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Shah RJ, Senjaliya SB, Harimoorthy V, Burgos A, Vege S, Lomas-Francis C, Westhoff CM, Joshi SR. Anti-Emm, a rare specificity to the high-incidence antigen Emm in an Indian patient defining the new blood group system EMM (ISBT042). Asian J Transfus Sci 2021; 15:223-225. [PMID: 34908758 PMCID: PMC8628250 DOI: 10.4103/ajts.ajts_59_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/07/2021] [Accepted: 06/27/2021] [Indexed: 11/04/2022] Open
Abstract
A transfusion recipient lacking a high-incidence antigen (HIA) and has corresponding alloantibody pose a problem in providing compatible blood unit. We encountered a patient with an antibody to an HIA that required identification to assess if compatible blood could be organized. A 65-year-old male was posted for coronary artery bypass grafting surgery. His blood specimen collected in EDTA was referred to the blood bank to provide blood for transfusion. The patient, grouped AB RhD+, had an antibody reacting in saline and antiglobulin phases. It agglutinated all the red blood cells (RBCs) of the 11-cell panel and random donors, indicating specificity to an HIA, though one of his siblings was compatible. After ruling out specificity to HIAs such as H, Inb, and INRA (IN5), the specimen was referred to the New York Blood Centre for further work-up. The antibody reacted with examples of red cells lacking HIA, except those with the Emm- phenotype. The patient's RBCs were typed as Emm-. Anti-Emm in the patient appeared to be naturally occurring as there was no history of transfusion. Naturally occurring alloantibody to an HIA, identified as anti-Emm in phenotype Emm-, is rare and the first of its kind to be reported from India. The case was instrumental in recognizing the Emm as the new blood group system assigned with the symbol ISBT042.
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Affiliation(s)
- Ripal J Shah
- Director, Prathama Blood Center, Ahmadabad, Gujarat, India
| | - Snehal B Senjaliya
- Research Assistant, Lok Samarpan Regional Blood Bank and Research Centre, Surat, Gujarat, India
| | - V Harimoorthy
- Quality Section Officer, Prathama Blood Center, Ahmadabad, Gujarat, India
| | - Anna Burgos
- Lead Technologist, Immunohematology Laboratory, New York, USA
| | - Sunitha Vege
- Technical Director, Genomics Laboratory, New York, USA
| | | | - Connie M Westhoff
- Executive Scientific Director, Immunohematology and Genomics Laboratory, New York Blood Centre, Long Island City, New York, USA
| | - Sanmukh Ratilal Joshi
- Director, Lok Samarpan Regional Blood Bank and Research Centre, Surat, Gujarat, India
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Lane WJ, Aeschlimann J, Vege S, Lomas-Francis C, Burgos A, Mah HH, Halls JBL, Baeck P, Ligthart PC, Veldhuisen B, Shah RJ, Joshi SR, Westhoff CM. PIGG defines the Emm blood group system. Sci Rep 2021; 11:18545. [PMID: 34535746 PMCID: PMC8448728 DOI: 10.1038/s41598-021-98090-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/31/2021] [Indexed: 11/09/2022] Open
Abstract
Emm is a high incidence red cell antigen with eight previously reported Emm- probands. Anti-Emm appears to be naturally occurring yet responsible for a clinically significant acute hemolytic transfusion reaction. Previous work suggests that Emm is located on a GPI-anchored protein, but the antigenic epitope and genetic basis have been elusive. We investigated samples from a South Asian Indian family with two Emm- brothers by whole genome sequencing (WGS). Additionally, samples from four unrelated Emm- individuals were investigated for variants in the candidate gene. Filtering for homozygous variants found in the Emm- brothers and by gnomAD frequency of < 0.001 resulted in 1818 variants with one of high impact; a 2-bp deletion causing a frameshift and premature stop codon in PIGG [NM_001127178.3:c.2624_2625delTA, p.(Leu875*), rs771819481]. PIGG encodes for a transferase, GPI-ethanolaminephosphate transferase II, which adds ethanolamine phosphate (EtNP) to the second mannose in a GPI-anchor. The four additional unrelated Emm- individuals had various PIGG mutations; deletion of Exons 2-3, deletion of Exons 7-9, insertion/deletion (indel) in Exon 3, and new stop codon in Exon 5. The Emm- phenotype is associated with a rare deficiency of PIGG, potentially defining a new Emm blood group system composed of EtNP bound to mannose, part of the GPI-anchor. The results are consistent with the known PI-linked association of the Emm antigen, and may explain the production of the antibody in the absence of RBC transfusion. Any association with neurologic phenotypes requires further research.
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Affiliation(s)
- William J Lane
- Department of Pathology, Hale Building for Transformative Medicine, Brigham and Women's Hospital, Rm 8002L, 60 Fenwood Rd, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Judith Aeschlimann
- Immunohematology and Genomics Laboratory, New York Blood Center, New York, NY, USA
| | - Sunitha Vege
- Immunohematology and Genomics Laboratory, New York Blood Center, New York, NY, USA
| | | | - Anna Burgos
- Immunohematology and Genomics Laboratory, New York Blood Center, New York, NY, USA
| | - Helen H Mah
- Department of Pathology, Hale Building for Transformative Medicine, Brigham and Women's Hospital, Rm 8002L, 60 Fenwood Rd, Boston, MA, 02115, USA
| | - Justin B L Halls
- Department of Pathology, Hale Building for Transformative Medicine, Brigham and Women's Hospital, Rm 8002L, 60 Fenwood Rd, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Peter Baeck
- Childrens Clinic, County Hospital, Kalmar, Sweden
| | - Peter C Ligthart
- Department of Immunohematology Diagnostic Services, Sanquin, Amsterdam, The Netherlands
| | - Barbera Veldhuisen
- Department of Immunohematology Diagnostic Services, Sanquin, Amsterdam, The Netherlands
| | | | - Sanmukh R Joshi
- Department of Research, Lok Samarpan Raktdan Kendra, Surat, Gujarat, India
| | - Connie M Westhoff
- Immunohematology and Genomics Laboratory, New York Blood Center, New York, NY, USA
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