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Akinbolaji TJ. When and why is red blood cell genotyping applicable in transfusion medicine: a systematic review of the literature. Immunohematology 2024; 40:58-64. [PMID: 38910442 DOI: 10.2478/immunohematology-2024-009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
This review aims to provide a better understanding of when and why red blood cell (RBC) genotyping is applicable in transfusion medicine. Articles published within the last 8 years in peer-reviewed journals were reviewed in a systematic manner. RBC genotyping has many applications in transfusion medicine including predicting a patient's antigen profile when serologic methods cannot be used, such as in a recently transfused patient, in the presence of autoantibody, or when serologic reagents are not available. RBC genotyping is used in prenatal care to determine zygosity and guide the administration of Rh immune globulin in pregnant women to prevent hemolytic disease of the fetus and newborn. In donor testing, RBC genotyping is used for resolving ABO/D discrepancies for better donor retention or for identifying donors negative for high-prevalence antigens to increase blood availability and compatibility for patients requiring rare blood. RBC genotyping is helpful to immunohematology reference laboratory staff performing complex antibody workups and is recommended for determining the antigen profiles of patients and prospective donors for accurate matching for C, E, and K in multiply transfused patients. Such testing is also used to determine patients or donors with variant alleles in the Rh blood group system. Information from this testing aides in complex antibody identification as well as sourcing rare allele-matched RBC units. While RBC genotyping is useful in transfusion medicine, there are limitations to its implementation in transfusion services, including test availability, turn-around time, and cost.
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Affiliation(s)
- Thompson J Akinbolaji
- Immunohematology Reference Laboratory, Biomedical Services, American Red Cross, Douglasville, GA, Georgia
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Clausen FB. Antenatal RHD screening to guide antenatal anti-D immunoprophylaxis in non-immunized D- pregnant women. Immunohematology 2024; 40:15-27. [PMID: 38739027 DOI: 10.2478/immunohematology-2024-004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
In pregnancy, D- pregnant women may be at risk of becoming immunized against D when carrying a D+ fetus, which may eventually lead to hemolytic disease of the fetus and newborn. Administrating antenatal and postnatal anti-D immunoglobulin prophylaxis decreases the risk of immunization substantially. Noninvasive fetal RHD genotyping, based on testing cell-free DNA extracted from maternal plasma, offers a reliable tool to predict the fetal RhD phenotype during pregnancy. Used as a screening program, antenatal RHD screening can guide the administration of antenatal prophylaxis in non-immunized D- pregnant women so that unnecessary prophylaxis is avoided in those women who carry a D- fetus. In Europe, antenatal RHD screening programs have been running since 2009, demonstrating high test accuracies and program feasibility. In this review, an overview is provided of current state-of-the-art antenatal RHD screening, which includes discussions on the rationale for its implementation, methodology, detection strategies, and test performance. The performance of antenatal RHD screening in a routine setting is characterized by high accuracy, with a high diagnostic sensitivity of ≥99.9 percent. The result of using antenatal RHD screening is that 97-99 percent of the women who carry a D- fetus avoid unnecessary prophylaxis. As such, this activity contributes to avoiding unnecessary treatment and saves valuable anti-D immunoglobulin, which has a shortage worldwide. The main challenges for a reliable noninvasive fetal RHD genotyping assay are low cell-free DNA levels, the genetics of the Rh blood group system, and choosing an appropriate detection strategy for an admixed population. In many parts of the world, however, the main challenge is to improve the basic care for D- pregnant women.
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Affiliation(s)
- Frederik B Clausen
- Laboratory of Blood Genetics, Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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Schimanski B, Kräuchi R, Stettler J, Lejon Crottet S, Niederhauser C, Clausen FB, Fontana S, Hodel M, Amylidi-Mohr S, Raio L, Abbal C, Henny C. Fetal RHD Screening in RH1 Negative Pregnant Women: Experience in Switzerland. Biomedicines 2023; 11:2646. [PMID: 37893020 PMCID: PMC10604374 DOI: 10.3390/biomedicines11102646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
RH1 incompatibility between mother and fetus can cause hemolytic disease of the fetus and newborn. In Switzerland, fetal RHD genotyping from maternal blood has been recommended from gestational age 18 onwards since the year 2020. This facilitates tailored administration of RH immunoglobulin (RHIG) only to RH1 negative women carrying a RH1 positive fetus. Data from 30 months of noninvasive fetal RHD screening is presented. Cell-free DNA was extracted from 7192 plasma samples using a commercial kit, followed by an in-house qPCR to detect RHD exons 5 and 7, in addition to an amplification control. Valid results were obtained from 7072 samples, with 4515 (64%) fetuses typed RHD positive and 2556 (36%) fetuses being RHD negative. A total of 120 samples led to inconclusive results due to the presence of maternal or fetal RHD variants (46%), followed by women being serologically RH1 positive (37%), and technical issues (17%). One sample was typed false positive, possibly due to contamination. No false negative results were observed. We show that unnecessary administration of RHIG can be avoided for more than one third of RH1 negative pregnant women in Switzerland. This reduces the risks of exposure to a blood-derived product and conserves this limited resource to women in actual need.
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Affiliation(s)
- Bernd Schimanski
- Interregional Blood Transfusion SRC Berne Ltd., 3008 Berne, Switzerland
| | - Rahel Kräuchi
- Interregional Blood Transfusion SRC Berne Ltd., 3008 Berne, Switzerland
| | - Jolanda Stettler
- Interregional Blood Transfusion SRC Berne Ltd., 3008 Berne, Switzerland
| | | | - Christoph Niederhauser
- Interregional Blood Transfusion SRC Berne Ltd., 3008 Berne, Switzerland
- Institute for Infectious Diseases, University of Berne,3010 Berne, Switzerland
| | - Frederik Banch Clausen
- Department of Clinical Immunology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Stefano Fontana
- Interregional Blood Transfusion SRC Berne Ltd., 3008 Berne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1005 Lausanne, Switzerland
| | - Markus Hodel
- Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland
| | - Sofia Amylidi-Mohr
- Department of Obstetrics and Gynecology, University Hospital of Berne—Inselspital, 3010 Berne, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology, University Hospital of Berne—Inselspital, 3010 Berne, Switzerland
| | - Claire Abbal
- Division of Hematology, Lausanne University Hospital—CHUV, 1011 Lausanne, Switzerland
| | - Christine Henny
- Interregional Blood Transfusion SRC Berne Ltd., 3008 Berne, Switzerland
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Singh K. Prenatal Interventions for the Treatment of Congenital Disorders. Regen Med 2023. [DOI: 10.1007/978-981-19-6008-6_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Uzunel M, Tiblad E, Mörtberg A, Wikman A. Single-exon approach to non-invasive fetal RHD screening in early pregnancy: An update after 10 years' experience. Vox Sang 2022; 117:1296-1301. [PMID: 36102142 PMCID: PMC9826394 DOI: 10.1111/vox.13348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/29/2022] [Accepted: 08/05/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Anti-D prophylaxis, administered to RhD-negative women, has significantly reduced the incidence of RhD immunization. Non-invasive fetal RHD screening has been used in Stockholm for more than 10 years to identify women who will benefit from prophylaxis. The method is based on a single-exon approach and is used in early pregnancy. The aim of this study was to update the performance of the method. MATERIALS AND METHODS The single exon assay from Devyser AB is a multiplex kit detecting both exon 4 of the RHD gene and the housekeeping gene GAPDH. Cell-free DNA was extracted from 1 ml of plasma from EDTA blood taken during early pregnancy, weeks 10-12. The genetic RHD results were compared with serological typing of newborns for a determination of sensitivity and specificity. RESULTS In total, 4337 pregnancies were included in the study; 44 samples (1%) were inconclusive either due to maternal RHD gene variants (n = 34) or technical reasons (n = 10). Of the remaining 4293 pregnancies, a total number of nine discrepant results were found. False positive results (n = 7) were mainly (n = 4) due to RHD gene variants in the child. False-negative results were found in two cases, of which one was caused by a technical error. None of the false-negative cases was due to RHD gene variants. Overall, the sensitivity of the method was 99.93% and specificity 99.56%. CONCLUSION The single-exon assay used in this study is correlated with high sensitivity and specificity.
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Affiliation(s)
- Mehmet Uzunel
- Division of Therapeutic Immunology and Transfusion Medicine, Karolinska InstitutetSolnaSweden
| | - Eleonor Tiblad
- Department of Women's Health, Division of ObstetricsKarolinska University HospitalStockholmSweden,Clinical Epidemiology Division, Department of Medicine SolnaKarolinska InstitutetSolnaSweden
| | - Anette Mörtberg
- The Department of Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
| | - Agneta Wikman
- The Department of Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
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DUFOUR P, GERARD C, CHANTRAINE F, Jean‐Marc MINON. Investigation of discrepancies obtained during fifteen years of non‐invasive fetal
RHD
genotyping in apparent serologic RhD‐negative pregnant women. Prenat Diagn 2022; 42:1262-1272. [DOI: 10.1002/pd.6219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/06/2022] [Accepted: 07/26/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Patrice DUFOUR
- Department of Laboratory Medicine Immunohaematology and transfusion medicine division Centre Hospitalier Régional de la Citadelle Liège Belgium
| | - Christiane GERARD
- Blood Transfusion Service University of Liège (ULiège), CHU Liège Belgium
| | - Frédéric CHANTRAINE
- Department of Obstetrics and Gynecology Centre Hospitalier Universitaire de Liège CHR Citadelle Liège Belgium
| | - MINON Jean‐Marc
- Department of Laboratory Medicine Immunohaematology and transfusion medicine division Centre Hospitalier Régional de la Citadelle Liège Belgium
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Kjeldsen-Kragh J, Hellberg Å. Noninvasive Prenatal Testing in Immunohematology-Clinical, Technical and Ethical Considerations. J Clin Med 2022; 11:jcm11102877. [PMID: 35629001 PMCID: PMC9147107 DOI: 10.3390/jcm11102877] [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: 04/12/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/22/2022] Open
Abstract
Hemolytic disease of the fetus and newborn (HDFN), as well as fetal and neonatal alloimmune thrombocytopenia (FNAIT), represent two important disease entities that are caused by maternal IgG antibodies directed against nonmaternally inherited antigens on the fetal blood cells. These antibodies are most frequently directed against the RhD antigen on red blood cells (RBCs) or the human platelet antigen 1a (HPA-1a) on platelets. For optimal management of pregnancies where HDFN or FNAIT is suspected, it is essential to determine the RhD or the HPA-1a type of the fetus. Noninvasive fetal RhD typing is also relevant for identifying which RhD-negative pregnant women should receive antenatal RhD prophylaxis. In this review, we will give an overview of the clinical indications and technical challenges related to the noninvasive analysis of fetal RBCs or platelet types. In addition, we will discuss the ethical implications associated with the routine administration of antenatal RhD to all pregnant RhD-negative women and likewise the ethical challenges related to making clinical decisions concerning the mother that have been based on samples collected from the (presumptive) father, which is a common practice when determining the risk of FNAIT.
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Affiliation(s)
- Jens Kjeldsen-Kragh
- Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, SE-221 85 Lund, Sweden;
- Department of Laboratory Medicine, University Hospital of North Norway, N-9019 Tromsø, Norway
- Correspondence: ; Tel.: +46-722-48-1303 or +45-4283-7300
| | - Åsa Hellberg
- Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, SE-221 85 Lund, Sweden;
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Legler TJ, Bauerschmitz GJ, Frohn C. Nichtinvasiver Pränataltest zur Bestimmung des fetalen Rhesusfaktors. TRANSFUSIONSMEDIZIN 2022. [DOI: 10.1055/a-1623-9111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Seit dem 01.07.2021 soll in Deutschland die präpartale Anti-D-Prophylaxe in Abhängigkeit vom Ergebnis des nichtinvasiven Pränataltests zur Bestimmung des fetalen Rhesusfaktors (NIPT-RhD)
verabreicht werden. In der Praxis ergeben sich gelegentlich Fragen zur Bewertung der Testergebnisse, die auf die Komplexität des Rhesus-Blutgruppensystems zurückzuführen sind. Antworten auf
diese und andere Fragen zum NIPT-RhD gibt dieser Beitrag.
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Dziegiel MH, Krog GR, Hansen AT, Olsen M, Lausen B, Nørgaard LN, Bergholt T, Rieneck K, Clausen FB. Laboratory Monitoring of Mother, Fetus, and Newborn in Hemolytic Disease of Fetus and Newborn. Transfus Med Hemother 2021; 48:306-315. [PMID: 34803574 DOI: 10.1159/000518782] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/27/2021] [Indexed: 01/12/2023] Open
Abstract
Background Laboratory monitoring of mother, fetus, and newborn in hemolytic disease of fetus and newborn (HDFN) aims to guide clinicians and the immunized women to focus on the most serious problems of alloimmunization and thus minimize the consequences of HDFN in general and of anti-D in particular. Here, we present the current approach of laboratory screening and testing for prevention and monitoring of HDFN at the Copenhagen University Hospital in Denmark. Summary All pregnant women are typed and screened in the 1st trimester. This serves to identify the RhD-negative pregnant women who at gestational age (GA) of 25 weeks are offered a second screen test and a non-invasive fetal RhD prediction. At GA 29 weeks, and again after delivery, non-immunized RhD-negative women carrying an RhD-positive fetus are offered Rh immunoglobulin. If the 1st trimester screen reveals an alloantibody, antenatal investigation is initiated. This also includes RhD-positive women with alloantibodies. Specificity and titer are determined, the fetal phenotype is predicted by non-invasive genotyping based on cell-free DNA (RhD, K, Rhc, RhC, RhE, ABO), and serial monitoring of titer commences. Based on titers and specificity, monitoring with serial peak systolic velocity measurements in the fetal middle cerebral artery to detect anemia will take place. Intrauterine transfusion is given when fetal anemia is suspected. Monitoring of the newborn by titer and survival of fetal red blood cells by flow cytometry will help predict the length of the recovery of the newborn.
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Affiliation(s)
- Morten Hanefeld Dziegiel
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Grethe Risum Krog
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne Todsen Hansen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Olsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Lausen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lone Nikoline Nørgaard
- Department of Obstetrics, Center of Fetal Medicine and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Bergholt
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Klaus Rieneck
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik Banch Clausen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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