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Shad GA, Ghasemi A, Zadsar M, Shaeigan M, Samiee S, Zare A. PLT antigen discrepancy pattern among couples with recurrent abortion. Front Med (Lausanne) 2024; 11:1291779. [PMID: 38651057 PMCID: PMC11033322 DOI: 10.3389/fmed.2024.1291779] [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: 09/29/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Background Recurrent abortion refers to a condition of two or more consecutive pregnancies without known etiology affected by miscarriage before the completion of the 20th week of gestational age. However, several hypotheses have been proposed, but not much data are available concerning the relationship between human platelet antigens (HPAs) polymorphisms and recurrent abortion. This study was conducted to evaluate the genetic differences between HPA-1, -2, -3, -5, and - 15 in Iranian couples with a history of recurrent abortion. Methods In this cross-sectional study, a total of 74 couples with at least 2 recurrent abortions without any known specified reasons enrolled in the study. HPA polymorphisms genotyping was performed by single-specific primer PCR. Genotype frequency was calculated using the Hardy-Weinberg equation. Results A total of 39 couples (52.7%) had HPA genotyping partial mismatches. The most common partial mismatch pairs were found concomitantly on both HPA-15a and HPA-15b in three couples (4%), followed by two (2.7%) on HPA-3a and one (1.3%) in each HPA-2b and HPA-5b. There was a deviation from the Hardy-Weinberg equilibrium in the HPA-2 and -5 systems. Conclusion The present study declared that partial mismatches of HPA-3 and -15 genotypes were common among Iranian couples due to the history of recurrent abortion and approximately half of the couples carried at least one HPA gene that was absent in their partners. Further studies might be helpful to clarify the association between HPA polymorphisms and recurrent abortion, such as an investigation into the alloantibodies against HPAs.
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Affiliation(s)
| | - Ali Ghasemi
- Department of Biochemistry and Hematology, Faculty of Medicine Semnan University of Medical Sciences, Semnan, Iran
| | - Maryam Zadsar
- Infectious Disease Specialist, Blood Transfusion Research Center/High Institute for Research & Education in Transfusion Medicine/Microbiology Department, Tehran, Iran
| | - Mojgan Shaeigan
- Immunology, Blood Transfusion Research Center /High Institute for Research & Education in Transfusion Medicine, Immunohematology Department, Tehran, Iran
| | - Shahram Samiee
- Biochemistry, Iranian Blood Transfusion Organization Research Center, Tehran, Iran
| | - Ahad Zare
- Sarem Fertility and Infertility Research Center, Sarem Cell Research Center, Sarem Hospital, Tehran, Iran
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Ghaffari K, Rad MA, Moradi Hasan-Abad A, Khosravi M, Benvidi A, Iraji M, Khargh HAH, Ghasemi A. Association of the human platelet antigens polymorphisms with platelet count in patients with COVID-19. Front Med (Lausanne) 2023; 10:1265568. [PMID: 38020117 PMCID: PMC10658732 DOI: 10.3389/fmed.2023.1265568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/28/2023] [Indexed: 12/01/2023] Open
Abstract
Polymorphism in human platelet antigen (HPA)-1 and HPA-3 (GPIIb/IIIa), HPA-2 (GPIb/IX), HPA-4 (GPIIIa), HPA-5 (GPIa/IIa), & HPA-15 (CD109) was investigated in 86 COVID-19-infected patients with thrombocytopenia (Group A) and 136 COVID-19-infected patients without thrombocytopenia (Group B). HPA genotyping was done by the sequence-specific primers PCR method. Lower HPA-3a and higher HPA-3b (P = 0.028) allele frequencies were seen in Group A than in Group B, and homozygosity for HPA 3b (P = 0.038) alleles was more prevalent in Group A than in Group B. The allele and genotype distributions of the other HPA polymorphic variants were similar between the two groups. Univariate analysis identified the CCGGGC (P = 0.016) combined genotype to be negatively associated & the TCGGGC (P = 0.003) and CCGGGC (P = 0.003) to be positively associated with thrombocytopenia. The frequency of anti-HPA-1a and anti-HPA-3a antibodies was significantly higher in all patients compared to other anti-HPAs antibodies (P < 0.05). These results highlight the role of HPAs in the thrombocytopenia of COVID-19 infected patients. This is the first evidence demonstrating the differential association of the six common HPA gene variants and specific HPA genotype combinations with thrombocytopenia in COVID-19-infected patients.
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Affiliation(s)
- Kazem Ghaffari
- Student Research Committee, Khomein University of Medical Sciences, Khomein, Iran
- Department of Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
| | - Mahsa Ashrafi Rad
- Department of Biochemistry and Hematology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Amin Moradi Hasan-Abad
- Autoimmune Diseases Research Center, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Mersedeh Khosravi
- Department of Biochemistry, Semnan University of Medical Sciences, Semnan, Iran
| | - Arefeh Benvidi
- Department of Biochemistry, Semnan University of Medical Sciences, Semnan, Iran
| | - Mahsa Iraji
- Department of Biochemistry, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Ali Ghasemi
- Department of Biochemistry and Hematology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran
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Zemer VS, Mousa K, Herscovici T, Steinberg-Shemer O, Bonstein L, Yacobovich J. Neonatal Thrombocytopenia: Differing Characteristics of NAIT Versus Non-NAIT. J Pediatr Hematol Oncol 2023; 45:e728-e732. [PMID: 37027241 DOI: 10.1097/mph.0000000000002669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/23/2023] [Indexed: 04/08/2023]
Abstract
While neonatal alloimmune thrombocytopenia (NAIT) is the most common cause of severe neonatal thrombocytopenia good clinical predictors are lacking. We analyzed cases of neonatal thrombocytopenia in Schneider Children's Medical Center of Israel to pinpoint qualifiers of NAIT (NAIT+) in comparison to non-NAIT (NAIT-) thrombocytopenia. Patient and maternal data were retrospectively collected on all thrombocytopenic newborns undergoing a workup for NAIT in our tertiary center between 2001 and 2016. Among 26 thrombocytopenic neonates, the mean nadir in NAIT+ patients (25×10 9 /L) was significantly lower than NAIT- patients (64×10 9 /L) ( P <0.001). 61.5% of NAIT+ infants required treatment compared with 23% of non-NAIT ( P =0.015). NAIT+ patients also required more therapeutic modalities than infants with NAIT- thrombocytopenia. Human platelet antigen (HPA)-1a and HPA-5b alloantibodies most frequently caused NAIT. In summary, thrombocytopenia in NAIT+ was significantly more severe compared with NAIT- and more likely to require treatment. In addition, despite the varied ethnic population in Israel, the HPA alloantibodies found in our population were most similar to those common in Western countries. In the absence of rigorous prenatal screening options, we suggest platelet counts below 40 to 50×10 9 /L in a healthy newborn be considered most suggestive for NAIT and warrant urgent NAIT-specific analysis.
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Affiliation(s)
- Vered S Zemer
- Clalit Health Services
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | | | - Tina Herscovici
- Departments of Neonatology
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Orna Steinberg-Shemer
- Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Lilach Bonstein
- Blood Bank and Platelet Immunology Laboratories, Rambam Health Care Campus, Haifa, Israel
| | - Joanne Yacobovich
- Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
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Escamilla-Guerrero G, García-Rosales JC. [Genotyping and its applications, a look to the future]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:S37-S45. [PMID: 36378105 PMCID: PMC10396029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/19/2022] [Indexed: 06/16/2023]
Abstract
The detection of the most significant erythrocyte antigens present in each one of the individuals is fundamental when carrying out a transfusion or a transplant. Detection to date is performed by conventional serological methods through the antigen-antibody reaction. But several drawbacks may arise depending on the pathology under study, limiting the availability of blood components. Molecular methods such as genotyping is a tool that complements sensitivity and specificity and has come to revolutionize immunohematology in the blood bank, allowing not only the detection of erythrocyte antigens but also platelet antigens. These methodologies are applicable in patients and in large-scale donors, starting from the allelic variants present in each of the genes that code for the antigens of clinical interest, using microarray systems or systems based on particles labeled with specific probes or their variants that allow an analysis from the immunohematological point of view.
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Affiliation(s)
- Guillermo Escamilla-Guerrero
- Limogen, Laboratorio de Innovación Molecular y Genética, Laboratorio de Biología Molecular e Inmunohematología. Tlalnepantla, Estado de México, MéxicoLimogenMéxico
| | - Juan Carlos García-Rosales
- Limogen, Laboratorio de Innovación Molecular y Genética, Laboratorio de Biología Molecular e Inmunohematología. Tlalnepantla, Estado de México, MéxicoLimogenMéxico
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Kuroishi A, Takihara Y, Hirayama F. Current understanding and future perspectives for anti-human platelet antigen-15 antibodies in patients with alloimmune thrombocytopenia: History, laboratory testing, and clinical impact. Transfusion 2022; 62:1128-1141. [PMID: 35266549 DOI: 10.1111/trf.16845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ayumu Kuroishi
- Laboratory, Japanese Red Cross Kinki Block Blood Center, Ibaraki-shi, Osaka, Japan
| | | | - Fumiya Hirayama
- Japanese Red Cross Kinki Block Blood Center, Ibaraki-shi, Osaka, Japan
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Jovanovic Srzentic S, Lilic M, Vavic N, Radovic I, Djilas I. Genotyping of Eight Human Platelet Antigen Systems in Serbian Blood Donors: Foundation for Platelet Apheresis Registry. Transfus Med Hemother 2021; 48:228-233. [PMID: 34539316 DOI: 10.1159/000514487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of this study was to investigate the allele and genotype frequencies of 8 human platelet antigen (HPA) systems among blood donors from the Blood Transfusion Institute of Serbia and to compare them with published studies. These data would be useful to establish the basis for a platelet apheresis donor registry. Material and Methods Seventy-two unrelated male platelet apheresis/blood donors from Serbia were typed for 8 HPA systems (HPA-1 to HPA-6, HPA-9, and HPA-15) via the FluoGene method, based on polymerase chain reaction-sequence-specific amplification (PCR-SSP; PCR using sequence-specific primers) with fluorometric signal detection. Allele and genotype frequencies were estimated by direct counting and compared to the expected genotype frequencies according to the Hardy-Weinberg principle. The transfusion mismatch probability was calculated for every HPA specificity. Results The allele frequencies were: HPA-1a, 0.868; HPA-1b, 0.132; HPA-2a, 0.917; HPA-2b, 0.083; HPA-3a, 0.611; HPA-3b, 0.389; HPA-5a, 0.903; HPA-5b, 0.097; HPA-9a, 0.993; HPA-9b, 0.007; HPA-15a, 0.472; and HPA-15b, 0.528. For HPA-4 and HPA-6 only allele a was detected. Discussion The HPA allele frequencies of European populations showed no significant differences in comparison with our results. Statistically significant differences were revealed in comparison with some populations of non-European origin. In the tested donors no HPA-2 bb genotype was detected, but we found 1 donor with the rare HPA-9b allele. The biggest transfusion mismatch probability in the Serbian population is for systems HPA-15 (37.4%) and HPA-3 (36.2%), which means that more than a third of random transfusions could cause mismatch in these systems. This study was enabled by the introduction of molecular HPA typing, and it provides initial results of the HPA allele and genotype frequencies in the population of blood donors in Serbia. They will be used to provide a compatible blood supply on demand for treating patients with alloimmune thrombocytopenic disorders. The successful implementation of PCR-SSP with fluorometric signal detection could be further complemented in the future by the introduction of high-throughput methods, which will largely depend on the available financial resources.
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Affiliation(s)
- Snezana Jovanovic Srzentic
- Department of Prenatal Molecular Testing and Blood Group Typing, Blood Transfusion Institute of Serbia, Belgrade, Serbia
| | - Marko Lilic
- Department of Biology, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Natasa Vavic
- Department of Donor Apheresis, Blood Transfusion Institute of Serbia, Belgrade, Serbia
| | - Ivana Radovic
- Department of Prenatal Molecular Testing and Blood Group Typing, Blood Transfusion Institute of Serbia, Belgrade, Serbia
| | - Iva Djilas
- Department of Blood Donor Testing, Blood Transfusion Institute of Serbia, Belgrade, Serbia
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Human platelet antigen 1-6, 9 and 15 in the Iranian population: An anthropological genetic analysis. Sci Rep 2020; 10:7442. [PMID: 32366900 PMCID: PMC7198494 DOI: 10.1038/s41598-020-64469-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/15/2020] [Indexed: 11/09/2022] Open
Abstract
Human platelet antigens (HPAs) are membranous glycoproteins considered as alloantigens due to their polymorphisms. HPA-incompatibility in multiple pregnancies or blood transfusion can induce the development of alloantibodies leading to thrombocytopenia. The frequency of HPAs varies among populations, so that deep knowledge of HPA frequencies will help us to reduce those incompatibilities. Herein, we studied the allele and genotype frequencies of HPA1-6, HPA9, and HPA15 among the Iranians with intra- and inter-populations analyses on 36 worldwide populations with diverse ethnicities. The analysis shows that the HPA2 and HPA5 have the greatest differences in genotype distribution between the Iranians and other nations, although similar to other populations, the sole allele found in HPA4, 6, and 9 is “a”. Despite other HPAs, the most frequent allele in HPA15 is “b”, which is also abundant in HPA3. Hierarchical clustering indicates the highest degree of global similarity in HPA genotype frequency among Iranian, Argentinian, Brazilian, and German Turkish populations. Our findings can be applied to decrease the risk of alloimmunizations and platelet disorders, especially in neonates.
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Abdelgader AM, Al Ghumlas AK. The future of voluntary blood donation in the Kingdom of Saudi Arabia. Transfusion 2020; 60 Suppl 1:S28-S34. [PMID: 32009238 DOI: 10.1111/trf.15683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/21/2019] [Accepted: 12/18/2019] [Indexed: 12/15/2022]
Abstract
Replacement blood donations are a major source of blood in KSA. This presentation highlights "the peace time and war experiences," where the voluntary donor potential was tested. THE "PEACETIME EXPERIENCE"-KING SAUD UNIVERSITY STUDENT DONOR DRIVE: This donor drive commenced in 1983 with 13 donors in its first and the annual collection reached 4500 blood units in the academic session 1995-1996, when the student enrollment was around 30,000. In 2018 the enrollment jumped to 120,000 students. If we add the staff and auxiliary personnel, the population of potential voluntary blood donors will be enough to cover the current and future blood needs of King Khalid University Hospital. Unfortunately, this drive did not survive due to administrative and organizational difficulties. THE "FIRST" GULF WAR EXPERIENCE: At the end of 1990, when the Allied Forces started to end the Iraqi occupation of Kuwait, the Saudi Ministry of Health waged a publicity campaign asking healthy individuals to donate their blood. The response was phenomenal, and the blood inventory in blood banks swelled about five- to sevenfold. First-time donors broke the "fear barrier," went through the donation experience, and it is hoped they will return to donate voluntarily. CONCLUSIONS: The major lesson learned from the King Saud University student donor drive and Gulf War experience is the enormous voluntary donor potential in Saudi Arabia. There is a need for forward planning to shift the current partial involuntary donor system to a voluntary system based on nonremunerated donors.
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Affiliation(s)
- A M Abdelgader
- College of Medicine, Al Faisal University and King Khalid University Hospital, Riyadh, Saudi Arabia.,The Coagulation Research Laboratory, Department of Physiology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abeer K Al Ghumlas
- The Coagulation Research Laboratory, Department of Physiology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Neffati A, Sellami MH, Bellali H, Kâabi H, Chaabene M, Hmida S. [Polymorphism of human platelet antigens in Tunisian population: Clinical and anthropological interests]. Transfus Clin Biol 2019; 26:266-272. [PMID: 30827792 DOI: 10.1016/j.tracli.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/04/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Human Platelet Antigens (HPA) are of considerable interest in obstetric transfusion medicine and anthropological genetics. This study aims to provide clinicians with a detailed database of HPA antigenic variants, which allows them to estimate the probability of allo-immunisation of each antigen. In addition, it aims to make an interethnic comparison of the Tunisian population with other populations. METHODS The target population consists of 324 healthy and unrelated Tunisian blood donors recruited from the National Blood Transfusion Center in Tunis. DNA extraction was performed by the Salting Out method and molecular genotyping was performed by the PCR-SSP technique. The statistical analysis was performed using two approaches: manual calculation and computerized calculation. Phylogenetic trees were constructed through the use of Standard Genetic Distances that were calculated from allelic frequencies. RESULTS With the exception of the HPA-4 system, statistical analysis showed that all HPA systems are polymorphic especially the two systems HPA-3 and HPA-15. The inter-ethnic analysis showed that Tunisians are closer to North Africans and Caucasians than Sub-Saharan and Asian populations, which shows genetic mixing between Tunisians, Arabs, Europeans and Africans. CONCLUSION The results of this study could be exploited to prepare a ready-to-use genotyping plate dedicated to HPA antigens, with the aim of ensuring better management, especially for polytransfused patients.
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Affiliation(s)
- A Neffati
- Unité de recherche « immunogénétique, thérapie cellulaire et transfusion sanguine », département d'immuno-hématologie, centre national de transfusion sanguine de Tunis, université de Tunis El Manar, 13, rue Djbel-Lakhdar, 1006 Bab Saadoun, Tunis, Tunisie.
| | - M H Sellami
- Unité de recherche « immunogénétique, thérapie cellulaire et transfusion sanguine », département d'immuno-hématologie, centre national de transfusion sanguine de Tunis, université de Tunis El Manar, 13, rue Djbel-Lakhdar, 1006 Bab Saadoun, Tunis, Tunisie
| | - H Bellali
- Unité de recherche « immunogénétique, thérapie cellulaire et transfusion sanguine », département d'immuno-hématologie, centre national de transfusion sanguine de Tunis, université de Tunis El Manar, 13, rue Djbel-Lakhdar, 1006 Bab Saadoun, Tunis, Tunisie
| | - H Kâabi
- Unité de recherche « immunogénétique, thérapie cellulaire et transfusion sanguine », département d'immuno-hématologie, centre national de transfusion sanguine de Tunis, université de Tunis El Manar, 13, rue Djbel-Lakhdar, 1006 Bab Saadoun, Tunis, Tunisie
| | - M Chaabene
- Unité de recherche « immunogénétique, thérapie cellulaire et transfusion sanguine », département d'immuno-hématologie, centre national de transfusion sanguine de Tunis, université de Tunis El Manar, 13, rue Djbel-Lakhdar, 1006 Bab Saadoun, Tunis, Tunisie
| | - S Hmida
- Unité de recherche « immunogénétique, thérapie cellulaire et transfusion sanguine », département d'immuno-hématologie, centre national de transfusion sanguine de Tunis, université de Tunis El Manar, 13, rue Djbel-Lakhdar, 1006 Bab Saadoun, Tunis, Tunisie
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Eyada TK, Amin DG, Samih I, Khedr SM. Human platelet antigen 1, 2 and 5 gene polymorphisms in Egyptians and their potential association with susceptibility to immune thrombocytopenic purpura in Egyptian patients. ACTA ACUST UNITED AC 2017; 23:111-116. [PMID: 28823219 DOI: 10.1080/10245332.2017.1365435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study determined the incidence of HPA1, HPA2 and HPA5 polymorphisms in 120 Egyptian immune thrombocytopenic purpura (ITP) patients and 120 healthy Egyptian subjects. METHODS Human platelet antigen (HPA) genotyping was done using the polymerase chain reaction-restriction fragment length polymorphism. RESULTS The frequency of HPA1 allele a and b was 78.75 and 21.25% in controls, 80.8 and 19.2% in ITP, respectively. HPA2 allele a and b frequency was 86.25 and 13.75% in controls and of 74.6 and 25.4% in patients, respectively. HPA5 allele a and b frequency was 87.5 and 12.5% in controls, in patients it was 85 and 15%, respectively. With the exception of HPA2, no other significant difference was encountered in HPA allele frequency between controls and ITP patients. DISCUSSION Egyptian HPA profile is closely linked to Middle East and neighboring Arabs. The current study noted that in all the studied HPA systems 1, 2 and 5, the 'a' allele is more prevalent than the b allele; the most frequent genotype was the homozygous a/a genotype. HPA2b frequency, homo- and hetero-zygous HPA2b genotype frequencies were significantly higher in ITP patients compared to controls. CONCLUSION HPA 2b are 2.37 times more likely to develop ITP compared to those without this allele. The relatively high allele frequency of the HPA-1b in the Egyptian population suggests that this ethnic group has a higher risk of alloimmunization.
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Affiliation(s)
- Tayssir Kamel Eyada
- a Clinical and Chemical Pathology, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Dalia Gamil Amin
- b Clinical and Chemical Pathology, The BMT Unit, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Ihab Samih
- c Department of Internal Medicine, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Salwa Mohamed Khedr
- a Clinical and Chemical Pathology, Faculty of Medicine , Cairo University , Cairo , Egypt
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