly and hence improve the reading of agglutination. Three to four log leuco reduced red blood cells were transfused to patients in the study using blood collection bags with integral filters. RESULTS Alloimmunization rate of 4.24% was detected from 306 multiply transfused patients tested and followed up. The Transfusion therapy may become significantly complicated. CONCLUSION Red cell antibody screening and identification and subsequent issue of antigen negative blood have a significant role in improving blood safety. Centers that have incorporated antibody screen test and identification have ensured safe transfusion. Identified patients should be flagged in a database and information shared. Such patients can be given carry-on cards and educated about the names of the identified antibodies. Full red cell phenotyping of individuals, patients and donors, can be feasibility.
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Affiliation(s)
- Rashmi Sood
- Department of Transfusion Medicine at Artemis Health Institute, Gurgaon, India
| | - R. N. Makroo
- Department of Transfusion Medicine, Molecular Biology and Transplant Immunology, Indraprastha Apollo Hospital, New Delhi, India
| | - Vimarsh Riana
- Transfusion Medicine, Medanta The Medicity, Gurgaon, India
| | - N. L. Rosamma
- Department of Transfusion Medicine, Molecular Biology and Transplant Immunology, Indraprastha Apollo Hospital, New Delhi, India
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Nance ST, Keller MA. Comments on: molecular matching of red blood cells is superior to serological matching in sickle cell disease patients. Rev Bras Hematol Hemoter 2013; 35:9-11. [PMID: 23580875 PMCID: PMC3621626 DOI: 10.5581/1516-8484.20130005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 11/05/2012] [Indexed: 11/27/2022] Open
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The Lombardy Rare Donor Programme. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12 Suppl 1:s249-55. [PMID: 23522888 DOI: 10.2450/2013.0182-12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 11/12/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND In 2005, the government of Lombardy, an Italian region with an ethnically varied population of approximately 9.8 million inhabitants including 250,000 blood donors, founded the Lombardy Rare Donor Programme, a regional network of 15 blood transfusion departments coordinated by the Immunohaematology Reference Laboratory of the Ca' Granda Ospedale Maggiore Policlinico in Milan. During 2005 to 2012, Lombardy funded LORD-P with 14.1 million euros. MATERIALS AND METHODS During 2005-2012 the Lombardy Rare Donor Programme members developed a registry of blood donors and a bank of red blood cell units with either rare blood group phenotypes or IgA deficiency. To do this, the Immunohaematology Reference Laboratory performed extensive serological and molecular red blood cell typing in 59,738 group O or A, Rh CCDee, ccdee, ccDEE, ccDee, K- or k- donors aged 18-55 with a record of two or more blood donations, including both Caucasians and ethnic minorities. In parallel, the Immunohaematology Reference Laboratory implemented a 24/7 service of consultation, testing and distribution of rare units for anticipated or emergent transfusion needs in patients developing complex red blood cell alloimmunisation and lacking local compatible red blood cell or showing IgA deficiency. RESULTS Red blood cell typing identified 8,747, 538 and 33 donors rare for a combination of common antigens, negative for high-frequency antigens and with a rare Rh phenotype, respectively. In June 2012, the Lombardy Rare Donor Programme frozen inventory included 1,157 red blood cell units. From March 2010 to June 2012 one IgA-deficient donor was detected among 1,941 screened donors and IgA deficiency was confirmed in four previously identified donors. From 2005 to June 2012, the Immunohaematology Reference Laboratory provided 281 complex red blood cell alloimmunisation consultations and distributed 8,008 Lombardy Rare Donor Programme red blood cell units within and outside the region, which were transfused to 2,365 patients with no untoward effects. DISCUSSION Lombardy Rare Donor Programme, which recently joined the ISBT Working Party on Rare Donors, contributed to increase blood transfusion safety and efficacy inside and outside Lombardy.
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Blood donations motivators and barriers: a descriptive study of African American and white voters. Transfus Apher Sci 2012; 48:87-93. [PMID: 22920933 DOI: 10.1016/j.transci.2012.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 06/19/2012] [Accepted: 07/25/2012] [Indexed: 11/23/2022]
Abstract
African American adults are half as likely to donate blood than whites. In order to understand this difference, African American and white participants completed a survey regarding demographics, medical and donation history, and motivators and barriers. The most agreed upon motivators to blood donation were more convenient place and times, being asked and taking less than hour. Motivator responses which differed by race included donating for infectious disease test and reward, and assurance donating is safe. The most agreed upon barriers were not having a convenient place, not knowing where (response differed by race) and fear of needles, pain and feeling faint.
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Alternative blood products and clinical needs in transfusion medicine. Stem Cells Int 2012; 2012:639561. [PMID: 22567025 PMCID: PMC3337502 DOI: 10.1155/2012/639561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 12/30/2011] [Indexed: 01/19/2023] Open
Abstract
The primary focus of national blood programs is the provision of a safe and adequate blood supply. This goal is dependent on regular voluntary donations and a regulatory infrastructure that establishes and enforces standards for blood safety. Progress in ex vivo expansion of blood cells from cell sources including peripheral blood, cord blood, induced pluripotent stem cells, and human embryonic stem cell lines will likely make alternative transfusion products available for clinical use in the near future. Initially, alloimmunized patients and individuals with rare blood types are most likely to benefit from alternative products. However, in developed nations voluntary blood donations are projected to be inadequate in the future as blood usage by individuals 60 years and older increases. In developing nations economic and political challenges may impede progress in attaining self-sufficiency. Under these circumstances, ex vivo generated red cells may be needed to supplement the general blood supply.
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James AB, Hillyer CD, Shaz BH. Demographic differences in estimated blood donor eligibility prevalence in the United States. Transfusion 2011; 52:1050-61. [DOI: 10.1111/j.1537-2995.2011.03416.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wilkinson K, Harris S, Gaur P, Haile A, Armour R, Teramura G, Delaney M. Molecular blood typing augments serologic testing and allows for enhanced matching of red blood cells for transfusion in patients with sickle cell disease. Transfusion 2011; 52:381-8. [PMID: 21827505 DOI: 10.1111/j.1537-2995.2011.03288.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Katie Wilkinson
- Puget Sound Institute of Pathology and Puget Sound Blood Center, Seattle, Washington 98104, USA
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Schmid P, Huvard MJ, Lee-Stroka AH, Lee JY, Byrne KM, Flegel WA. Red blood cell preservation by droplet freezing with polyvinylpyrrolidone or sucrose-dextrose and by bulk freezing with glycerol. Transfusion 2011; 51:2703-8. [PMID: 21790629 DOI: 10.1111/j.1537-2995.2011.03258.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Red blood cell (RBC) preservation is essential to transfusion medicine. Many blood group reference laboratories need a method to preserve rare blood samples for serologic testing at a later date. This study offers a comparison of three common cryoprotective agents and protocols used today: bulk preservation with glycerol and droplet freezing with sucrose-dextrose (S+D) or polyvinylpyrrolidone (PVP). STUDY DESIGN AND METHODS Human blood from 14 volunteers was collected and frozen at set intervals over 2 weeks with PVP, S+D, or glycerol. The frozen RBCs were later thawed and the percentage of surviving RBCs was determined. Detailed protocols and an instructional video are supplied. RESULTS Over a 2-week period, RBCs preserved with glycerol and thawed with a widely used protocol showed a recovery of 41 ± 16% (mean ± standard deviation) while those thawed with a modified glycerol protocol showed a recovery of 76 ± 8%. RBCs preserved by droplet freezing with S+D showed a recovery of 56 ± 11% while those preserved by droplet freezing with PVP showed a recovery of 85 ± 6%. Recovery values were similar with ethylenediaminetetraacetic acid or heparin anticoagulants, differing freezing rates, and varying droplet volumes. CONCLUSION Droplet freezing with PVP offered the greatest recovery. While bulk freezing with glycerol can also be effective, droplet freezing may be a more convenient method overall. It requires less effort to thaw, needs much less storage room, and allows blood group laboratories to be frugal with thawing rare samples.
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Affiliation(s)
- Pirmin Schmid
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892, USA
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Chaudhari CN. Red Cell Alloantibodies in Multiple Transfused Thalassaemia Patients. Med J Armed Forces India 2011; 67:34-7. [PMID: 27365758 DOI: 10.1016/s0377-1237(11)80008-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 09/19/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Thalassaemia major patients require lifelong transfusion support due to which they are prone for alloimmunization to foreign RBCs. Alloimmunization can be prevented by extended phenotype match blood transfusion. The study was conducted to know the extent of problem of alloimmunization and to find important red cell antibodies in thalassaemia patients. METHODS A cross-sectional study was conducted. A total of 32 thalassaemia patients were enrolled. The specimen was subjected to red cell alloantibody and autoantibody by column gel agglutination technique. R 1 (w) R 1 , R 2 R 2 , rr (papaine and non papain) and 11 cell panel reagent cells were used in screening and identification of alloantibodies respectively. RESULT Six (18.8 %) subjects were alloimmunized. All alloimmunized subjects were recipient of more than 20 units of transfusion. Total seven clinically significant alloantibodies were identified. Anti E and anti c were commonest antibodies in four (12.5%) patients. CONCLUSION Red cell alloimmunization is an important risk in thalassaemia patient. 71.4% of alloantibodies were anti E and anti c type. Extended phenotype match blood transfusion for Rh-c and Rh-E antigens or level 2 antigen matching stringency needs to be explored in preventing alloimmunization in thalassaemia patients.
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Affiliation(s)
- C N Chaudhari
- Professor, Department of Microbiology, AFMC, Pune-40
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Abstract
Antigen diversity arises from changes at the gene level that range from single nucleotide polymorphisms (SNPs) to intra- and inter-genic exchanges, inversions, insertions, and deletions. Nucleotide changes often result in amino acid difference from the wild-type gene product and with those changes new blood group antigens arise. Alternatively, there is loss of expression altogether, which is deemed the 'null' phenotype. Near complete knowledge of the genetic changes underlying the expression of blood group antigens will lead to the reality that red cell genotyping as a test-of-record. The importance of molecular testing in immunohematology necessitates appropriate training and competency programs to ensure that the highly skilled staff has the appropriate knowledge background. This review summarizes the core mechanisms for gene expression and provides a compilation of the molecular basis for blood group expression.
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Affiliation(s)
- Gregory A Denomme
- BloodCenter of Wisconsin, 638 18th Street, PO Box 2178, Milwaukee, WI 53201-2178, United States.
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Abstract
PURPOSE OF REVIEW In the United States, blood donation rates of African-Americans are 25-50% of that of white individuals. As African-Americans make up an ever increasing and now substantial minority, and African-American recipients of blood transfusion, both specialized, such as sickle cell disease patients, and general hospitalized patients, have a better chance of receiving phenotype-matched or appropriate red blood cell units when there is a significant percentage of products in the inventory from African-American donors, it is important to understand the reason for the observed difference. RECENT FINDINGS Possible reasons for this discrepancy in donation rates include increased rates of donor deferral and ineligibility; increased barriers to donation, such as fear and distrust; and different marketing and education strategies. Thus, to increase the blood availability to African-American recipients, the reasons for these donation rate differences must be better understood and subsequently addressed through improved blood donor recruitment programs. The majority of African-American donor recruitment programs have focused on donating for sickle cell disease patients, particularly children, which have been of limited success. SUMMARY Significant improvements in African-American donor recruitment are needed to adequately meet the demand of African-American patients as well as the entire population.
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Affiliation(s)
- Beth H Shaz
- New York Blood Center, New York, New York 10065, USA.
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Abstract
When one looks at the field of molecular pathology or transplantation, it is evident that molecular biology has made a positive impact on medicine. However, the progress in transfusion medicine has been slower and more cautious than in other areas of the clinical laboratory. To understand where the field may go in the next 10 years requires that the reader understand what technology is available now. Therefore, this article discusses the current state of the art for red-cell genotyping and newer, ever-evolving molecular technologies. Because it is impossible to present all of the molecular techniques and their variations in this article, the author selects a group of methodologies to review and speculates where the field of molecular immunohematology may be in 2020.
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Affiliation(s)
- Joann M Moulds
- Clinical Immunogenetics, LifeShare Blood Centers, 8910 Linwood Avenue, Shreveport, LA 71106, USA.
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RH genotyping in a sickle cell disease patient contributing to hematopoietic stem cell transplantation donor selection and management. Blood 2010; 116:2836-8. [PMID: 20644109 DOI: 10.1182/blood-2010-04-279372] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
African individuals harbor molecular RH variants, which permit alloantibody formation to high-prevalence Rh antigens after transfusions. Genotyping identifies such RH variants, which are often missed by serologic blood group typing. Comprehensive molecular blood group analysis using 3 genotyping platforms, nucleotide sequencing, and serologic evaluation was performed on a 7-year-old African male with sickle cell disease who developed an "e-like" antibody shortly after initiating monthly red blood cell (RBC) transfusions for silent stroke. Genotyping of the RH variant predicted a severe shortage of compatible RBCs for long-term transfusion support, which contributed to the decision for hematopoetic stem cell transplantation. RH genotyping confirmed the RH variant in the human leukocyte antigen-matched sibling donor. The patient's (C)ce(s) type 1 haplotype occurs in up to 11% of African American sickle cell disease patients; however, haplotype-matched RBCs were serologically incompatible. This case documents that blood unit selection should be based on genotype rather than one matching haplotype.
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Vamvakas EC, Blajchman MA. Blood still kills: six strategies to further reduce allogeneic blood transfusion-related mortality. Transfus Med Rev 2010; 24:77-124. [PMID: 20303034 PMCID: PMC7126657 DOI: 10.1016/j.tmrv.2009.11.001] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
After reviewing the relative frequency of the causes of allogeneic blood transfusion-related mortality in the United States today, we present 6 possible strategies for further reducing such transfusion-related mortality. These are (1) avoidance of unnecessary transfusions through the use of evidence-based transfusion guidelines, to reduce potentially fatal (infectious as well as noninfectious) transfusion complications; (2) reduction in the risk of transfusion-related acute lung injury in recipients of platelet transfusions through the use of single-donor platelets collected from male donors, or female donors without a history of pregnancy or who have been shown not to have white blood cell (WBC) antibodies; (3) prevention of hemolytic transfusion reactions through the augmentation of patient identification procedures by the addition of information technologies, as well as through the prevention of additional red blood cell alloantibody formation in patients who are likely to need multiple transfusions in the future; (4) avoidance of pooled blood products (such as pooled whole blood-derived platelets) to reduce the risk of transmission of emerging transfusion-transmitted infections (TTIs) and the residual risk from known TTIs (especially transfusion-associated sepsis [TAS]); (5) WBC reduction of cellular blood components administered in cardiac surgery to prevent the poorly understood increased mortality seen in cardiac surgery patients in association with the receipt of non-WBC-reduced (compared with WBC-reduced) transfusion; and (6) pathogen reduction of platelet and plasma components to prevent the transfusion transmission of most emerging, potentially fatal TTIs and the residual risk of known TTIs (especially TAS).
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Affiliation(s)
- Eleftherios C Vamvakas
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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