1
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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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2
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Abstract
Red blood cell (RBC) transfusion is one of the most frequently performed clinical procedures and therapies to improve tissue oxygen delivery in hospitalized patients worldwide. Generally, the cross-match is the mandatory test in place to meet the clinical needs of RBC transfusion by examining donor-recipient compatibility with antigens and antibodies of blood groups. Blood groups are usually an individual's combination of antigens on the surface of RBCs, typically of the ABO blood group system and the RH blood group system. Accurate and reliable blood group typing is critical before blood transfusion. Serological testing is the routine method for blood group typing based on hemagglutination reactions with RBC antigens against specific antibodies. Nevertheless, emerging technologies for blood group testing may be alternative and supplemental approaches when serological methods cannot determine blood groups. Moreover, some new technologies, such as the evolving applications of blood group genotyping, can precisely identify variant antigens for clinical significance. Therefore, this review mainly presents a clinical overview and perspective of emerging technologies in blood group testing based on the literature. Collectively, this may highlight the most promising strategies and promote blood group typing development to ensure blood transfusion safety.
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Affiliation(s)
- Hong-Yang Li
- Department of Blood Transfusion, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Kai Guo
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Kai Guo
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3
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Miranda MR, Dos Santos TD, Castilho L. Systematic RHD genotyping in Brazilians reveals a high frequency of partial D in transfused patients serologically typed as weak D. Transfus Apher Sci 2021; 60:103235. [PMID: 34389204 DOI: 10.1016/j.transci.2021.103235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The discrimination between weak D types and partial D can be of clinical importance because carriers of partial D antigen may develop anti-D when transfused with D-positive red blood cell units. The aim of this study was to determine by molecular analysis the type of D variants among Brazilian patients requiring transfusions with serologic weak D phenotypes. MATERIAL AND METHODS Samples from 87 patients (53 with sickle cell disease, 10 with thalassemia and 24 with myelodysplastic syndrome), serologic typed as weak D by manual tube indirect antiglobulin test or gel test were first RHD genotyped by using the RHD BeadChip Kit (BioArray, Immucor). Sanger sequencing was performed when necessary. RESULTS RHD molecular analysis revealed 32 (36.8 %) variant RHD alleles encoding weak D phenotypes and 55 (63.2 %) alleles encoding partial D antigens. RHD variant alleles were present in the homozygous state or as a single RHD allele, one variant RHD allele associated with the RHDΨ allele, or two different variant RHD alleles in compound heterozygosity with each other in 70 patients, 4 patients and 13 patients, respectively. Alloanti-D was found in 9 (16.4 %) cases with RHD alleles predicting a partial D. DISCUSSION The frequency of partial D was higher than weak D types in Brazilian patients serologically typed as weak D, showing the importance to differentiate weak D types and partial D in transfused patients to establish a transfusion policy recommendation.
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4
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Floch A. Maternal red blood cell alloimmunisation Working Party, literature review. RH blood group system: Rare specificities. Transfus Clin Biol 2021; 28:314-320. [PMID: 33895380 DOI: 10.1016/j.tracli.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
This report is part of a series reporting the GRADE review performed by the 2018-2020 French Working Party on maternal red blood cell alloimmunisation. This report focusses on the clinical significance in obstetrics, as published in the scientific literature, of the rare RH antibodies, variants and antigens (i.e. excluding conventional RH1 trough RH8 antigens, RH12, RH22 and RH27, which are discussed in other reports of this series). Extremely severe or severe haemolytic disease of the fetus and the newborn (HDFN), leading to death or requiring transfusions, have been reported for: anti-RH1 (-D) associated with DVI, DBT and DIVb phenotypes, RHD*12.04 (DOL4), RHD*03.03 (DIIIc), RHD*D-CE(2-5)-D, RHD*01EL.31 (RHD*148+1T), anti-RH9 (-CX), anti-RH11 (-EW), anti-RH17 (-Hr0), anti-RH18 (-Hr), anti-RH19 (-hrS), anti-RH23 (-DW), anti-RH29 ("total" Rh), anti-RH30 (-Goa), anti-RH32, anti-RH34 (-HrB), anti-RH36 (-Bea), anti-RH40 (-Tar), anti-RH46 (-Sec), anti-RH48 (-JAL), anti-RH54 (DAK), and antibodies to high prevalence antigens such as those associated with RHCE*02.08.02 (RHCE*CW-RHD(6-10)), RHCE*03N.01 (RHCE*cEMI). HDFN of moderate, mild or undetailed severity have been reported for: anti-RH1 associated with DHar, DIIIa and DIVa phenotypes, RHD*01EL.08 (RHD*486+1A),RHD*01EL.44 (RHD*D-CE(4-9)-D),RHD*25 (DNB), anti-RH20 (-VS), anti-RH31 (-hrB), anti-RH37 (-Evans), ani-RH42, anti-RH49 (-STEM), anti-RH51 (-MAR), anti-RH55 (-LOCR), anti-RH58 (-CELO). Positive direct antiglobulin test in the newborn but no clinically significant HDFN has been reported for anti-RH1 (-D) associated with RHD*10.05 (DAU5), RHD*12.02 (DOL2). Because so many specificities are associated with severe HDFN in the RH system, all RH antibodies should be considered as potentially able to cause HDFN, even if none has been reported yet.
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Affiliation(s)
- A Floch
- Université Paris Est Creteil, Inserm, IMRB, 8, rue du Général-Sarrail, 94010 Créteil, France; Établissement français du sang Île-de-France, IMRB, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Laboratory of Excellence GR-Ex, IMRB, 8, rue du Général-Sarrail, 94010 Créteil, France.
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5
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Floch A, Téletchéa S, Tournamille C, de Brevern AG, Pirenne F. A Review of the Literature Organized Into a New Database: RHeference. Transfus Med Rev 2021; 35:70-77. [PMID: 33994075 DOI: 10.1016/j.tmrv.2021.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 01/18/2023]
Abstract
Hundreds of articles containing heterogeneous data describe D variants or add to the knowledge of known alleles. Data can be difficult to find despite existing online blood group resources and genetic and literature databases. We have developed a modern, elaborate database for D variants, thanks to an extensive literature search with meticulous curation of 387 peer-reviewed articles and 80 abstracts from major conferences and other sources. RHeference contains entries for 710 RHD alleles, 11 RHCE alleles, 30 phenotype descriptions (preventing data loss from historical sources), 35 partly characterized alleles, 3 haplotypes, and 16 miscellaneous entries. The entries include molecular, phenotypic, serological, alloimmunization, haplotype, geographical, and other data, detailed for each source. The main characteristics are summarized for each entry. The sources for all information are included and easily accessible through doi and PMID links. Overall, the database contains more than 10,000 individual pieces of data. We have set up the database architecture based on our previous expertise on database setup and biocuration for other topics, using modern technologies such as the Django framework, BioPython, Bootstrap, and Jquery. This architecture allows an easy access to data and enables simple and complex queries: combining multiple mutations, keywords, or any of the characteristics included in the database. RHeference provides a complement to existing resources and will continue to grow as our knowledge expands and new articles are published. The database url is http://www.rheference.org/.
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Affiliation(s)
- Aline Floch
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France; EFS Ile-de-France Créteil, Creteil, France; Laboratory of Excellence GR-Ex, Paris, France
| | | | - Christophe Tournamille
- EFS Ile-de-France Créteil, Creteil, France; Laboratory of Excellence GR-Ex, Paris, France
| | - Alexandre G de Brevern
- Laboratory of Excellence GR-Ex, Paris, France; Université de Paris, INSERM UMR_S 1134, BIGR, DSIMB, Univ de la Réunion, Univ des Antilles, Paris, France; Institut National de la Transfusion Sanguine, Paris, France
| | - France Pirenne
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France; EFS Ile-de-France Créteil, Creteil, France; Laboratory of Excellence GR-Ex, Paris, France.
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6
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Mathur G, Vege S, Lomas-Francis C, Westhoff CM. A novel RHD*DAU allele with c.1136C>T (p.Thr379Met) and c.17C>T (p. Pro6Leu). Transfusion 2020; 60:E51-E52. [PMID: 33037611 DOI: 10.1111/trf.16135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/12/2020] [Accepted: 08/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Gagan Mathur
- School of Medicine, Department of Pathology, University of Missouri-Kansas City, Kansas City, Missouri.,Department of Pathology, Saint Luke's Health System, Kansas City, Missouri
| | - Sunitha Vege
- Immunohematology and Genomics, New York Blood Center Enterprises, New York, New York.,Immunohematology and Genomics, New York Blood Center Enterprises, Kansas City, Kansas
| | - Christine Lomas-Francis
- Immunohematology and Genomics, New York Blood Center Enterprises, New York, New York.,Immunohematology and Genomics, New York Blood Center Enterprises, Kansas City, Kansas
| | - Connie M Westhoff
- Immunohematology and Genomics, New York Blood Center Enterprises, New York, New York.,Immunohematology and Genomics, New York Blood Center Enterprises, Kansas City, Kansas
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7
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Vege S, Sprogøe U, Lomas-Francis C, Jakobsen MA, Antonsen B, Aeschlimann J, Yazer M, Westhoff CM. Impact of RHD genotyping on transfusion practice in Denmark and the United States and identification of novel RHD alleles. Transfusion 2020; 61:256-265. [PMID: 32975828 DOI: 10.1111/trf.16100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Reduced D antigen on red blood cells (RBCs) may be due to "partial" D phenotypes associated with loss of epitope(s) and risk for alloimmunization or "weak" D phenotypes that do not lack major epitopes with absence of clinical complications. Genotyping of samples with weak and discrepant D typing is recommended to guide transfusion and RhIG prophylaxis. The goal was to compare the impact of RHD genotyping on transfusion practice in two centers serving different populations. STUDY DESIGN AND METHODS Fifty-seven samples from Denmark and 353 from the United States with weak or discrepant D typing were genotyped. RBC typing was by multiple methods and reagents. DNA isolated from white blood cells was tested with RBC-Ready Gene D weak or CDE in Denmark or RHD BeadChip in the United States. RHD was sequenced for those unresolved. RESULTS Of Caucasian samples from Denmark, 90% (n = 51) had weak D types 1, 2, or 3; two had other weak D, two partial D, and two new alleles. In diverse ethnic U.S. samples, 44% (n = 155) had weak D types 1, 2, or 3 and 56% (n = 198) had other alleles: uncommon weak D (n = 13), weak 4.0 (n = 62), partial D (n = 107), no RHD (n = 9), and new alleles (n = 7). CONCLUSION Most samples with weak or variable D typing from Denmark had alleles without risk for anti-D. In U.S. samples, 48% could safely be treated as D+, 18% may require consideration if pregnancy possible, and 34% could potentially benefit from being treated as D-. Black and multiracial ethnicities were overrepresented relative to population.
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Affiliation(s)
- Sunitha Vege
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
| | - Ulrik Sprogøe
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Christine Lomas-Francis
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
| | - Marianne A Jakobsen
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Berit Antonsen
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Judith Aeschlimann
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
| | - Mark Yazer
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.,Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Connie M Westhoff
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
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8
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Anderson R, Vege S, Aeschlimann J, Westhoff C, Banerjee S, Yang J.
RHCE*02
(
c.148G>A
,
p.Val50Ile
) allele with silenced
RHCE*Ce
expression. Transfusion 2020; 60:E23-E24. [DOI: 10.1111/trf.15936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Sunitha Vege
- Laboratory of Immunohematology and GenomicsNew York Blood Center Enterprise Long Island City New York USA
| | - Judith Aeschlimann
- Laboratory of Immunohematology and GenomicsNew York Blood Center Enterprise Long Island City New York USA
| | - Connie Westhoff
- Laboratory of Immunohematology and GenomicsNew York Blood Center Enterprise Long Island City New York USA
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9
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Classification of major and minor blood group antigens in the Kuwaiti Arab population. Transfus Apher Sci 2020; 59:102748. [DOI: 10.1016/j.transci.2020.102748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 11/24/2022]
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10
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RHD and RHCE molecular analysis in weak D blood donors and in patients with Rh antibodies against their own corresponding Rh antigen. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 18:295-303. [PMID: 32697929 DOI: 10.2450/2020.0026-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Rh system is the largest and most polymorphic blood group system. The existence of a large number of RH alleles results in variant phenotypes that often complicate blood donor phenotyping and the distinction between auto- and allo-antibodies in recipients who have anti-Rh antibodies in the presence of their own corresponding Rh antigen. Knowledge of these variants is necessary in order to make blood transfusion safer. MATERIALS AND METHODS Samples from 48 blood donors with serological weak D and from 29 patients who had anti-Rh antibody in the presence of their own corresponding Rh antigen were evaluated molecularly for RHD and RHCE alleles using a blood-multiplex ligation-dependent probe amplification assay and Sanger sequencing. RESULTS Rh variants were found in 45 of the 48 blood donors: 24/45 (53%) were weak D, 2/45 (4%) partial D and 19/45 (42%) were weak and partial D. The remaining three donors (6%) did not show a mutation in the RHD allele. Among the 29 patients, 13/29 had anti-e, of whom 4/13 had genotypes that predicted a partial e antigen; 11/29 had anti-D, with 6/11 being identified as partial D; 2/29 had anti-c, of whom 1/2 was predicted to express partial c antigen; 4/29 who had anti-E and 4/29 who had anti-C did not show mutations in RHCE*C or RHCE*E. DISCUSSION It was possible to find individuals with clinically significant Rh phenotypes due to the weak reactivity of the D antigen, detected through serological tests in blood donors. In patients, when found with the anti-Rh antibody in the presence of the same Rh antigen, it is difficult to distinguish an auto-antibody from an allo-antibody by serological tests; in these cases, molecular methods (genotyping) can help us to determine whether there are changes in the RH alleles and to discover the nature of the antibody (allo or auto).
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11
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Khetan D, Verma A, Chaudhary RK, Shukla JS. Molecular characterisation of RhD variants in North Indian blood donor population. Transfus Med 2020; 30:295-303. [PMID: 32488899 DOI: 10.1111/tme.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/01/2020] [Accepted: 05/10/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES A molecular analysis of serologically RhD variant samples was conducted to find the incidence of various D variants in our blood donor population. BACKGROUND Determining a blood donor's RhD phenotype and genotype is important as transfusion of units with a weak D or partial D phenotype can result in immunisation of the recipients. METHODS Samples with discrepant D and weak D phenotypes identified on testing with at least five different monoclonal anti-D antisera were considered serological RhD variant and subjected to molecular testing (Massarray kit, Agena Bioscience, San Diego) for variant RHD gene. RESULTS A total of 39 samples, including 19 RhD discrepant samples and 20 weak D samples, were identified as serological RhD variant from a total of 4386 samples. Thirteen (13/39) samples carried variants leading to weak D phenotype, and eight samples had variants leading to partial D categories. Seven samples (7) could not be characterised, whereas 11 samples were identified as Rh negative (RHD*01N.01) after molecular testing. Overall incidence of D variants in the study population was 0.48%. RHD*weak D type 1(5, 0.1%) and RHD*DFR1 (5, 1%) were the most common variants identified. CONCLUSIONS Few samples with weak reaction on serological testing were found to be partial D variant and vice versa. Donor centres should develop a protocol for genotyping of samples with aberrant results on serological testing for assessing the actual RhD status of an individual as results of serological testing may be misleading.
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Affiliation(s)
- Dheeraj Khetan
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anviti Verma
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajendra K Chaudhary
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Jai Shankar Shukla
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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12
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Cruz BR, de Souza Silva TC, de Souza Castro B, Chiba AK, Moritz E, Braga JP, Figueiredo MS, Bordin JO. Molecular matching for patients with haematological diseases expressing altered RHD-RHCE genotypes. Vox Sang 2019; 114:605-615. [PMID: 31087345 DOI: 10.1111/vox.12789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 04/03/2019] [Accepted: 04/17/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The high homology and the inverted orientation of RHD and RHCE may give rise to non-functional and aberrant RH alleles. RH genotyping is used to screen RH matched donors to African descent patients. This study aimed to define a strategy for testing RHD and RHCE variants in blood donors to provide compatible units for transfusion of patients with haematological diseases. MATERIALS AND METHODS Samples from 132 patients [101 Sickle cell disease (SCD), 14 myelodysplastic syndrome (MDS), 17 acute myelogenous leukaemia (AML)] and 198 Brazilian donors were studied. Major blood group alleles, RHD, RHCE alleles and RHD zygosity were determined by the blood-MLPA assay. Sequencing was performed to determine RHD and RHCE variant subtypes. A match was an RH genotype that did not encode Rh antigens absent in the patient, along with matching for ABO, MNS, KEL, FY, JK and DI antigens. RESULTS Overall, 7·6% of blood donors and 17.4% of patients presented RH genotypes that predict expression of partial Rh antigens or lack of high prevalence Rh antigens. From 23 patients with clinically relevant RH genotypes, 15 had available matched donors. CONCLUSION We report the presence of clinically relevant RH genotypes in SCD and in non-SCD patients. In our admixed population, many patients carry variant RHCE alleles in heterozygosity with normal RHCE alleles. Thus, our results suggest that donors could be selected based on the normal RH allele.
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Affiliation(s)
- Bruno Ribeiro Cruz
- Department of Clinical and Experimental Oncology, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Thamy Caroline de Souza Silva
- Department of Clinical and Experimental Oncology, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Bianca de Souza Castro
- Department of Clinical and Experimental Oncology, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Akemi Kuroda Chiba
- Department of Clinical and Experimental Oncology, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Elyse Moritz
- Department of Clinical and Experimental Oncology, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Josefina Pellegrini Braga
- Department of Pediatrics, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Maria Stella Figueiredo
- Department of Clinical and Experimental Oncology, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - José O Bordin
- Department of Clinical and Experimental Oncology, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
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13
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de Paula Vendrame TA, Latini FRM, de Medeiros Person R, Cortez AJP, Castilho L, Arnoni CP. Novel RHD alleles in African Brazilians. Transfusion 2019; 59:3035-3036. [PMID: 31013354 DOI: 10.1111/trf.15327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/27/2019] [Accepted: 03/30/2019] [Indexed: 11/30/2022]
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14
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de Brevern AG, Floch A, Barrault A, Martret J, Bodivit G, Djoudi R, Pirenne F, Tournamille C. Alloimmunization risk associated with amino acid 223 substitution in the RhD protein: analysis in the light of molecular modeling. Transfusion 2018; 58:2683-2692. [DOI: 10.1111/trf.14809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 04/09/2018] [Accepted: 04/21/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Alexandre G. de Brevern
- INSERM UMR_S 1134; Univ. Paris Diderot, Sorbonne Paris Cité, Univ. de la Réunion, Univ. Antilles; Paris
- Laboratory of Excellence GR-Ex; Paris
- Institut National de la Transfusion Sanguine (INTS); Paris
| | - Aline Floch
- Laboratory of Excellence GR-Ex; Paris
- Etablissement Français du Sang Ile de France; Créteil France
- IMRB-INSERM U955 Team 2 “Transfusion et Maladies du Globule Rouge”; Créteil France
- UPEC; Université Paris Est-Créteil; Créteil France
| | | | | | - Gwellaouen Bodivit
- Laboratory of Excellence GR-Ex; Paris
- Etablissement Français du Sang Ile de France; Créteil France
- IMRB-INSERM U955 Team 2 “Transfusion et Maladies du Globule Rouge”; Créteil France
| | - Rachid Djoudi
- Etablissement Français du Sang Ile de France; Créteil France
| | - France Pirenne
- Laboratory of Excellence GR-Ex; Paris
- Etablissement Français du Sang Ile de France; Créteil France
- IMRB-INSERM U955 Team 2 “Transfusion et Maladies du Globule Rouge”; Créteil France
- UPEC; Université Paris Est-Créteil; Créteil France
| | - Christophe Tournamille
- Laboratory of Excellence GR-Ex; Paris
- Etablissement Français du Sang Ile de France; Créteil France
- IMRB-INSERM U955 Team 2 “Transfusion et Maladies du Globule Rouge”; Créteil France
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15
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Floch A, Tournamille C, Chami B, Pirenne F. Genotyping in Sickle Cell Disease Patients: The French Strategy. Transfus Med Hemother 2018; 45:264-270. [PMID: 30283276 DOI: 10.1159/000490858] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/11/2018] [Indexed: 01/13/2023] Open
Abstract
This review presents the French strategy for blood group genotyping in high-responder and newly diagnosed sickle cell disease (SCD) patients. In addition to FY, JK, and MNS genotyping, the RH blood group system is now explored in SCD patients in France. Molecular typing has been used for the deduction of partial RH2 (C) antigens since 2010, and the gradual implementation of systematic RHD and RHCE genotyping nationwide was initiated in late 2014. In our laboratory, 962 RH:2 (C-positive) SCD patients have been tested since 2010, and 1,148 SCD patients of all RH phenotypes have been genotyped for clinically relevant alleles of RHD and RHCE since late 2014.
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Affiliation(s)
- Aline Floch
- Etablissement Français du Sang (EFS) - Ile de France, Créteil, France.,INSERM U955, Equipe 2 'Transfusion et maladies du globule rouge', Créteil, France.,Laboratory of Excellence GR-Ex, Créteil, France.,Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est-Créteil (UPEC), Faculté de Médecine, Créteil, France
| | - Christophe Tournamille
- Etablissement Français du Sang (EFS) - Ile de France, Créteil, France.,INSERM U955, Equipe 2 'Transfusion et maladies du globule rouge', Créteil, France.,Laboratory of Excellence GR-Ex, Créteil, France
| | - Btissam Chami
- Etablissement Français du Sang (EFS) - Ile de France, Créteil, France
| | - France Pirenne
- Etablissement Français du Sang (EFS) - Ile de France, Créteil, France.,INSERM U955, Equipe 2 'Transfusion et maladies du globule rouge', Créteil, France.,Laboratory of Excellence GR-Ex, Créteil, France.,Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est-Créteil (UPEC), Faculté de Médecine, Créteil, France
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Vendrame T, Latini FRM, Person R, Cortez AJP, Castilho L, Arnoni CP. Molecular characterization of three novelRHDalleles in Brazilians. Transfusion 2018; 58:1814-1815. [DOI: 10.1111/trf.14638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/08/2018] [Accepted: 02/14/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Tatiane Vendrame
- Colsan, Associação Beneficente de Coleta de SangueSão Paulo SP Brazil
| | | | - Rosangela Person
- Colsan, Associação Beneficente de Coleta de SangueSão Paulo SP Brazil
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de Moura Neto JP, Cerqueira BAV, Santos WVB, Lyra IM, Goncalves MS. The DAU Allele and Anti-D Alloimmunization Present With High Frequency in Brazilian Sickle Cell Disease Patients. J Hematol 2017; 6:73-80. [PMID: 32300397 PMCID: PMC7155847 DOI: 10.14740/jh316w] [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: 01/08/2017] [Accepted: 02/14/2017] [Indexed: 11/16/2022] Open
Abstract
Background Antigens DIIIa, DAR and DAU are common in people of African descent and are involved in anti-D alloimmunization. Sickle cell disease (SCD) patients frequently need blood therapy and are vulnerable to alloimmunization. Methods The study included SCD patients from the Brazilian state of Bahia, which has the highest incidence of the disease in Brazil; 241 SCD patients and 220 healthy individuals were studied. Alleles were characterized by PCR-RFLP and PCR-SSP techniques. Results The DAU allele was found in 22.3% (43/193) of the SCD patients. Two (1%) patients had the DIIIa/D wild-type genotype, one (0.5%) had the DIIIa/D- genotype, 11 (5.7%) had the DAR/D wild-type genotype and three (1.6%) had the DAR/D- genotype. Two patients were positive for the 667T>G mutation and the 1136C>T mutation, one (0.5%) had the genotype DIIIa/DAU, and one (0.5%) had the genotype DAR/DAU. Conclusion There was statistical significance when the allele frequencies were evaluated among SCD, sickle cell anemia (HbSS) patients and healthy individuals. The frequencies of the DIIIa, DAR and DAU alleles among SCD patients differ from those of healthy individuals from the same population, and a high frequency of the DAU variant was associated with anti-D alloimmunization in these patients.
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Affiliation(s)
| | | | | | | | - Marilda Souza Goncalves
- Fundacao Oswaldo Cruz - Centro de Pesquisas Goncalo Moniz, Salvador, Bahia, Brazil.,Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Chou ST, Westhoff CM. Application of genomics for transfusion therapy in sickle cell anemia. Blood Cells Mol Dis 2017; 67:148-154. [DOI: 10.1016/j.bcmd.2017.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 08/07/2017] [Indexed: 12/23/2022]
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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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Prisco Arnoni C, Guilhem Muniz J, de Paula Vendrame TA, de Medeiros Person R, Roche Moreira Latini F, Castilho L. RHCEvariants inherited with alteredRHDalleles in Brazilian blood donors. Transfus Med 2016; 26:285-90. [DOI: 10.1111/tme.12309] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 11/28/2022]
Affiliation(s)
- C. Prisco Arnoni
- Technical scientific department Colsan - Associação Beneficente de Coleta de Sangue; São Paulo SP Brazil
| | - J. Guilhem Muniz
- Technical scientific department Colsan - Associação Beneficente de Coleta de Sangue; São Paulo SP Brazil
| | - T. A. de Paula Vendrame
- Technical scientific department Colsan - Associação Beneficente de Coleta de Sangue; São Paulo SP Brazil
| | - R. de Medeiros Person
- Technical scientific department Colsan - Associação Beneficente de Coleta de Sangue; São Paulo SP Brazil
| | - F. Roche Moreira Latini
- Technical scientific department Colsan - Associação Beneficente de Coleta de Sangue; São Paulo SP Brazil
| | - L. Castilho
- Molecular Immunohematology Laboratory Hemocentro - Unicamp; Campinas SP Brazil
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Arnoni CP, Muniz JG, de Paula Vendrame TA, Gazito D, de Medeiros Person R, Latini FRM, Castilho L. Identification of four novelRHDalleles with altered expression of D in Brazilians. Transfusion 2016; 56:1475-6. [DOI: 10.1111/trf.13590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 01/22/2016] [Accepted: 01/29/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Diana Gazito
- Colsan-Associação Beneficente de Coleta de Sangue
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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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Westhoff CM, Vege S, Hipsky CH, Horn T, Hue-Roye K, Keller J, Velliquette R, Lomas-Francis C, Chou ST, Reid ME. RHCE*ceAG (254C>G, Ala85Gly) is prevalent in blacks, encodes a partial ce-phenotype, and is associated with discordant RHD zygosity. Transfusion 2015; 55:2624-32. [PMID: 26173592 DOI: 10.1111/trf.13225] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND RHCE*ceAG has the nucleotide change c.254C>G, which encodes p.Ala85Gly associated with altered expression of e antigen. We analyzed serologic and DNA-based testing data on samples with RHCE*ceAG to determine its effect on antigen expression, linkage with RHD, and its prevalence in African Americans. STUDY DESIGN AND METHODS Serologic testing was performed by standard methods. Genomic DNA was used for polymerase chain reaction-restriction fragment length polymorphism, RH-specific exon sequencing, and RHD zygosity, and Rh-cDNA was sequenced. Samples from 32 individuals referred for serologic problems, 57 patients with sickle cell disease, and 44 donors positive for c.254C>G were investigated. Allele prevalence was determined in random African Americans. RESULTS Red blood cells from samples homozygous RHCE*ceAG/ceAG or in trans to RHCE*cE reacted variably with anti-e reagents and 17 samples from the 32 referred patients had alloanti-e in their plasma. The majority of samples with RHCE*ceAG, when tested for RHD zygosity gave discordant results between PstI-RFLP and hybrid box assay. Rare samples with 254C>G had additional allelic changes: one with c.697G (p.233Glu), three with c.733G, 941C (p.245Val, 314Ala), and two with c.307T (p.103Ser) encoding robust C antigen expression in the absence of other C-specific nucleotides. A total of 101 samples with RHCE*ceAG were encountered in 1159 randomly selected African Americans. CONCLUSIONS RHCE*ceAG (c.254G, p.85Gly) encodes a partial phenotype and the absence of the high-prevalence antigen RH59 (CEAG). The allele was present in one in 11 African Americans and is most often in cis to a RHD deletion associated with discordant RHD zygosity. To further determine clinical significance, detection of this allele should be part of routine RHCE genotyping in this population.
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Affiliation(s)
| | | | | | - Trina Horn
- National Molecular Laboratory, American Red Cross
| | - Kim Hue-Roye
- Laboratory of Immunochemistry, New York Blood Center, New York, New York
| | | | | | | | - Stella T Chou
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marion E Reid
- Laboratory of Immunochemistry, New York Blood Center, New York, New York
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Moulds JM, Noumsi GT, Billingsley KL. A comparison of methods for the detection of the r'(s) haplotype. Transfusion 2014; 55:1418-22. [PMID: 25496603 DOI: 10.1111/trf.12956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/16/2014] [Accepted: 10/21/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The r'(s) haplotype is found in 5% to 15% of individuals of African descent. Persons with this haplotype have a partial C antigen and weakened e and can produce anti-C or other "e-like" alloantibodies. Thus, for these chronically transfused patients, accurate detection of the r'(s) haplotype is important for selection of matched units. STUDY DESIGN AND METHODS African-American donors were genotyped using the human erythrocyte antigen (HEA) microarray. Samples (n = 125) identified as "possible r'(s) " were then tested by IDCORE XT and RHD and RHCE microarrays. DNA sequencing was used to resolve discordant samples. The genotyping results were compared to serologic testing using a monoclonal anti-C reagent (Clone MS24). RESULTS Of the 125 possible r'(s) samples identified by HEA, only 94 (75%) were confirmed by both RHD and RHCE microarrays. The IDCORE XT accurately detected 93 of 94 (99%) of the confirmed r'(s) and had no false positives. DNA sequencing of the one discordant sample revealed the presence of a compound heterozygote with RHD* DIII.4/RHCE*ceVS.02 as one haplotype and r'(s) Type 2 as the other. The 31 unconfirmed r'(s) samples carried RHCE*ceVS.03 not linked to the hybrid RHD-CE-D. This occurred most often with RHD*DIIIa (55%) or RHD*01 (19%) and rarely with DIII.4, DIII.6, DAU3, and weak D Type 14. Serologic testing with anti-C gave 100% concordance with the r'(s) samples. CONCLUSIONS The predominant type of r'(s) in African-Americans is Type 1, which can be detected either by a reagent anti-C containing Clone MS24 or by IDCORE XT. However, serology cannot differentiate between a normal C allele and the hybrid.
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Affiliation(s)
- Joann M Moulds
- John J. Moulds Scientific Support Services, LifeShare Blood Centers, Shreveport, Louisiana
| | - Ghislain T Noumsi
- John J. Moulds Scientific Support Services, LifeShare Blood Centers, Shreveport, Louisiana
| | - Katrina L Billingsley
- John J. Moulds Scientific Support Services, LifeShare Blood Centers, Shreveport, Louisiana
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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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Xu P, Li Y, Yu H. Prevalence, specificity and risk of red blood cell alloantibodies among hospitalised Hubei Han Chinese patients. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 12:56-60. [PMID: 24333071 PMCID: PMC3926729 DOI: 10.2450/2013.0013-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 07/30/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND The prevalence, specificity and risk of red blood cell alloantibodies vary widely among different geographic areas, races, and diseases and according to different methods of study, but no data are available on the Chinese Han population, who were investigated in the present study. MATERIALS AND METHODS Antibody screening was conducted among 42,517 hospitalised Hubei Han Chinese individuals using column agglutination technology. Samples that were positive in antibody screening were subjected to antibody identification by the tube test. Clinical data, including gender, age, race, transfusion history and records of alloantibody detection, transfusion reactions or haemolytic disease of the newborn, were collected to analyse the prevalence and specificity of alloantibodies and complications associated with them. RESULTS A total of 212 patients with alloantibodies were identified among 42,517 patients, yielding a prevalence of 0.50% in this study. Significantly different prevalence rates were observed according to age and sex. The most frequently identified alloantibodies were anti-E (87/212, 41.0%), anti-D (45/212, 21.2%), anti-M (41/212, 19.3%) and a combination of anti-E and anti-c (13/212, 6.1%). Haemolytic disease was observed in 13 infants with anti-D, three infants with anti-E and one infant with anti-Fy(a) alloantibodies. Delayed haemolytic transfusion reactions occurred in four patients with alloantibodies. DISCUSSION In hospitalised Hubei Han Chinese individuals, the overall prevalence of alloantibodies was 0.50%, with anti-E, anti-D and anti-M being the most frequently identified alloantibodies. These results indicate that anti-D and anti-E alloantibodies were major risk factors for haemolytic disease of the newborn or delayed haemolytic transfusion reactions in this study population.
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Affiliation(s)
- Pu Xu
- Department of Blood Transfusion, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Yan Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Hua Yu
- Department of Blood Transfusion, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
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Genomic analyses of RH alleles to improve transfusion therapy in patients with sickle cell disease. Blood Cells Mol Dis 2013; 52:195-202. [PMID: 24309423 DOI: 10.1016/j.bcmd.2013.11.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/01/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Red cell (RBC) blood group alloimmunization remains a major problem in transfusion medicine. Patients with sickle cell disease (SCD) are at particularly high risk for developing alloantibodies to RBC antigens compared to other multiply transfused patient populations. Hemagglutination is the classical method used to test for blood group antigens, but depending on the typing methods and reagents used may result in discrepancies that preclude interpretation based on serologic reactivity alone. Molecular methods, including customized DNA microarrays, are increasingly used to complement serologic methods in predicting blood type. The purpose of this study was to determine the diversity and frequency of RH alleles in African Americans and to assess the performance of a DNA microarray for RH allele determination. MATERIAL AND METHODS Two sets of samples were tested: (i) individuals with known variant Rh types and (ii) randomly selected African American donors and patients with SCD. Standard hemagglutination tests were used to establish the Rh phenotype, and cDNA- and gDNA-based analyses (sequencing, PCR-RFLP, and customized RHD and RHCE microarrays were used to predict the genotype). RESULTS In a total of 829 samples (1658 alleles), 72 different alleles (40 RHD and 32 RHCE) were identified, 22 of which are novel. DNA microarrays detected all nucleotides probed, allowing for characterization of over 900 alleles. CONCLUSIONS High-throughput DNA testing platforms provide a means to test a relatively large number of donors and potentially prevent immunization by changing the way antigen-negative blood is provided to patients. Because of the high RH allelic diversity found in the African American population, determination of an accurate Rh phenotype often requires DNA testing, in conjunction with serologic testing. Allele-specific microarrays offer a means to perform high-throughput donor Rh typing and serve as a valuable adjunct to serologic methods to predict Rh type. Because DNA microarrays test for only a fixed panel of allelic polymorphisms and cannot determine haplotype phase, alternative methods such as Next Generation Sequencing hold the greatest potential to accurately characterize blood group phenotypes and ameliorate the clinical course of multiply-transfused patients with sickle cell disease.
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von Zabern I, Wagner FF, Moulds JM, Moulds JJ, Flegel WA. D category IV: a group of clinically relevant and phylogenetically diverse partial D. Transfusion 2013; 53:2960-73. [PMID: 23461862 PMCID: PMC3681876 DOI: 10.1111/trf.12145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 01/06/2013] [Accepted: 01/10/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The D typing strategies in several European countries protect carriers of D category VI (DVI) from anti-D immunization but not carriers of other partial D. Besides DVI, one of the clinically most important partial D is D category IV (DIV). A detailed description and direct comparison of the different DIV types was missing. STUDY DESIGN AND METHODS RHD nucleotide sequences were determined from genomic DNA. D epitope patterns were established with commercial monoclonal anti-D panels. RESULTS DIV comprises several variants of the D antigen with distinct serology, molecular structures, evolutionary origins, and ethnic prevalences. The DIV phenotype is determined by 350H shared by all, but not limited to, DIV variants which are further divided into DIVa and DIVb. The DIVa phenotype is expressed by DIV Type 1.0 harboring 350H and the dispersed amino acids 62F, 137V, and 152T. The DIVb phenotype is expressed by DIV Type 3 to Type 5 representing RHD-CE-D hybrids. Four of the six postulated DIV variants were encountered among 23 DIV samples analyzed. Of 12 DIV carriers with anti-D, 10 were female and seven likely immunized by pregnancy. Two DIV-related alleles are newly described: DWN, which differs from DIV Type 4 by 350D and epitope pattern. DNT carries 152T, known to cause a large D antigen density. CONCLUSION DIV alleles arose from at least two independent evolutionary events. DIV Type 1.0 with DIVa phenotype belongs to the oldest extant human RHD alleles. DIV Type 2 to Type 5 with DIVb phenotype arose from more recent gene conversions. Anti-D immunization, especially dreaded in pregnancies, will be avoided not only in carriers of DVI but also in carriers of other D variants like DIV, if our proposed D typing strategy is adopted.
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Affiliation(s)
- Inge von Zabern
- Department of Transfusion Medicine, University Hospital Ulm
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm
- DRK (German Red Cross) Blood Donor Service Baden-Württemberg - Hessen, Institute Ulm, Germany
| | | | - Joann M. Moulds
- Scientific Support Services, LifeShare Blood Centers, Shreveport, LA, USA
| | - John J. Moulds
- Scientific Support Services, LifeShare Blood Centers, Shreveport, LA, USA
| | - Willy A. Flegel
- Department of Transfusion Medicine, University Hospital Ulm
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Westhoff CM, Vege S, Horn T, Hue-Roye K, Halter Hipsky C, Lomas-Francis C, Reid ME. RHCE*ceMO is frequently in cis to RHD*DAU0 and encodes a hr(S) -, hr(B) -, RH:-61 phenotype in black persons: clinical significance. Transfusion 2013; 53:2983-9. [PMID: 23772606 PMCID: PMC3784631 DOI: 10.1111/trf.12271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 03/13/2013] [Accepted: 04/22/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND RHCE*ceMO has nucleotide changes 48G>C and 667G>T, which encode, respectively, 16Cys and 223Phe associated with altered expression of e antigen. RHD*DAU0 has Nucleotide 1136C>T, which encodes 379Met associated with normal levels of D. We compiled serologic and DNA testing data on samples with RHCE*ceMO to determine the red blood cell (RBC) antigen expression, antibody specificity, RHD association, and the prevalence in African-American persons. STUDY DESIGN AND METHODS Serologic testing was performed by standard methods. Genomic DNA was used for polymerase chain reaction-restriction fragment length polymorphism and RH-exon sequencing, and for some, Rh-cDNA was sequenced. Seventy-seven (50 donor and 27 patient) samples with RHCE*ceMO were studied, and 350 African-American persons were screened for allele prevalence. RESULTS RBCs from RHCE*ceMO homozygotes (or heterozygotes with RHCE*cE in trans) were weak or nonreactive with some anti-e and were nonreactive with polyclonal anti-hr(S) and anti-hr(B) . Twenty-three transfused patients homozygous for RHCE*ceMO/ceMO or with RHCE*ceMO in trans to RHCE*cE or *ce had alloanti-e, anti-f, anti-hr(S) /hr(B) , or an antibody to a high-prevalence Rh antigen. Three patients with alloanti-c had RHCE*ceMO in trans to RHCE*Ce. RHD*DAU0 was present in 30% of African-American persons tested and in 69 of 77 (90%) of samples with RHCE*ceMO. CONCLUSIONS RHCE*ceMO encodes partial e, as previously reported, and also encodes partial c, a hr(S) - and hr(B) - phenotype, and the absence of a high-prevalence antigen (RH61). The antibody in transfused patients depended on the RHCE allele in trans. RHCE*ceMO was present in one in 50 African-American persons with an allele frequency of 0.01, is often linked to RHD*DAU0, and is potentially of clinical significance for transfusion.
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Affiliation(s)
- Connie M Westhoff
- Laboratory of Immunohematology and Genomics, New York Blood Center; Laboratory of Immunochemistry, New York Blood Center, New York, New York; National Molecular Testing Laboratory, American Red Cross, Philadelphia, Pennsylvania
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High prevalence of red blood cell alloimmunization in sickle cell disease despite transfusion from Rh-matched minority donors. Blood 2013; 122:1062-71. [DOI: 10.1182/blood-2013-03-490623] [Citation(s) in RCA: 331] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Key Points
Rh serologic phenotype–matched transfusions from minority donors do not prevent all Rh alloimmunization in patients with SCD. Variant RH genes are common in patients with SCD and contribute to Rh alloimmunization and transfusion reactions.
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Systematic RH genotyping and variant identification in French donors of African origin. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12 Suppl 1:s264-72. [PMID: 23867180 DOI: 10.2450/2013.0270-12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/22/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND RH molecular analysis has enabled the documentation of numerous variants of RHD and RHCE alleles, especially in individuals of African origin. The aim of the present study was to determine the type and frequency of D and/or RhCE variants among blood donors of African origin in France, by performing a systematic RH molecular analysis, in order to evaluate the implications for blood transfusion of patients of African origin. MATERIALS AND METHODS Samples from 316 African blood donors, whose origin was established by their Fy(a-b-) phenotype, were first analysed using the RHD and RHCE BeadChips Kit (BioArray Solutions, Immucor, Warren, NJ, USA). Sequencing was performed when necessary. RESULTS RHD molecular analysis showed that 26.2% of donors had a variant RHD allele. It allowed the prediction of a partial D in 11% of cases. RHCE molecular analysis showed that 14.2% of donors had a variant RHCE allele or RH [RN or (C)ces] haplotype. A rare Rh phenotype associated with the loss of a high-prevalence antigen or partial RhCE antigens were predicted from RHCE molecular analysis in 1 (0.3%) and 17 (5%) cases, respectively. DISCUSSION Systematic RHD and RHCE molecular analysis performed in blood donors of African origin provides transfusion-relevant information for individuals of African origin because of the frequency of variant RH alleles. RH molecular analysis may improve transfusion therapy of patients by allowing better donor and recipient matching, based not only on phenotypically matched red blood cell units, but also on units that are genetically matched with regards to RhCE variants.
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Westhoff CM, Vege S, Halter Hipsky C, Hue-Roye K, Copeland T, Velliquette RW, Horn T, Lomas-Francis C, Reid ME. RHCE*ceTI encodes partial c and partial e and is often in cis to RHD*DIVa. Transfusion 2013; 53:741-6. [PMID: 22804620 PMCID: PMC3477252 DOI: 10.1111/j.1537-2995.2012.03800.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the Rh blood group system, variant RhD and RhCE express several partial antigens. We investigated RH in samples with partial DIVa that demonstrated weak and variable reactivity with anti-C. STUDY DESIGN AND METHODS Standard hemagglutination techniques, polymerase chain reaction-based assays, and RH sequencing were used. RESULTS DNA analysis showed that six red blood cell (RBC) samples with weak and inconsistent reactivity with anti-C lacked RHCE*C, but all had RHD*DIVa, which encodes partial D and Go(a) . We then tested RBCs from 19 Go(a+) cryopreserved samples (confirmed to have RHD*DIVa) with four anti-C and observed weak variable reactions. RHCE genotyping found all but one of the samples with RHD*DIVa also had RHCE nt 48G>C and 1025C>T, named RHCE*ceTI. Lookback of samples referred for workup and found to have either allele revealed 47 of 55 had both RHD*DIVa and RHCE*ceTI, four had RHD*DIVa without RHCE*ceTI, and four had RHCE*ceTI without RHD*DIVa. Alloanti-c was found in a patient with c+ RBCs and RHCE*ceTI in trans to RHCE*Ce, and alloanti-e was found in a patient with e+ RBC and RHCE*ceTI in trans to RHCE*cE. RHD*DIVa in trans to RHD erroneously tested as RHD hemizygous. CONCLUSIONS RHD*DIVa and RHCE*ceTI almost always, but not invariably, travel together. This haplotype is found in people of African ancestry and the RBCs can demonstrate aberrant reactivity with anti-C. RHCE*ceTI encodes partial c and e antigens. We confirm that RHD zygosity assays are unreliable in samples with RHD*DIVa.
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Affiliation(s)
- Connie M Westhoff
- Laboratory of Immunohematology and Genomics, New York Blood Center, Long Island City, New York 10065, USA.
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Reid ME, Halter Hipsky C, Hue-Roye K, Coghlan G, Olsen C, Lomas-Francis C. The low-prevalence Rh antigen STEM (RH49) is encoded by two different RHCE*ce818T alleles that are often in cis to RHD*DOL. Transfusion 2013; 53:539-44. [PMID: 22738288 PMCID: PMC3461235 DOI: 10.1111/j.1537-2995.2012.03754.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND STEM (RH49) is a low-prevalence antigen in the Rh blood group system. A scarcity of anti-STEM has precluded extensive study of this antigen. We report that two alleles with a RHCE*ce818C>T change encode a partial e, and a hr(S) -, hr(B) +, STEM+ phenotype and that both alleles are frequently in cis to RHD*DOL1 or RHD*DOL2. STUDY DESIGN AND METHODS Blood samples were from donors and patients in our collections. Hemagglutination, DNA, and RNA testing was performed by standard techniques. RESULTS Fourteen STEM+ samples were heterozygous RHCE*ce818C/T: six had RHCE*ceBI and eight had a novel allele, RHCE*ceSM. Eleven were heterozygous for RHD*DOL1 or RHD*DOL2. Eleven samples, previously typed STEM-, had RHCE*ce818C/C (consensus nucleotide). RBCs from informative STEM+ samples were e+/- hr(S) - hr(B) +. One person who was heterozygous RHCE*ceBI and RHCE*cE had an anti-e-like antibody in her plasma, and one person, who was hemizygous for RHD*DOL2, had anti-D in her plasma. CONCLUSIONS We show that two alleles with a RHCE*ce818C>T change (RHCE*ceBI and RHCE*ceSM) encode a hr(S) - hr(B) + STEM+ phenotype. In addition, both alleles are frequently in cis to RHD*DOL1 or RHD*DOL2 and RHCE*ceBI encodes a partial e antigen. In the small cohort of samples tested, RHD*DOL invariably traveled with RHCE*ce818T. Our study also confirmed the presumption that RHD*DOL2, like RHD*DOL1, encodes a partial D antigen and the low-prevalence antigen DAK.
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Affiliation(s)
- Marion E Reid
- Laboratory of Immunochemistry, New York Blood Center, New York, New York 10065, USA.
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Affiliation(s)
- Geoff Daniels
- International Blood Group Reference Laboratory; NHS Blood and Transplant; Bristol UK
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Roussel M, Poupel S, Nataf J, Juszczak G, Woimant G, Mailloux A, Menanteau C, Pham BN, Rouger P, Le Pennec PY, Peyrard T. RHD*DOL1andRHD*DOL2encode a partial D antigen and are in cis with the rareRHCE*ceBIallele in people of African descent. Transfusion 2012; 53:363-72. [DOI: 10.1111/j.1537-2995.2012.03743.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Red blood cell alloimmunization in sickle cell disease: pathophysiology, risk factors, and transfusion management. Blood 2012; 120:528-37. [PMID: 22563085 DOI: 10.1182/blood-2011-11-327361] [Citation(s) in RCA: 271] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Red blood cell transfusions have reduced morbidity and mortality for patients with sickle cell disease. Transfusions can lead to erythrocyte alloimmunization, however, with serious complications for the patient including life-threatening delayed hemolytic transfusion reactions and difficulty in finding compatible units, which can cause transfusion delays. In this review, we discuss the risk factors associated with alloimmunization with emphasis on possible mechanisms that can trigger delayed hemolytic transfusion reactions in sickle cell disease, and we describe the challenges in transfusion management of these patients, including opportunities and emerging approaches for minimizing this life-threatening complication.
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Abstract
Transfusion remains the main treatment of sickle cell disease patients. Red cell alloimmunization is frequent because of the antigen disparities between patients of African descent and donors of European ancestry. Alloimmunization is associated with severe hemolytic transfusion reaction, autoantibody formation, and difficulties in the management of transfusion compatibility. Beside common antigens, a number of different RH variant antigens found in individuals of African descent can be involved in alloimmunization. If some variants, such as Hr(S) negative antigens, are known to prone significant alloantibodies and delayed hemolytic transfusion reactions, it is not clear whether all the described variants represent a clinical risk for sickle cell disease patients. The knowledge of the clinical relevance of RH variants is a real issue. An abundance of molecular tools are developed to detect variants, but they do not distinguish those likely to prone immunization from those that are unlikely to prone immunization and delayed hemolytic transfusion reactions. A strategy of prevention, which generally requires rare red blood cells, cannot be implemented without this fundamental information. In this review, we discuss the relevance of RH variants in sickle cell disease, based on the published data and on our experience in transfusion of these patients.
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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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Lomas-Francis C, Halter Hipsky C, Velliquette RW, Reid ME. DIII Type 7 is likely the original serologically defined DIIIb. Transfusion 2011; 52:39-42. [PMID: 21745213 DOI: 10.1111/j.1537-2995.2011.03233.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Due to their homology, close proximity, and opposite orientation, RHD and RHCE can exchange nucleotides giving rise to variant alleles. Some of these variants encode the so-called partial phenotypes. The DIII partial D category has been subdivided into DIIIa, DIIIb, DIIIc, DIII Type 4, DIII Type 6, and DIII Type 7. During DNA-based screening tests, we identified a second example of DIII Type 7 in a Dce donor from South Africa. Our study describes hemagglutination tests on this sample and raises a question regarding the molecular basis of the originally defined DIIIb category. STUDY DESIGN AND METHODS Hemagglutination and DNA testing were performed by standard techniques. RESULTS Red blood cells from this DIII Type 7 donor typed D+C-E-c+e+G-, DAK+ and did not react with anti-D made by people with the DIII phenotype. The allele is RHD*DIII 150C, 178C, 201A, 203A, 307C, 410T, 455C, 602G, 667G. CONCLUSIONS Based on the serotype and ethnicity (black African), it is likely that DIII Type 7 is the originally defined DIIIb category.
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Hipsky CH, Hue-Roye K, Lomas-Francis C, Huang CH, Reid ME. Molecular basis of the rare gene complex, DIVa(C)-, which encodes four low-prevalence antigens in the Rh blood group system. Vox Sang 2011; 102:167-70. [DOI: 10.1111/j.1423-0410.2011.01519.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Silvy M, Di Cristofaro J, Beley S, Papa K, Rits M, Richard P, Chiaroni J, Bailly P. Identification of RHCE and KEL alleles in large cohorts of Afro-Caribbean and Comorian donors by multiplex SNaPshot and fragment assays: a transfusion support for sickle cell disease patients. Br J Haematol 2011; 154:260-70. [PMID: 21623766 DOI: 10.1111/j.1365-2141.2011.08691.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To lower the alloimmunization risk following transfusion in blacks, we developed two genotyping assays for large-scale screening of Comorian and Afro-Caribbean donors. One was a multiplex SNaPshot assay designed to identify ce(s) (340), ceMO/AR/EK/BI/SM, ce(s) , ce(s) (1006) and KEL*6/*7 alleles. The other was a multiplex fragment assay designed to detect RHD, RHDψ and RHCE*C and 455A>C transversion consistent with (C)ce(s) Type 1 and DIII Type5 ce(s) . Variant RHCE*ce alleles or RH haplotypes were detected in 58·69% of Comorians and 41·23% of Afro-Caribbeans. The ce(s) allele, (C)ce(s) Type 1, and DIII Type 5 ce(s) haplotypes were identified respectively in 39·13%, 14·67% and 4·88% of Comorians and 32·23%, 5·28% and 1·76% of Afro-Caribbeans. Genotypes consistent with partial D, C, c and/or e antigen expression were observed in 26·08% of Comorians and 14·69% of Afro-Caribbeans. No homozygous genotype corresponding to the RH:-18, -34, and -46 phenotypes were found. However, over 50% of genotypes produced low-prevalence antigens at risk for negative recipients, i.e., V, VS, JAL, and/or KEL6. One new variant RHCE*ce(s) (712) allele was identified. This is the first determination of variant RHCE and KEL allele frequencies. Results indicate the most suitable targets for molecular assay screening to optimize use of compatible blood units and lower immunization risk.
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Affiliation(s)
- Monique Silvy
- Laboratoire d'Hématologie Moléculaire, Établissement Français du Sang Alpes Méditerranée, UMR 6578, Université de Méditerranée, Marseille, France
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Hue-Roye K, Reid ME, Westhoff CM, Lomas-Francis C. Red cells from the original JAL+ proband are also DAK+ and STEM+. Vox Sang 2011; 101:61-4. [PMID: 21477150 DOI: 10.1111/j.1423-0410.2010.01465.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The low-prevalence Rh antigen, JAL, was named after the index case, Mr. J. Allen. Based on reactivity of seven multi-specific sera with his RBCs, it was apparent that they express at least one additional low-prevalence antigen. The purpose of this study was to investigate the other low-prevalence antigen(s) on J. Allen's RBCs. METHODS Blood samples and reagents were from our collections. Hemagglutination and DNA analyses were performed by standard methods. RESULTS Our DNA analyses confirmed the presence of RHCE*ceS(340T) in J. Allen and revealed the presence of RHCE*ceBI (ce 48C, 712G, 818T, 1132G) and RHD*DOL (509T, 667T). RBCs from J. Allen were agglutinated by anti-JAL, anti-STEM, and anti-DAK. Two of the reactive multi-specific sera reported in the original paper reacted with RBCs from J. Allen, and with RBCs from four other people with RHCE*ceBI, including the original STEM+ index case (P. Stemper) but not with RBCs with the DIIIa, DAK+ phenotype. We conclude that they contain anti-STEM. CONCLUSION J.Allen's RBCs express the low-prevalence Rh antigens, JAL, V/VS (extremely weakly), STEM, and DAK. The presence of JAL on the variant Rhce, RhceJAL (16Cys, 114Trp, 245Val), STEM on the variant Rhce, RhceBI (16Cys, 238Val, 273Val, 378Val), and DAK on the variant RhD (170Thr, 223Val), encoded by RHD*DOL in trans to RHCE*ceBI is consistent with expression of these antigens. When J. Allen RBCs are used to detect and identify an anti-JAL, it is important to remember that they also express STEM and DAK.
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Affiliation(s)
- K Hue-Roye
- Laboratory of Immunochemistry, New York Blood Center, New York, NY, USA
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