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Polin H, Wenighofer B, Polonyi N, Danzer M. Evaluation of the LightCycler ® PRO Instrument as a Platform for Rhesus D Typing. Biomedicines 2024; 12:1785. [PMID: 39200249 PMCID: PMC11352138 DOI: 10.3390/biomedicines12081785] [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: 06/23/2024] [Revised: 07/25/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Rapid and reliable Rhesus D typing is crucial for blood donation centers. In instances of massive blood transfusion or reduced antigen expression, DNA-based phenotype prediction becomes mandatory. Our molecular RHD typing approach involves an initial real-time PCR for the most common aberrant RHD types in our region, RHD*01W.1 (weak D type 1), RHD*01W.2 (weak D type 2), RHD*01W.3 (weak D type 3), and RHD*07.01 (DVII). For comprehensive coverage, Sanger sequencing of RHD coding regions is performed in the case of PCR target-negative results. We evaluated the specificity and accuracy of these methods using the recently launched LightCycler® PRO real-time platform. All findings demonstrated remarkable accuracy. Notably, the LightCycler® PRO instrument offers a distinct advantage in data interpretation and integration via the HL7 interface. This study underlines the importance of including advanced molecular techniques in blood typing protocols, especially in scenarios where conventional serological methods may be insufficient.
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Affiliation(s)
- Helene Polin
- Red Cross Transfusion Service of Upper Austria, Krankenhausstrasse 7, 4020 Linz, Austria
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2
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Zhou S, Liu M, Shao L, Song W, Wang L, Fan Y. Accuracy of RHC/c genotyping in Chinese Han population. Transfus Med 2024; 34:298-303. [PMID: 38808544 DOI: 10.1111/tme.13056] [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] [Received: 01/05/2024] [Revised: 04/08/2024] [Accepted: 05/18/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND AND OBJECTIVES The RHCE gene plays an important role in the complex and polymorphic Rh blood group system. RHCE genotyping holds significant clinical and transfusion-related implications. The objective of this study was to evaluate the accuracy of RHC/c genotyping in the Chinese Han population. MATERIALS AND METHODS Blood samples were obtained from 653 Chinese Han blood donors. The serological RhD and RhCcEe types were determined using monoclonal antibodies. Subsequently, multiplex real-time polymerase chain reaction (PCR) analysis was performed for RHC and RHc genotyping. Additionally, exon 2 of RHCE and exon 1 of RHD were sequenced. RESULTS The analysis in this study found 443 RhD-positive donors and 210 RhD-negative donors. Among the 653 total donors, discrepancies between the RHC genotyping results and the serological results were found in 37 individuals. Specifically, 6 false-positive RhC results in RhD-positive donors and 28 false-positive RhC results in RhD-negative donors were identified based on c.48C in RHCE exon 1. Additionally, 3 false-negative RhC results were observed in the RhD-positive donors due to a 109 bp insertion in RHCE intron 2. RHc typing demonstrated complete consistency between the real-time PCR and the serological results. CONCLUSION In the Chinese Han population, RHC genotyping was reliable when consistent results were achieved by both c.48C-based and 109 bp insertion-based genotyping. Moreover, RHc genotyping based on c.203A and c.307C polymorphic loci demonstrated dependable performance.
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Affiliation(s)
- Shihang Zhou
- Department of Blood Group, Dalian Blood Center, Dalian, China
| | - Ming Liu
- Department of Cell Biology, Dalian Medical University, Dalian, China
| | - Linnan Shao
- Department of Blood Group, Dalian Blood Center, Dalian, China
| | - Wenqian Song
- Department of Blood Group, Dalian Blood Center, Dalian, China
| | - Liying Wang
- College of Laboratory Medicine, Dalian Medical University, Dalian, China
| | - Yaxin Fan
- Department of Blood Group, Dalian Blood Center, Dalian, China
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3
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Jeong IH, Yu S, Kim TY, Oh SY, Cho D. Guide to Rho(D) Immune Globulin in Women With Molecularly Defined Asian-type DEL (c.1227G>A). Ann Lab Med 2024; 44:307-313. [PMID: 38384203 PMCID: PMC10961623 DOI: 10.3343/alm.2023.0356] [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] [Received: 09/09/2023] [Revised: 12/17/2023] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
Rh hemolytic disease of the fetus and newborn is a potential risk for D-negative mothers who produce anti-D during pregnancy, which can lead to morbidity and mortality in subsequent pregnancies. To prevent this hemolytic disease, Rho(D) immune globulin (RhIG) is generally administered to D-negative mothers without anti-D at 28 weeks of gestation and shortly after delivery. However, current guidelines suggest that pregnant mothers with molecularly defined weak D types 1, 2, 3, 4.0, and 4.1 do not need RhIG as they are unlikely to produce alloanti-D when exposed to fetuses with D-positive red cells. This issue and the necessity of RHD genotyping have been extensively discussed in Western countries, where these variants are relatively common. Recent evidence indicates that women with Asian-type DEL (c.1227G>A) also do not form alloanti-D when exposed to D-positive red cells. We report that mothers with molecularly defined Asian-type DEL, similar to those with weak D types 1, 2, 3, 4.0, and 4.1, do not require RhIG before and after delivery. Collectively, this review could pave the way for the revision of international guidelines to include the selective use of RhIG based on specific genotypes, particularly in women with the Asian-type DEL.
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Affiliation(s)
- In Hwa Jeong
- Department of Laboratory Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - SooHo Yu
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Yeul Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duck Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
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4
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Trueba-Gómez R, Rosenfeld-Mann F, Estrada-Juárez H. Prediction of the antigenic regions in eight RhD variants identified by computational biology. Vox Sang 2024; 119:590-597. [PMID: 38523363 DOI: 10.1111/vox.13620] [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] [Received: 12/14/2023] [Revised: 02/23/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND AND OBJECTIVES Changes in RHD generate variations in protein structure that lead to antigenic variants. The classical model divides them into quantitative (weak and Del) and qualitative (partial D). There are two types of protein antigens: linear and conformational. Computational biology analyses the theoretical assembly of tertiary protein structures and allows us to identify the 'topological' differences between isoforms. Our aim was to determine the theoretical antigenic differences between weak RhD variants compared with normal RhD based on structural analysis using bioinformatic techniques. MATERIALS AND METHODS We analysed the variations in secondary structures and hydrophobicity of RHD*01, RHD*01W.1, W2, W3, RHD*09.03.01, RHD*09.04, RHD*11, RHD*15 and RHD*21. We then modelled the tertiary structure and calculated their probable antigenic regions, intra-protein interactions, displacement and membrane width and compared them with Rhce. RESULTS The 10 proteins are similar in their secondary structure and hydrophobicity, with the main differences observed in the exofacial coils. We identified six potential antigenic regions: one that is unique to RhD (R3), one that is common to all D (R6), three that are highly variable among RhD isoforms (R1, R2 and R4), one that they share with Rhce (R5) and two that are unique to Rhce (Ra and Rbc). CONCLUSION The alloimmunization capacity of these subjects could be explained by the variability of the antigen pattern, which is not necessarily recognized or recognized with lower intensity by the commercially available antibodies, and not because they have a lower protein concentration in the membrane.
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Affiliation(s)
- Rocio Trueba-Gómez
- Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes," Coordinación de Hematología Perinatal, Mexico City, Mexico
- Comité de Trombosis y Hemostasia AMEH-CLAHT, A.C., Mexico City, Mexico
| | | | - Higinio Estrada-Juárez
- Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes," Coordinación de Hematología Perinatal, Mexico City, Mexico
- Comité de Trombosis y Hemostasia AMEH-CLAHT, A.C., Mexico City, Mexico
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5
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Wu PC, McGowan EC, Lee YQ, Ghosh S, Hansson J, Olsson ML. Epigenetic dissection of human blood group genes reveals regulatory elements and detailed characteristics of KEL and four other loci. Transfusion 2024; 64:1083-1096. [PMID: 38644556 DOI: 10.1111/trf.17840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/23/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Blood typing is essential for safe transfusions and is performed serologically or genetically. Genotyping predominantly focuses on coding regions, but non-coding variants may affect gene regulation, as demonstrated in the ABO, FY and XG systems. To uncover regulatory loci, we expanded a recently developed bioinformatics pipeline for discovery of non-coding variants by including additional epigenetic datasets. METHODS Multiple datasets including ChIP-seq with erythroid transcription factors (TFs), histone modifications (H3K27ac, H3K4me1), and chromatin accessibility (ATAC-seq) were analyzed. Candidate regulatory regions were investigated for activity (luciferase assays) and TF binding (electrophoretic mobility shift assay, EMSA, and mass spectrometry, MS). RESULTS In total, 814 potential regulatory sites in 47 blood-group-related genes were identified where one or more erythroid TFs bound. Enhancer candidates in CR1, EMP3, ABCB6, and ABCC4 indicated by ATAC-seq, histone markers, and co-occupancy of 4 TFs (GATA1/KLF1/RUNX1/NFE2) were investigated but only CR1 and ABCC4 showed increased transcription. Co-occupancy of GATA1 and KLF1 was observed in the KEL promoter, previously reported to contain GATA1 and Sp1 sites. TF binding energy scores decreased when three naturally occurring variants were introduced into GATA1 and KLF1 motifs. Two of three GATA1 sites and the KLF1 site were confirmed functionally. EMSA and MS demonstrated increased GATA1 and KLF1 binding to the wild-type compared to variant motifs. DISCUSSION This combined bioinformatics and experimental approach revealed multiple candidate regulatory regions and predicted TF co-occupancy sites. The KEL promoter was characterized in detail, indicating that two adjacent GATA1 and KLF1 motifs are most crucial for transcription.
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Affiliation(s)
- Ping Chun Wu
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine and the Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Eunike C McGowan
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine and the Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Yan Quan Lee
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine and the Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Sudip Ghosh
- Department of Experimental Medical Science and Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Jenny Hansson
- Department of Experimental Medical Science and Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Martin L Olsson
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine and the Lund Stem Cell Center, Lund University, Lund, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, Sweden
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da Silva Rodrigues de Araújo C, Machado BA, Dos Santos TD, Pasqualotti A, Castilho L. The c.845 G>A change (p.Gly282Asp) in RHCE*ce causing an E-like antigen. Transfusion 2024; 64:E1-E2. [PMID: 38111258 DOI: 10.1111/trf.17619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/03/2023] [Accepted: 11/10/2023] [Indexed: 12/20/2023]
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Hou J, Li J, Xia Y, Zhang X, Yang J, Li M, Zhou Y. Frequency of the 'Asia type' DEL with weak D phenotype in chinese. Transfus Clin Biol 2023; 30:387-392. [PMID: 37380099 DOI: 10.1016/j.tracli.2023.06.003] [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] [Received: 03/27/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND DEL individuals account for 9-30% of serological RhD negative population in east Asia and majority of them carrying the RHD*DEL1 allele are referred to as 'Asia type' DEL individuals. There is a lack of data on the molecular basis for 'Asia type' DELs with weak RhD phenotype. Therefore, the aim of this study is to unveil 'Asia type' DELs by elucidating the genetic background and analyzing the serological results. METHODS With a microplate typing protocol, RhD characterization was performed in samples from one million blood donors collected at Chengdu blood center during the period from 2019 to 2022. RhD confirmatory test was performed by direct antiglobulin test and indirect antiglobulin test with five anti-D reagents to detect RhD variants. Molecular characterization of samples categorized as RhD variants was studied by using direct genomic DNA sequencing and RHD zygosity analysis, followed by adsorption and elution tests conduced for samples carrying RHD*DEL1 allele to confirm the presence of RhD antigens on the red cells. RESULTS We reported here 21 RhD variant samples were detected by micro-column gel agglutination assay with IgG anti-D antibodies. Moreover, the agglutination reaction was stronger with IgG anti-D reagents in micro-column gel card than with IgM/IgG blended anti-D antibodies. Each of the 21 samples carried the RHD*DEL1 allele, which indicated that they were 'Asia type' DEL. Of the 21 'Asia type' DEL samples, 9 samples were detected to be RHD+/ RHD + homozygotes, whereas the other 12 samples were RHD+/RHD- hemizygotes. Among the samples phenotyped for RhCE, seven were CCee and four were Ccee. CONCLUSIONS In this study, DEL samples carrying RHD*DEL1 showed weak RhD phenotype with some anti-D reagents in RhD confirmatory test, which suggest that a serology strategy using several anti-D reagents may be helpful to detect this 'Asia type' DEL. Further studies are needed to elucidate whether the 'Asia type' DELs with weak RhD phenotype have stronger antigenicity and could cause serious transfusion reaction.
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Affiliation(s)
- Jue Hou
- Blood Grouping Reference Laboratory, Chengdu Blood Center, Chengdu, China
| | - Jian Li
- Blood Grouping Reference Laboratory, Chengdu Blood Center, Chengdu, China
| | - Yu Xia
- Blood Grouping Reference Laboratory, Chengdu Blood Center, Chengdu, China
| | - Xuemei Zhang
- Blood Grouping Reference Laboratory, Chengdu Blood Center, Chengdu, China
| | - Jianying Yang
- Blood Grouping Reference Laboratory, Chengdu Blood Center, Chengdu, China
| | - Meng Li
- Blood Grouping Reference Laboratory, Chengdu Blood Center, Chengdu, China
| | - Ying Zhou
- Blood Grouping Reference Laboratory, Chengdu Blood Center, Chengdu, China
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8
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Hutchison CJ, Srivastava K, Polin H, Bueno MU, Flegel WA. Rh flow cytometry: An updated methodology for D antigen density applied to weak D types 164 and 165. Transfusion 2023; 63:2141-2151. [PMID: 37792462 PMCID: PMC10680490 DOI: 10.1111/trf.17543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND An original methodology for determining the D antigen density on red cells was published in 2000 and has been applied in many publications since. This flow cytometry-based assay remained largely unrevised utilizing monoclonal anti-Ds that are not readily available anymore. We updated the methodology to quantify erythrocyte D antigen sites using microspheres and monoclonal anti-Ds that are commercially available today. METHODS The absolute D antigen density of a frozen standard CcDEe cell, drawn in 2003, a fresh blood donation from the same individual, drawn in 2022, and an internal control CcDEe cell, was quantified by flow cytometry using fluorescence-labeled microspheres. The internal control CcDEe cell was used in conjunction with 9 commercial anti-Ds to determine D antigen densities of 7 normal D, 4 partial D, and 11 weak D type samples, including 2 novel alleles. RESULTS The reproducibility of the updated assay was evaluated with red cells of published D antigen densities. The current results matched the known ones closely. The new weak D types 164 and 165 carried 4500 and 1505 D antigens/red cell, respectively. The absolute D antigen density decreased from 27,231 to 26,037 in an individual over 19 years. DISCUSSION The updated assay gave highly reproducible results for the D antigen densities of Rh phenotypes. Readily available anti-Ds allowed for the determination of the D antigen densities of 7 weak D types. The assay is suitable to evaluate the effects of distinct amino acid substitutions on the RhD phenotype.
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Affiliation(s)
- Chloe Jayne Hutchison
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Helene Polin
- Department of Immunogenetics, Red Cross Transfusion Service for Upper Austria, Linz, Austria
| | - Marina Ursula Bueno
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Trueba-Gómez R, Rosenfeld-Mann F, Baptista-González HA, Domínguez-López ML, Estrada-Juárez H. Use of computational biology to compare the theoretical tertiary structures of the most common forms of RhCE and RhD. Vox Sang 2023; 118:881-890. [PMID: 37559188 DOI: 10.1111/vox.13509] [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: 01/18/2023] [Revised: 07/11/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Computational biology analyses the theoretical tertiary structure of proteins and identifies the 'topological' differences between RhD and RhCE. Our aim was to identify the theoretical structural differences between the four isoforms of RhCE and RhD using computational biological tools. MATERIALS AND METHODS Physicochemical profile was determined by hydrophobicity and electrostatic potential analysis. Secondary and tertiary structures were generated using computational biology tools. The structures were evaluated and validated using Ramachandran algorithm, which calculates the single score, p-value and root mean square deviation (RMSD). Structures were overlaid on local refinement of 'RhAG-RhCE-ANK' (PBDID 7uzq) and RhAG to compare their spatial distribution within the membrane. RESULTS All proteins differed in surface area and electrostatic distance due to variations in hydrophobicity and electrostatic potential. The RMSD between RhD and RhCE was 0.46 ± 0.04 Å, and the comparison within RhCE was 0.57 ± 0.08 Å. The percentage of amino acids in the hydrophobic thickness was 50.24% for RhD while for RhCE it ranged between 73.08% and 76.68%. The RHAG hydrophobic thickness was 34.2 Å, and RhCE's hydrophobic thickness was 33.83 Å. We suggest that the C/c antigens differ exofacially at loops L1 and L2. For the E/e antigens, the difference lies in L6. By contrast, L4 is the same for all proteins except Rhce. CONCLUSION The physicochemical properties of Rh proteins made them different, although their genes are homologous. Using computational biology, we model structures with sufficient precision, similar to those obtained experimentally. An amino acid variation alters the folding of the tertiary structure and the interactions with other proteins, modifying the electrostatic environment, the spatial conformations and therefore the antigenic recognition.
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Affiliation(s)
- Rocio Trueba-Gómez
- Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Coordinación de Hematología Perinatal, Mexico City, Mexico
- Posgrado en Ciencias Químico Biológicas, Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Fany Rosenfeld-Mann
- Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Coordinación de Hematología Perinatal, Mexico City, Mexico
| | - Hector A Baptista-González
- Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Coordinación de Hematología Perinatal, Mexico City, Mexico
| | - María L Domínguez-López
- Posgrado en Ciencias Químico Biológicas, Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Higinio Estrada-Juárez
- Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Coordinación de Hematología Perinatal, Mexico City, Mexico
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Ohto H, Ito S, Srivastava K, Ogiyama Y, Uchikawa M, Nollet KE, Flegel WA. Asian-type DEL (RHD*DEL1) with an allo-anti-D: A paradoxical observation in a healthy multiparous woman. Transfusion 2023; 63:1601-1611. [PMID: 37465939 PMCID: PMC10528739 DOI: 10.1111/trf.17465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The DEL phenotype is the D variant expressing the least amounts of D antigen per red cell. Asian-type DEL (RHD:c:1227G > A) is the most prevalent DEL in East Asia without any anti-D alloimmunization reported before. We investigated the first observation of an anti-D in any DEL phenotype, reported in the Japanese language at a 1987 conference, only 3 years after the discovery of DEL. METHODS We contacted the proband 35 years after the initial report. Standard hemagglutination, adsorption/elution, and flow cytometry tests were performed, as was nucleotide sequencing for the RHD, RHCE, and HLA class I and class II genes. RESULTS The healthy multiparous Japanese woman, a regular blood donor, still had the anti-D of titer 8 representing an alloantibody by standard serologic methods. Unexpectedly, she carried an Asian-type DEL without any additional RHD gene variation. All 12 HLA alleles identified were known in the Japanese population. Interestingly, one of her HLA-DRB1 and a variant of her HLA-DQB1 alleles had previously been associated with anti-D immunization. CONCLUSION We described an allo-anti-D, maintained for more than three decades, in an Asian-type DEL. The combination of two implicated HLA alleles were rare and could have contributed to the anti-D immunization. Continued monitoring of anti-D immunization events in patients with DEL is warranted, and we discuss possible mechanisms for further study. As only this single observation has been recognized in the last 35 years, the current recommendation is affirmed: Individuals with Asian-type DEL should be treated as Rh D-positive for transfusion and Rh immune prophylaxis purposes.
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Affiliation(s)
- Hitoshi Ohto
- Department of Mesenchymal Stem Cell Research, Fukushima Medical University, Fukushima, Japan
| | - Shoichi Ito
- Tohoku Block Blood Center, Japanese Red Cross Society, Sendai, Japan
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Yoshiko Ogiyama
- Tohoku Block Blood Center, Japanese Red Cross Society, Sendai, Japan
| | - Makoto Uchikawa
- Kanto-Koshinetsu Block Blood Center, Japanese Red Cross Society, Tokyo, Japan
| | - Kenneth Eric Nollet
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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11
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Drouin M, Rochette S, St-Louis M, Lewin A, Laganière J. Prevalence of weak D phenotypes in the general population of Québec, Canada: A focus on weak D type 42. Vox Sang 2023. [PMID: 37183976 DOI: 10.1111/vox.13447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/06/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Weak D type 42 accounts for an unusually high proportion of weak D phenotypes in Québec (Canada), which contrasts with other predominantly White populations. However, its prevalence in the general population is unknown. We estimated the prevalence of weak D type 42 and other common weak D phenotypes in Québec. MATERIALS AND METHODS We screened for RHD*01W.42 alleles among 1000 individuals of CARTaGENE-a cohort representative of Québec's population. The prevalence of weak D type 42 was calculated based on the allele frequency of RHD*01W.42 and d (i.e., all recessive alleles that confer a D- phenotype), assuming a Hardy-Weinberg equilibrium. This prevalence was then leveraged to calculate that of other common weak D phenotypes, using published prevalence estimates among weak D phenotypes. RESULTS Two individuals harboured the RHD*01W.42/RHD*01 heterozygous genotype. Assuming an allele frequency of 38.19% for d, the overall prevalence of weak D type 42 was 0.08%. The following prevalence estimates were also obtained: 0.44% for all weak D phenotypes and 0.07%, 0.01% and 0.04% for weak D types 1, 2 and 3, respectively. CONCLUSION Québec has the highest documented prevalence of weak D type 42, which was estimated at 0.08%.
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Affiliation(s)
- Mathieu Drouin
- Medical Affairs and Innovation, Héma-Québec, Québec, Québec, Canada
| | - Samuel Rochette
- Medical Affairs and Innovation, Héma-Québec, Québec, Québec, Canada
| | - Maryse St-Louis
- Medical Affairs and Innovation, Héma-Québec, Québec, Québec, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Québec, Québec, Canada
| | - Josée Laganière
- Medical Affairs and Innovation, Héma-Québec, Québec, Québec, Canada
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12
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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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13
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Never-homozygous genetic variants in healthy populations are potential recessive disease candidates. NPJ Genom Med 2022; 7:54. [PMID: 36075934 PMCID: PMC9458638 DOI: 10.1038/s41525-022-00322-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
The rapid pace with which genetic variants are now being determined means there is a pressing need to understand how they affect biological systems. Variants from healthy individuals have previously been used to study blood groups or HLA diversity and to identify genes that can apparently be nonfunctional in healthy people. These studies and others have observed a lower than expected frequency of homozygous individuals for potentially deleterious alleles, which would suggest that several of these alleles can lead to recessive disorders. Here we exploited this principle to hunt for potential disease variants in genomes from healthy people. We identified at least 108 exclusively heterozygous variants with evidence for an impact on biological function. We discuss several examples of candidate variants/genes including CCDC8, PANK3, RHD and NLRP12. Overall, the results suggest there are many, comparatively frequent, potentially lethal or disease-causing variants lurking in healthy human populations.
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14
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Tounsi WA, Lenis VP, Tammi SM, Sainio S, Haimila K, Avent ND, Madgett TE. Rh Blood Group D Antigen Genotyping Using a Portable Nanopore-based Sequencing Device: Proof of Principle. Clin Chem 2022; 68:1196-1201. [PMID: 35652461 DOI: 10.1093/clinchem/hvac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/13/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Nanopore sequencing is direct sequencing of a single-stranded DNA molecule using biological pores. A portable nanopore-based sequencing device from Oxford Nanopore Technologies (MinION) depends on driving a DNA molecule through nanopores embedded in a membrane using a voltage. Changes in current are then measured by a sensor, thousands of times per second and translated to nucleobases. METHODS Genomic DNA (gDNA) samples (n = 13) were tested for Rh blood group D antigen (RHD) gene zygosity using droplet digital PCR. The RHD gene was amplified in 6 overlapping amplicons using long-range PCR. Amplicons were purified, and the sequencing library was prepared following the 1D Native barcoding gDNA protocol. Sequencing was carried out with 1D flow cells R9 version. Data analysis included basecalling, aligning to the RHD reference sequence, and calling variants. Variants detected were compared to the results acquired previously by the Ion Personal Genome Machine (Ion PGM). RESULTS Up to 500× sequence coverage across the RHD gene allowed accurate variant calling. Exonic changes in the RHD gene allowed RHD allele determination for all samples sequenced except 1 RHD homozygous sample, where 2 heterozygous RHD variant alleles are suspected. There were 3 known variant RHD alleles (RHD*01W.02, RHD*11, and RHD*15) and 6 novel RHD variant alleles, as previously seen in Ion PGM sequencing data for these samples. CONCLUSIONS MinION was effective in blood group genotyping, provided enough sequencing data to achieve high coverage of the RHD gene, and enabled confident calling of variants and RHD allele determination.
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Affiliation(s)
- Wajnat A Tounsi
- Faculty of Applied Medical Sciences, Department of Medical Laboratory Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- School of Biomedical Sciences, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Vasileios P Lenis
- School of Biomedical Sciences, Faculty of Health, University of Plymouth, Plymouth, UK
- School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, UK
| | - Silja M Tammi
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Susanna Sainio
- Blood Group Unit, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Katri Haimila
- Blood Group Unit, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Neil D Avent
- School of Biomedical Sciences, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Tracey E Madgett
- School of Biomedical Sciences, Faculty of Health, University of Plymouth, Plymouth, UK
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15
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Seheult JN, Callum J, Delaney M, Drake R, Dunbar NM, Harm SK, Hess JR, Jackson BP, Javanbakht A, Moore SA, Murphy MF, Raval JS, Staves J, Tuott EE, Wendel S, Ziman A, Yazer MH. Rate of D-alloimmunization in trauma does not depend on the number of RhD-positive units transfused: The BEST collaborative study. Transfusion 2022; 62 Suppl 1:S185-S192. [PMID: 35748692 DOI: 10.1111/trf.16952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Evidence indicates the life-saving benefits of early blood product transfusion in severe trauma resuscitation. Many of these products will be RhD-positive, so understanding the D-alloimmunization rate is important. METHODS This was a multicenter, retrospective study whereby injured RhD-negative patients between 18-50 years of age who received at least one unit of RhD-positive red blood cells (RBC) or low titer group O whole blood (LTOWB) during their resuscitation between 1 January, 2010 through 31 December, 2019 were identified. If an antibody detection test was performed ≥14 days after the index RhD-positive transfusion then basic demographic information was collected, including whether the patient became D-alloimmunized. The overall D-alloimmunization rate, and the rate stratified by the number of units transfused, were calculated. RESULTS Data were collected from nine institutions. Five institutions reported fewer than 10 eligible patients each and were excluded. From the remaining four institutions, all from the USA, there were 235 eligible patients; 77 (random effects estimate: 32.7%; 95% CI: 19.1-50.1%) became D-alloimmunized. Three of the institutions reported D-alloimmunization rates ≥38.6%, while the remaining institution's rate was 12.2%. In both random and fixed-effects models, the rate of D-alloimmunization was not significantly different between those who received one RhD-positive unit and those who received multiple RhD-positive units. CONCLUSION In this large, multicenter study of injured patients, the overall rate of D-alloimmunization fell within the range previously reported. The rate of D-alloimmunization did not increase as the number of transfused RhD-positive units increased. These data can help to inform RhD type selection decisions.
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Affiliation(s)
- Jansen N Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston health Sciences Centre and Queen's University, Kingston, Ontario, Canada
| | - Meghan Delaney
- Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pathology and Pediatrics, George Washington University Medical School, Washington, District of Columbia, USA
| | - Rosanna Drake
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sarah K Harm
- Department of pathology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - John R Hess
- Transfusion Service, Harborview Medical Center and the Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Bryon P Jackson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ayda Javanbakht
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sarah A Moore
- Department of Surgery, University of New Mexico, Albuquerque, New Mexico
| | - Michael F Murphy
- National Health Service Blood and Transplant, and Oxford Biomedical Research Centre, Oxford, UK
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Julie Staves
- National Health Service Blood and Transplant, and Oxford Biomedical Research Centre, Oxford, UK
| | - Erin E Tuott
- Transfusion Service, Harborview Medical Center and the Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Alyssa Ziman
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, UCLA Health, Los Angeles, California, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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16
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Lai S, Tian L, Hou L. A novel missense mutation (c.221G>C) in RHD gene identified in a Chinese woman. Transfusion 2022; 62:E30-E31. [PMID: 35694763 DOI: 10.1111/trf.16945] [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: 03/16/2022] [Accepted: 03/25/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Shichao Lai
- Emergency Department, West China Hospital, Sichuan University, Chengdu, China
| | - Li Tian
- Department of Blood Immunology, Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Li Hou
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
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17
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Wagner FF, Weinstock C. Terminologie der Blutgruppenantigene und -antikörper. TRANSFUSIONSMEDIZIN 2022. [DOI: 10.1055/a-1623-9083] [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
ZusammenfassungFür den Austausch von immunhämatologischen Befunden und für die Versorgung mit Blutpräparaten ist es erforderlich, dass alle Beteiligten das Gleiche meinen, wenn sie über
Blutgruppenantigene und Antikörper sprechen. Eine Arbeitsgruppe der International Society of Blood Transfusion (ISBT) erarbeitet die dafür erforderliche Terminologie und passt diese den
neuen Erkenntnissen regelmäßig an. Dieser Beitrag berichtet über den aktuellen Stand der international gebräuchlichen Terminologie der Blutgruppenantigene und die Empfehlungen der deutschen
Richtlinie.
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Affiliation(s)
- Franz F. Wagner
- Zentralinstitut Springe, DRK-Blutspendedienst NSTOB, Springe, Deutschland
- MVZ Clementinenkrankenhaus, Springe, Deutschland
| | - Christof Weinstock
- DRK-Blutspendedienst Baden-Württemberg – Hessen, Institut für Klinische Transfusionsmedizin und Immungenetik Ulm; Abteilung Transfusionsmedizin, Universität Ulm, Ulm,
Deutschland
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18
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Morin PA, Perreault J, St-Louis M, Leiva-Torres GA, Robitaille N, Trépanier P. Weak D type 42: Antigen density and risk of alloimmunization in the province of Québec. Vox Sang 2022; 117:943-948. [PMID: 35297064 DOI: 10.1111/vox.13271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/14/2022] [Accepted: 03/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES A high proportion of suspected weak D patients referred to Héma-Québec were genotyped as weak D type 42 (368/2105, 17.5%). These patients are currently considered D with regard to RhD immunoprophylaxis in pregnancy and transfusion. The goal of this study was to retrospectively evaluate the risk of alloimmunization in weak D type 42 patients and to characterize their RhD surface molecule expression on red blood cells (RBCs) in comparison to other weak D types (1, 2 and 3). MATERIALS AND METHODS A retrospective analysis using the weak D type 42 patients' medical data to verify potential anti-D alloimmunization events was conducted. Quantitative analyses using flow cytometry were also performed on RBCs to quantify the cell surface density of the D antigen. RESULTS Data on 215 subjects with weak D type 42 were reviewed. None developed immune allo-anti-D; three had definite exposure to D+ red cells and 41 had possible exposure through pregnancy. Flow cytometry analysis showed that weak D types 1, 2, 3 and 42 had relative antigen densities of 2.7%, 2.2%, 8.1% and 3.6%, respectively, with R1R2 red cells referencing 100% density. The estimated antigen density range of weak D type 42 was 819-1104 sites per RBC. CONCLUSION Our retrospective alloimmunization data analysis and antigen density study establish a basis for the consideration of a weak D type 42 individual as D+. This consideration would allow for a targeted reduction of RhD immunoprophylaxis in pregnancy and the unjustified use of D- units for transfusion.
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Affiliation(s)
- Pierre-Aurèle Morin
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Josée Perreault
- Héma-Québec, Medical Affairs and Innovation, Québec City, Québec, Canada
| | - Maryse St-Louis
- Héma-Québec, Medical Affairs and Innovation, Québec City, Québec, Canada
| | | | | | - Patrick Trépanier
- Héma-Québec, Medical Affairs and Innovation, Québec City, Québec, Canada
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19
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Ying Y, Zhang J, Hong X, Xu X, He J, Zhu F. The Significance of RHD Genotyping and Characteristic Analysis in Chinese RhD Variant Individuals. Front Immunol 2021; 12:755661. [PMID: 34867989 PMCID: PMC8633534 DOI: 10.3389/fimmu.2021.755661] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background RhD is the most important and complex blood group system because of its highly polymorphic and immunogenic nature. RhD variants can induce immune response by allogeneic transfusion, organ transplantation, and fetal immunity. The transfusion strategies are different for RhD variants formed by various alleles. Therefore, extensive investigation of the molecular mechanism underlying RhD variants is critical for preventing immune-related blood transfusion reactions and fetal immunity. Methods RhD variants were collected from donors and patients in Zhejiang Province, China. The phenotypes were classified using the serologic method. The full coding regions of RHD gene were analyzed using the PCR-SBT method. The multiplex ligation-dependent probe amplification (MLPA) assay was used to analyze the genotype and gene copy number. SWISS-MODLE and PyMOL software were used to analyze 3D structures of RhD caused by the variant alleles. The effect of non-synonymous substitutions was predicted using Polymorphism Phenotyping algorithm (PolyPhen-2), Sorting Intolerant From Tolerant (SIFT), and Protein Variation Effect Analyzer (PROVEAN) software. Results In the collected RhD variants, 28 distinct RHD variant alleles were identified, including three novel variant alleles. RH-MLPA assay is advantageous for determining the copy number of RHD gene. 3D homology modeling predicted that protein conformation was disrupted and may explain RhD epitope differential expression. A total of 14 non-synonymous mutations were determined to be detrimental to the protein structure. Discussion We revealed the diversity of RHD alleles present in eastern Chinese RhD variants. The bioinformatics of these variant alleles extended our knowledge of RhD variants, which was crucial for evaluating their impact to guide transfusion support and avoid immune-related blood transfusion reactions.
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Affiliation(s)
- Yanling Ying
- Blood Center of Zhejiang Province, Institute of Transfusion Medicine, Hangzhou, China.,Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
| | - Jingjing Zhang
- Blood Center of Zhejiang Province, Institute of Transfusion Medicine, Hangzhou, China.,Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
| | - Xiaozhen Hong
- Blood Center of Zhejiang Province, Institute of Transfusion Medicine, Hangzhou, China.,Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
| | - Xianguo Xu
- Blood Center of Zhejiang Province, Institute of Transfusion Medicine, Hangzhou, China.,Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
| | - Ji He
- Blood Center of Zhejiang Province, Institute of Transfusion Medicine, Hangzhou, China.,Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
| | - Faming Zhu
- Blood Center of Zhejiang Province, Institute of Transfusion Medicine, Hangzhou, China.,Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
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20
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Uzuni A, Wlosinski L, Lopez-Plaza I. Updated Evaluation of RhD Status Among Women of Child-Bearing Age in Detroit, Michigan. Am J Clin Pathol 2021; 156:1000-1006. [PMID: 34050357 DOI: 10.1093/ajcp/aqab061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The Rh blood group system is one of the most important and immunogenic blood group systems after the ABO blood group system and, like other blood group antigens, it follows ethnic and racial trends. However, when it comes to D variants-partial D and weak D-most of the cohorts studied in the literature have been of European descent. This study aimed to discover the variant D trends in Detroit, Michigan, with an emphasis on Black communities. METHODS From 2016 to 2018, there were 102 patients (women of childbearing potential: < 50 years) at Henry Ford Hospital that had serologic D discrepant testing. These patients were sent out for molecular RHD determination. RESULTS In total, 12.7% of patients were characterized as RhD positive and 87.3% of patients were characterized as RhD variants (nominated as RhD negative at our institution). CONCLUSIONS Our predominantly Black cohort sheds light on the diversity of the RhD antigen. The majority of Blacks were classified as RhD variants (RhD negative nomination at our institution). Therefore, molecular testing for this patient population with serologic RhD discrepancies is paramount to properly manage their obstetric care.
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Affiliation(s)
- Ajna Uzuni
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Lindsey Wlosinski
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Ileana Lopez-Plaza
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
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21
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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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22
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Leiva-Torres GA, Chevrier MC, Constanzo-Yanez J, Lewin A, Lavoie J, Laganière J, Baillargeon N, Trépanier P, Robitaille N. High prevalence of weak D type 42 in a large-scale RHD genotyping program in the province of Quebec (Canada). Transfusion 2021; 61:2727-2735. [PMID: 34121202 DOI: 10.1111/trf.16518] [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: 01/22/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The determination of the RhD phenotype is crucial to avoid alloimmunization, especially in childbearing women. Following the 2015 recommendation from the Work Group on RHD Genotyping, a large-scale RHD genotyping program was implemented in the province of Quebec (Canada) and offered to women ≤45 years old with a serological weak D or discordant results. Since weak D type 42 was previously shown to be prevalent among French Canadians, genotyping for that variant was also performed. Our aim was to report the prevalence of the weak D alleles in the province of Quebec. STUDY DESIGN AND METHODS A retrospective study of 2105 women with serological weak D referred to Hema-Quebec's immunohematology reference laboratory (IRL) between June 2016 and May 2020 was conducted. Results from the serological tests performed by the referring hospital were compiled and RHD were genotyped. RESULTS Most patients presented at least one serological result ≤2+ before being referred to Hema-Quebec. Weak D type 42 was the most prevalent variant, representing 17.5% (368/2105) of all individuals tested. Only 15.3% (323/2105) of patients were weak D type 1, 3.3% (69/2105) were type 2, and 8.6% (180/2105) were type 3. Weak D type 42 is highly expressed in regions with low immigration rate and known for their founder effect. CONCLUSION Our RHD genotyping program allowed for a better management of weak D. The province of Quebec presents a unique RHD genotype distribution. We confirmed that weak D type 42 is associated with a founder effect found in Caucasian French Canadians.
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Affiliation(s)
| | | | | | - Antoine Lewin
- Medical Affairs and Innovation, Hema-Quebec, Quebec, Quebec, Canada
| | - Josée Lavoie
- Medical Affairs and Innovation, Hema-Quebec, Quebec, Quebec, Canada
| | - Josée Laganière
- Medical Affairs and Innovation, Hema-Quebec, Quebec, Quebec, Canada
| | - Nadia Baillargeon
- Immunohematology Reference Laboratory, Hema-Quebec, Montreal, Quebec, Canada
| | | | - Nancy Robitaille
- Immunohematology Reference Laboratory, Hema-Quebec, Montreal, Quebec, Canada
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23
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Raud L, Le Tertre M, Vigneron L, Ka C, Richard G, Callebaut I, Chen JM, Férec C, Le Gac G, Fichou Y. Missense RHD single nucleotide variants induce weakened D antigen expression by altering splicing and/or protein expression. Transfusion 2021; 61:2468-2476. [PMID: 34110623 DOI: 10.1111/trf.16538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/09/2021] [Accepted: 04/28/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although D variant phenotype is known to be due to genetic defects, including rare missense single nucleotide variants (SNVs), within the RHD gene, few studies have addressed the molecular and cellular mechanisms driving this altered expression. We and others showed previously that splicing is commonly disrupted by SNVs in constitutive splice sites and their vicinity. We thus sought to investigate whether rare missense SNVs located in "deep" exonic regions could also impair this mechanism. STUDY DESIGN AND METHODS Forty-six missense SNVs reported within exons 6 and 7 were first selected from the Human RhesusBase. Their respective effect on splicing was assessed by using an in vitro assay. An RhD-negative cell model was further generated by using the CRISPR-Cas9 approach. RhD-mutated proteins were overexpressed in the newly created model, and cell membrane expression of the D antigen was measured by flow cytometry. RESULTS Minigene splicing assay showed that 14 of 46 (30.4%) missense SNVs alter splicing. Very interestingly, further investigation of two missense SNVs, which both affect codon 338 and confer a weak D phenotype, showed various mechanisms: c.1012C>G (p.Leu338Val) disrupts splicing only, while c.1013T>C (p.Leu338Pro) alters only the protein structure, in agreement with in silico prediction tools and 3D protein structure visualization. CONCLUSION Our functional data set suggests that missense SNVs damage quantitatively D antigen expression by, at least, two different mechanisms (splicing alteration and protein destabilization) that may act independently. These data thereby contribute to extend the current knowledge of the molecular mechanisms governing weakened D expression.
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Affiliation(s)
- Loann Raud
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Marlène Le Tertre
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France.,Service de Génétique Médicale, CHRU Brest, Brest, France
| | | | - Chandran Ka
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France.,Service de Génétique Médicale, CHRU Brest, Brest, France
| | - Gaëlle Richard
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Isabelle Callebaut
- Sorbonne Université, Muséum National d'Histoire Naturelle, UMR CNRS 7590, Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie (IMPMC), Paris, France
| | - Jian-Min Chen
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Claude Férec
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France.,Service de Génétique Médicale, CHRU Brest, Brest, France
| | - Gérald Le Gac
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France.,Service de Génétique Médicale, CHRU Brest, Brest, France
| | - Yann Fichou
- Univ Brest, Inserm, EFS, UMR1078, GGB, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
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24
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Next-generation sequencing of 35 RHD variants in 16 253 serologically D- pregnant women in the Finnish population. Blood Adv 2021; 4:4994-5001. [PMID: 33057632 DOI: 10.1182/bloodadvances.2020001569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022] Open
Abstract
Fetal RHD screening for targeted routine antenatal anti-D prophylaxis has been implemented in many countries, including Finland, since the 2010s. Comprehensive knowledge of the RHD polymorphism in the population is essential for the performance and safety of the anti-D prophylaxis program. During the first 3 years of the national screening program in Finland, over 16 000 samples from RhD- women were screened for fetal RHD; among them, 79 samples (0.5%) containing a maternal variant allele were detected. Of the detected maternal variants, 35 cases remained inconclusive using the traditional genotyping methods and required further analysis by next-generation sequencing (NGS) of the whole RHD gene to uncover the variant allele. In addition to the 13 RHD variants that have been previously reported in different populations, 8 novel variants were also detected, indicating that there is more variation of RHD in the RhD- Finnish population than has been previously known. Three of the novel alleles were identified in multiple samples; thus, they are likely specific to the original Finnish population. National screening has thus provided new information about the diversity of RHD variants in the Finnish population. The results show that NGS is a powerful method for genotyping the highly polymorphic RHD gene compared with traditional methods that rely on the detection of specific nucleotides by polymerase chain reaction amplification.
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25
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Liu C, Xue Y, Ouchari M, Yin Q. Transfusion management of a Chinese pregnant woman with RHD*DEL1 allele. Transfus Clin Biol 2021; 28:293-295. [PMID: 33991666 DOI: 10.1016/j.tracli.2021.05.001] [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: 12/16/2020] [Revised: 04/25/2021] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
We report the case of a 33-year-old pregnant Chinese woman who typed as Rh-negative in routine serology. Two injections of RhIG were given and two Rh-negative red cell units were sourced and put aside then returned with a reduced shelf life. RHD*DEL1 allele was determined in this woman by RHD genotyping two month later after delivery occasionally. In this representative case, a pregnant woman with RHD*DEL1 allele can safely be managed as Rh-positive, avoiding the unnecessary procurement of Rh-negative red cells and payment for RhIG injections. We analyzed the cost benefit of using RHD genotyping to guide transfusion management on the Chinese pregnant woman in Beijing where the average salary level is top-ranked in China. Considering the healthcare condition in China, we recommend molecular analysis of serologic Rh-negative early in pregnancy before the Rh-negative transfusion and administration of RhIG become unnecessarily required.
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Affiliation(s)
- Chunyan Liu
- Department of Obstetrics & Gynecology, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Yun Xue
- College of Medical Technology and Engineering, Henan University of Science and Technology, 471023 Luoyang, Henan, China
| | - Mouna Ouchari
- Department of Immunology, Columbia University, 10027 New York, USA
| | - Qinan Yin
- College of Medical Technology and Engineering, Henan University of Science and Technology, 471023 Luoyang, Henan, China.
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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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Frequency and characterization of RHD variant alleles in a population of blood donors from southeastern Brazil: Comparison with other populations. Transfus Apher Sci 2021; 60:103135. [PMID: 33867285 DOI: 10.1016/j.transci.2021.103135] [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: 11/12/2020] [Revised: 03/28/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The correct determination of D antigen could help to avoid alloimmunization in pregnant women and patients receiving blood transfusions. However, there are limitations in the identification of D variants as the partial and weak D phenotypes make the determination of D antigen a great challenge in the transfusion routine.' STUDY DESIGN AND METHODS The molecular characterization of D variants was performed on blood donors from southeastern Brazil with atypical D typing. Furthermore, the serological profile of all RHD variant alleles identified was analyzed using different Anti-D clones. The prevalence of RHD alleles and genotypes found was compared with those described in other countries and in other regions from Brazil. RESULTS Atypical serologic D typing occurred in 0.79 % of blood donors. The majority of RHD variant alleles (88 %) were first characterized by multiplex PCR and PCR-SSP as RHD*weak partial 4 (47 %), followed by RHD*weak D type 3 (29.9 %), RHD*weak D type 2 (3.9 %) and RHD*weak D type 1 (3.1 %). Genomic DNA sequencing characterized the RHD*weak partial 4 variants found in RHD*DAR1.2 (weak 4.2.2) (22 %), RHD*DAR3 (weak 4.0.1) (2.4 %), RHD*DAR3.1 (weak 4.0) (22 %) and RHD*DAR4 (weak 4.1) (0.8 %). RHD variant alleles associated with partial D, such as, RHD*DAU-4 (1.6 %), RHD*DAU-5 (2.4 %), RHD*DAU-6 (1.6 %), RHD* DIII type 8 (1.6 %), RHD*DVII (3.9 %) and RHD* DMH (0.8 %) were also observed. CONCLUSION The prevalence of RHD variant alleles observed in this cohort differ from those found in other populations, including Brazilians from other regions. RHD allele distribution in specific regions should be considered for implementation of algorithms and genotyping strategies aiming at a more effective and safe transfusion.
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Floch A, Pirenne F, Barrault A, Chami B, Toly-Ndour C, Tournamille C, de Brevern AG. Insights into anti-D formation in carriers of RhD variants through studies of 3D intraprotein interactions. Transfusion 2021; 61:1286-1301. [PMID: 33586199 DOI: 10.1111/trf.16301] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/04/2020] [Accepted: 01/13/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Many RhD variants associated with anti-D formation (partial D) in carriers exposed to the conventional D antigen carry mutations affecting extracellular loop residues. Surprisingly, some carry mutations affecting transmembrane or intracellular domains, positions not thought likely to have a major impact on D epitopes. STUDY DESIGN AND METHODS A wild-type Rh trimer (RhD1 RhAG2 ) was modeled by comparative modeling with the human RhCG structure. Taking trimer conformation, residue accessibility, and position relative to the lipid bilayer into account, we redefine the domains of the RhD protein. We generated models for RhD variants carrying one or two amino acid substitutions associated with anti-D formation in published articles (25 variants) or abstracts (12 variants) and for RHD*weak D type 38. We determined the extracellular substitutions and compared the interactions of the variants with those of the standard RhD. RESULTS The findings of the three-dimensional (3D) analysis were correlated with anti-D formation for 76% of RhD variants: 15 substitutions associated with anti-D formation concerned extracellular residues, and structural differences in intraprotein interactions relative to standard RhD were observed in the others. We discuss the mechanisms by which D epitopes may be modified in variants in which the extracellular residues are identical to those of standard RhD and provide arguments for the benignity of p.T379M (RHD*DAU0) and p.G278D (RHD*weak D type 38) in transfusion medicine. CONCLUSION The study of RhD intraprotein interactions and the precise redefinition of residue accessibility provide insight into the mechanisms through which RhD point mutations may lead to anti-D formation in carriers.
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Affiliation(s)
- Aline Floch
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - France Pirenne
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Aurélie Barrault
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Btissam Chami
- Etablissement francais du sang Ile-de-France, Creteil, France
| | - Cécile Toly-Ndour
- Unité Fonctionnelle d'expertise en Immuno-Hémobiologie Périnatale, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Service de Médecine Fœtale, Pôle Périnatalité, Hôpital Trousseau, GH HUEP, APHP, Paris, France
| | - Christophe Tournamille
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Alexandre G de Brevern
- Laboratoire d'Excellence GR-Ex, Paris, France.,Université de Paris, Biologie Intégrée du Globule Rouge UMR_S1134, Inserm, Université de la Réunion, Université des Antilles, Paris, France.,Institut National de la Transfusion Sanguine (INTS), Paris, France
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Yanasik M, Oguz FS, Besisik SK, Huslu M, Ozturk G, Temurhan S, Aydin F. Frequency of RHD variants in serologically weak D Turkish blood donors. Transfus Apher Sci 2020; 60:103024. [PMID: 33308979 DOI: 10.1016/j.transci.2020.103024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND RhD typing has remained of primary importance, as being the leading cause of hemolytic disease of the newborn. Among Rh system's 55 blood group antigens, RhD is the most immunogenic. We aimed with this study to determine weak D/partial D variant frequency in blood donors who were admitted to our blood center and have serologically designated blood group weak D. MATERIALS AND METHODS We screened blood donors who admitted between 2011 and 2017 to our blood center. Sixty-seven serologically weak D phenotyped donors have participated in the study. These donors' samples were studied further by Polymerase Chain Reaction Sequence- Specific Primers (PCR-SSP) for determining D variants. RESULTS Weak D phenotype was detected in 228(0.12 %) out of 177,554 donors. Sixty-seven of them agreed to take part in the study. The frequency of weak D and partial D was 68.7 % (n = 46), and 22.4 % (n = 15), in order. The most encountered weak D and partial D variant was type 15 and DFR type, respectively. CONCLUSIONS The prevalence of serologically weak D phenotypes varies by race and ethnicity. Turkey is a country covering a mixture of European and Asian DNA with different ethnic groups. Thus, our research as giving the overall distribution of RHD variants from the largest city of Turkey, which may reflect the general ethnic background of the country, would help to the establishment of a databank for blood banking. This paper is the first molecular study on RHD variants in Turkey. New molecular research would be more reliable and precise.
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Affiliation(s)
- Melek Yanasik
- Istanbul Medical Faculty Hospital Blood Center, Istanbul University, Istanbul, Turkey
| | - Fatma Savran Oguz
- Istanbul Medical Faculty, Department of Medical Biology, Istanbul University, Istanbul, Turkey.
| | | | - Mukadder Huslu
- Istanbul Medical Faculty Hospital Blood Center, Istanbul University, Istanbul, Turkey
| | - Gulyuz Ozturk
- Department of Pediatric Hematology/Oncology & Bone Marrow Transplantation Unit, School of Medicine, Altunizade Hospital, Acıbadem University, Istanbul, Turkey
| | - Sonay Temurhan
- Istanbul Medical Faculty, Department of Medical Biology, Istanbul University, Istanbul, Turkey
| | - Filiz Aydin
- Istanbul Science University, Department of Medical Biology, Istanbul, Turkey
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30
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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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31
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Two Reliable Methodical Approaches for Non-Invasive RHD Genotyping of a Fetus from Maternal Plasma. Diagnostics (Basel) 2020; 10:diagnostics10080564. [PMID: 32764529 PMCID: PMC7460148 DOI: 10.3390/diagnostics10080564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/27/2022] Open
Abstract
Noninvasive fetal RHD genotyping is an important tool for predicting RhD incompatibility between a pregnant woman and a fetus. This study aimed to assess a methodological approach other than the commonly used one for noninvasive fetal RHD genotyping on a representative set of RhD-negative pregnant women. The methodology must be accurate, reliable, and broadly available for implementation into routine clinical practice. A total of 337 RhD-negative pregnant women from the Czech Republic region were tested in this study. The fetal RHD genotype was assessed using two methods: real-time PCR and endpoint quantitative fluorescent (QF) PCR. We used exon-7-specific primers from the RHD gene, along with internal controls. Plasma samples were analyzed and measured in four/two parallel reactions to determine the accuracy of the RHD genotyping. The RHD genotype was verified using DNA analysis from a newborn buccal swab. Both methods showed an excellent ability to predict the RHD genotype. Real-time PCR achieved its greatest accuracy of 98.6% (97.1% sensitivity and 100% specificity (95% CI)) if all four PCRs were positive/negative. The QF PCR method also achieved its greatest accuracy of 99.4% (100% sensitivity and 98.6% specificity (95% CI)) if all the measurements were positive/negative. Both real-time PCR and QF PCR were reliable methods for precisely assessing the fetal RHD allele from the plasma of RhD-negative pregnant women.
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RHD genotyping of serological weak D phenotypes in the Iranian blood donors and patients. Transfus Apher Sci 2020; 59:102870. [PMID: 32660892 DOI: 10.1016/j.transci.2020.102870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/13/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most prevalent weak D types in the Caucasians molecularly defined weak D types 1, 2 or 3 and can be managed safely as RhD-positive, conserving limited supplies of RhD-negative RBCs. Therefore, identification of RHD alleles prevalence in each population could improve the policies related to accuracy of RhD typing. The aim of this study was to determine the frequency of RHD variant alleles among donors and patients for the first time in Iran. MATERIALS AND METHODS RHD genotyping was performed on 100 blood donor and patient samples with weak D phenotype. PCR-SSP and DNA sequencing were used to identify the RHD alleles. RESULTS Molecular analysis showed only 15 samples were RHD*weak D 1(n = 13) and RHD*weak D 3(n = 2), and no cases of RHD*weak D 2 were detected. RHD*weak 15 (n = 43) was determined as the most prevalent D variants in our population and the other weak D types follows: RHD*weak 4, 5, 80 and one case of each one: RHD*weak 8, 11, 14, 100 and 105. Partial D variants also was identified in 18 samples as follows: RHD*partial DLO, DBT1, DV2, DHK and DAU-1. CONCLUSION The results of this study highlight the specific pattern of RHD status in the Iranian population. The weak D types 15 was the most common weak D type in the Iranian population. However, the screening for weak D types 1, 2 and 3 with 15 % frequency is also necessary for accurate RhD typing and developing clinical strategy of blood transfusion in weak D patients.
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33
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Flegel WA, Denomme GA, Queenan JT, Johnson ST, Keller MA, Westhoff CM, Katz LM, Delaney M, Vassallo RR, Simon CD, Sandler SG. It's time to phase out "serologic weak D phenotype" and resolve D types with RHD genotyping including weak D type 4. Transfusion 2020; 60:855-859. [PMID: 32163599 DOI: 10.1111/trf.15741] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 01/21/2020] [Accepted: 02/15/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Willy A Flegel
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | - John T Queenan
- Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Margaret A Keller
- National Molecular Laboratory, American Red Cross Biomedical Services, Philadelphia, Pennsylvania, USA
| | - Connie M Westhoff
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprises, New York, New York, USA
| | - Louis M Katz
- Mississippi Valley Regional Blood Center, Davenport, Iowa, USA
| | | | | | - Clayton D Simon
- Defense Health Agency, Armed Services Blood Program Office, Falls Church, Virginia, USA
| | - S Gerald Sandler
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
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34
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Londero D, Monge J, Hellberg A. A multi-centre study on the performance of the molecular genotyping platform ID RHD XT for resolving serological weak RhD phenotype in routine clinical practice. Vox Sang 2020; 115:241-248. [PMID: 31912520 DOI: 10.1111/vox.12886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/17/2019] [Accepted: 12/17/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES There is concern regarding the lack of prevention of unnecessary transfusion of RhD negative red cells and unnecessary administration of Rh immunoglobulin (RhIG) to pregnant women. In this study, performance of ID RHD XT, a genotyping assay for identification of six RHD allelic variants and human platelet antigens HPA-1a/1b was assessed. MATERIALS AND METHODS Whole blood samples presenting weak, discrepant or inconclusive D phenotype results were genotyped with ID RHD XT and compared to reference molecular tests. Candidacy for RhIG prophylaxis was determined by analysing samples from pregnant women. Hands-on time to complete the procedures was measured. RESULTS Overall, 167 samples were tested (55 donors, 56 patients, 52 pregnant women and four newborns). Agreement between ID RHD XT and the reference method was 100% (51% weak D type 1, 2 or 3; 35·5% weak D Types 1, 2 or 3 not detected; 4% RHD deletion; 1% RHD*Pseudogene; 1% RHD*DIIIa-CE(3-7)-D; and 4% no amplification variant detected for RHD genotype; and 64% HPA-1a/a; 30% HPA-1a/b; and 3% HPA-1b/b for HPA-1 genotype). Call rate was 98·2%. ID RHD XT identified 40% of the pregnant women that would not have required RhIG prophylaxis. Overall hands-on time was 25-45 min to process a batch of 24 samples, and four hours for total assay time. CONCLUSION ID RHD XT yielded reproducible results for RHD typing in serologically weak D phenotype individuals. ID RHD XT was proven useful for the correct management of patients with RhD serological discrepancies and the rational use of RhIG in pregnancy.
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Affiliation(s)
- Donatella Londero
- Immunohematology Laboratory, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Jorge Monge
- Immunohematology Laboratory, Basque Centre for Blood Transfusion & Human Tissues, Galdakao, Spain.,Cell Therapy, Stem Cells and Tissues Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Asa Hellberg
- Nordic Reference Laboratory for Genomic Blood Group Typing, Lund University Hospital, Lund, Sweden
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35
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Zhang X, Li G, Zhou Z, Shao C, Huang X, Li L, Li X, Liu Y, Fan H, Li J. Molecular and computational analysis of 45 samples with a serologic weak D phenotype detected among 132,479 blood donors in northeast China. J Transl Med 2019; 17:393. [PMID: 31775789 PMCID: PMC6880393 DOI: 10.1186/s12967-019-02134-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 11/09/2019] [Indexed: 02/07/2023] Open
Abstract
Background RH1 is one of the most clinically important blood group antigens in the field of transfusion and in the prevention of fetal incompatibility. The molecular analysis and characterization of serologic weak D phenotypes is essential to ensuring transfusion safety. Methods Blood samples from a northeastern Chinese population were randomly screened for a serologic weak D phenotype. The nucleotide sequences of all 10 exons, adjacent flanking intronic regions, and partial 5′ and 3′ untranslated regions (UTRs) were detected for RHD genes. Predicted deleterious structural changes in missense mutations of serologicl weak D phenotypes were analyzed using SIFT, PROVEAN and PolyPhen2 software. The protein structure of serologic weak D phenotypes was predicted using Swiss-PdbViewer 4.0.1. Results A serologic weak D phenotype was found in 45 individuals (0.03%) among 132,479 blood donors. Seventeen distinct RHD mutation alleles were detected, with 11 weak D, four partial D and two DEL alleles. Further analyses resulted in the identification of two novel alleles (RHD weak D 1102A and 399C). The prediction of a three-dimensional structure showed that the protein conformation was disrupted in 16 serologic weak D phenotypes. Conclusions Two novel and 15 rare RHD alleles were identified. Weak D type 15, DVI Type 3, and RHD1227A were the most prevalent D variant alleles in a northeastern Chinese population. Although the frequencies of the D variant alleles presented herein were low, their phenotypic and genotypic descriptions add to the repertoire of reported RHD alleles. Bioinformatics analysis on RhD protein can give us more interpretation of missense variants of RHD gene.
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Affiliation(s)
- Xu Zhang
- Institute of Transfusion Medicine, Liaoning Blood Center, Shenyang, Liaoning, China.,Key Laboratory of Blood Safety Research of Liaoning Province, Shenyang, Liaoning, China
| | - Guiji Li
- Department of Hematology, The Forth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhuren Zhou
- Institute of Transfusion Medicine, Liaoning Blood Center, Shenyang, Liaoning, China.,Key Laboratory of Blood Safety Research of Liaoning Province, Shenyang, Liaoning, China
| | - Chaopeng Shao
- Department of Transfusion, the Second People's Hospital of Shenzhen, Shenzhen, China
| | - Xuying Huang
- Institute of Transfusion Medicine, Liaoning Blood Center, Shenyang, Liaoning, China.,Key Laboratory of Blood Safety Research of Liaoning Province, Shenyang, Liaoning, China
| | - Lichun Li
- Institute of Transfusion Medicine, Liaoning Blood Center, Shenyang, Liaoning, China.,Key Laboratory of Blood Safety Research of Liaoning Province, Shenyang, Liaoning, China
| | - Xiaofeng Li
- Institute of Transfusion Medicine, Liaoning Blood Center, Shenyang, Liaoning, China.,Key Laboratory of Blood Safety Research of Liaoning Province, Shenyang, Liaoning, China
| | - Ying Liu
- Institute of Transfusion Medicine, Harbin Blood Center, Harbin, Heilongjiang, China
| | - Hua Fan
- Department of Hematology, The Forth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Jianping Li
- Institute of Transfusion Medicine, Liaoning Blood Center, Shenyang, Liaoning, China. .,Key Laboratory of Blood Safety Research of Liaoning Province, Shenyang, Liaoning, China. .,Institute of Transfusion Medicine, Harbin Blood Center, Harbin, Heilongjiang, China. .,Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China.
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36
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Trucco Boggione C, Nogués N, González-Santesteban C, Mufarrege N, Luján Brajovich M, Mattaloni SM, Leri M, Biondi C, Muñiz-Diaz E, Castilho L, Cotorruelo C. Characterization of RHD locus polymorphism in D negative and D variant donors from Northwestern Argentina. Transfusion 2019; 59:3236-3242. [PMID: 31503349 DOI: 10.1111/trf.15504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/25/2019] [Accepted: 07/04/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND A notable RHD variability has been observed in Central Argentina's current population attributed to the intermixing of different ethnic groups. The Northwestern region of the country is characterized by a markedly Amerindian genetic contribution. In this sense, the definition of the RHD polymorphism in individuals from this area was lacking. STUDY DESIGN AND METHODS A total of 757 donors from Northwestern Argentina, with D negative C and/or E positive (n = 526), and D variant (n = 231) phenotype defined by standard hemmaglutination tube techniques were genotyped using in-house PCR strategies, commercial SNP arrays and Sanger sequencing. RESULTS Among D negative C and/or E positive samples, RHD null (15.40%) and DEL alleles (3.23%) were identified. One unreported SNP c.1001T>A responsible for a null allele was found. RHD*01N.75 (4.18%) and RHD*DEL43 (2.66%) were the most prevalent variants following RHD*03N.01 (8.75%). The characterization of serologic weak D phenotypes showed that RHD*weak D type 1, 2, and 3 variants were found only in 37.24% of the samples, whereas RHD*weak D type 93 was the most prevalent allele (25.11%). Also, a previously unreported missense variation c.764G>A was identified. CONCLUSIONS A RHD genotyping strategy for patients and donors from Northwestern Argentina must consider the detection of the frequently found RHD*01N.75, RHD*DEL43, and RHD*weak D type 93 variants. Taking into account that RHD*DEL43 has scarcely been found in North Americans and Europeans whereas RHD*01N.75 and RHD*weak D type 93 have never been described in populations other than Argentineans, these RHD variants could be attributed to Native Amerindian genetic influence.
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Affiliation(s)
- Carolina Trucco Boggione
- Laboratorio de Inmunohematología e Inmunogenética, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, IDICER-CONICET, Rosario, Argentina
| | - Núria Nogués
- Laboratorio de Inmunohematología, Banc de Sang i Teixits BST, Barcelona, Spain
| | | | - Nicolás Mufarrege
- Laboratorio de Inmunohematología e Inmunogenética, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, IDICER-CONICET, Rosario, Argentina
| | - Melina Luján Brajovich
- Laboratorio de Inmunohematología e Inmunogenética, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, IDICER-CONICET, Rosario, Argentina
| | - Stella Maris Mattaloni
- Laboratorio de Inmunohematología e Inmunogenética, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, IDICER-CONICET, Rosario, Argentina
| | - Mónica Leri
- Banco Central de Sangre-SIPROSA, Tucumán, Argentina
| | - Claudia Biondi
- Laboratorio de Inmunohematología e Inmunogenética, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, IDICER-CONICET, Rosario, Argentina
| | - Eduardo Muñiz-Diaz
- Laboratorio de Inmunohematología, Banc de Sang i Teixits BST, Barcelona, Spain
| | | | - Carlos Cotorruelo
- Laboratorio de Inmunohematología e Inmunogenética, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, IDICER-CONICET, Rosario, Argentina
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Complete RHD next-generation sequencing: establishment of reference RHD alleles. Blood Adv 2019; 2:2713-2723. [PMID: 30337299 DOI: 10.1182/bloodadvances.2018017871] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 09/13/2018] [Indexed: 12/14/2022] Open
Abstract
The Rh blood group system (ISBT004) is the second most important blood group after ABO and is the most polymorphic one, with 55 antigens encoded by 2 genes, RHD and RHCE This research uses next-generation sequencing (NGS) to sequence the complete RHD gene by amplifying the whole gene using overlapping long-range polymerase chain reaction (LR-PCR) amplicons. The aim was to study different RHD alleles present in the population to establish reference RHD allele sequences by using the analysis of intronic single-nucleotide polymorphisms (SNPs) and their correlation to a specific Rh haplotype. Genomic DNA samples (n = 69) from blood donors of different serologically predicted genotypes including R1R1 (DCe/DCe), R2R2 (DcE/DcE), R1R2 (DCe/DcE), R2RZ (DcE/DCE), R1r (DCe/dce), R2r (DcE/dce), and R0r (Dce/dce) were sequenced and data were then mapped to the human genome reference sequence hg38. We focused on the analysis of hemizygous samples, as these by definition will only have a single copy of RHD For the 69 samples sequenced, different exonic SNPs were detected that correlate with known variants. Multiple intronic SNPs were found in all samples: 21 intronic SNPs were present in all samples indicating their specificity to the RHD*DAU0 (RHD*10.00) haplotype which the hg38 reference sequence encodes. Twenty-three intronic SNPs were found to be R2 haplotype specific, and 15 were linked to R1, R0, and RZ haplotypes. In conclusion, intronic SNPs may represent a novel diagnostic approach to investigate known and novel variants of the RHD and RHCE genes, while being a useful approach to establish reference RHD allele sequences.
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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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Perez‐Alvarez I, Hayes C, Hailemariam T, Shin E, Hutchinson T, Klapper E. RHDgenotyping of serologic RhD‐negative blood donors in a hospital‐based blood donor center. Transfusion 2019; 59:2422-2428. [DOI: 10.1111/trf.15325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 03/10/2019] [Accepted: 03/20/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ingrid Perez‐Alvarez
- Department of Pathology, Division of Transfusion MedicineUniversity of California Irvine Medical Center Irvine California
| | - Chelsea Hayes
- Department of Pathology, Division of Transfusion MedicineCedars‐Sinai Medical Center Los Angeles California
| | | | | | | | - Ellen Klapper
- Department of Pathology, Division of Transfusion MedicineCedars‐Sinai Medical Center Los Angeles California
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40
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Raba M. Selecting red blood cell units to perform RBCX in patients with sickle cell disease. Transfus Apher Sci 2019; 58:142-146. [PMID: 30910616 DOI: 10.1016/j.transci.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Red blood cell exchange (RBCX) is a standard option for treating or preventing complications in patients with sickle cell disease (SCD). According to the patient's blood volume, the amounts of red blood cells (RBC) to be exchanged and the practices of the apheresis and clinical teams, such treatment requires numerous red blood cell units (RBCUs) (3-15 RBCUs per procedure). To perform RBCXs safely and prevent the risk of alloimmunization, appropriate RBCUs must be selected and transfused to replace the sickled RBCs. Understanding of alloimmunization in patients with SCD strengthened the development of recommendations for preventing the risk of alloimmunization. This review describes the alloimmunization risk, the methods used to decrease the risk, and our own experience.
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Affiliation(s)
- M Raba
- Delivery and Immunohematology Unit, Etablissement Français du Sang, Centre Hospitalier Lyon Sud, Lyon, France.
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41
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Raud L, Ka C, Gourlaouen I, Callebaut I, Férec C, Le Gac G, Fichou Y. Functional analysis of novelRHDvariants: splicing disruption is likely to be a common mechanism of variant D phenotype. Transfusion 2019; 59:1367-1375. [DOI: 10.1111/trf.15210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/22/2018] [Accepted: 12/06/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Loann Raud
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies"; INSERM, EFS, Université de Brest, IBSAM, CHU de Brest; Brest France
- Laboratory of Excellence GR-Ex; Paris France
| | - Chandran Ka
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies"; INSERM, EFS, Université de Brest, IBSAM, CHU de Brest; Brest France
- Laboratory of Excellence GR-Ex; Paris France
| | - Isabelle Gourlaouen
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies"; INSERM, EFS, Université de Brest, IBSAM, CHU de Brest; Brest France
- Laboratory of Excellence GR-Ex; Paris France
| | - Isabelle Callebaut
- IMPMC, Sorbonne Universités - UMR CNRS 7590, UPMC Univ Paris 06, Muséum d'Histoire Naturelle, IRD UMR 206; Paris France
| | - Claude Férec
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies"; INSERM, EFS, Université de Brest, IBSAM, CHU de Brest; Brest France
- Laboratory of Excellence GR-Ex; Paris France
| | - Gérald Le Gac
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies"; INSERM, EFS, Université de Brest, IBSAM, CHU de Brest; Brest France
- Laboratory of Excellence GR-Ex; Paris France
| | - Yann Fichou
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies"; INSERM, EFS, Université de Brest, IBSAM, CHU de Brest; Brest France
- Laboratory of Excellence GR-Ex; Paris France
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42
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Takeuchi-Baba C, Ito S, Kinjo R, Miyagi H, Yasuda H, Ogasawara K, Ohto H. Production of RBC autoantibody mimicking anti-D specificity following transfusion in a patient with weak D Type 15. Transfusion 2019; 59:1190-1195. [DOI: 10.1111/trf.15207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/19/2018] [Accepted: 12/03/2018] [Indexed: 12/24/2022]
Affiliation(s)
| | - Shoichi Ito
- Japanese Red Cross Tohoku Block Center; Sendai Japan
| | - Rie Kinjo
- Department of Clinical Laboratory; Tomishiro Central Hospital; Okinawa Japan
| | - Hitomi Miyagi
- Department of Clinical Laboratory; Tomishiro Central Hospital; Okinawa Japan
| | - Hiroyasu Yasuda
- Division of Medical Technology; Fukushima Prefectural Hygiene Institute; Fukushima Japan
| | | | - Hitoshi Ohto
- Department of Advanced Cancer Immunotherapy; Fukushima Medical University; Fukushima Japan
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43
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Wen J, Verhagen OJ, Jia S, Liang Q, Wang Z, Wei L, Luo H, Luo G, Vidarsson G, Akker E, Ji Y, Schoot CE. A variant RhAG protein encoded by theRHAG*572Aallele causes serological weak D expression while maintaining normal RhCE phenotypes. Transfusion 2018; 59:405-411. [DOI: 10.1111/trf.14969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 08/01/2018] [Accepted: 08/17/2018] [Indexed: 01/30/2023]
Affiliation(s)
- Jizhi Wen
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center Guangzhou People's Republic of China
| | - Onno J.H.M. Verhagen
- Sanquin Research and Landsteiner Laboratory, Academic Medical CentreUniversity of Amsterdam Amsterdam The Netherlands
| | - Shuangshuang Jia
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center Guangzhou People's Republic of China
| | - Qianni Liang
- Department of Blood TransfusionGuangdong No. 2 Provincial People's Hospital Guangzhou People's Republic of China
| | - Zhen Wang
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center Guangzhou People's Republic of China
| | - Ling Wei
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center Guangzhou People's Republic of China
| | - Hong Luo
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center Guangzhou People's Republic of China
| | - Guangping Luo
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center Guangzhou People's Republic of China
| | - Gestur Vidarsson
- Sanquin Research and Landsteiner Laboratory, Academic Medical CentreUniversity of Amsterdam Amsterdam The Netherlands
| | - Emile Akker
- Sanquin Research and Landsteiner Laboratory, Academic Medical CentreUniversity of Amsterdam Amsterdam The Netherlands
| | - Yanli Ji
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center Guangzhou People's Republic of China
| | - C. Ellen Schoot
- Sanquin Research and Landsteiner Laboratory, Academic Medical CentreUniversity of Amsterdam Amsterdam The Netherlands
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Molano A, Apraiz I, España P, Azkarate M, Vesga MÁ, Rubia M, Piedrabuena M, Puente F, Veldhuisen B, Schoot E, Tejedor D, López M. Performance evaluation study of ID RHD XT, a new genotyping assay for the detection of high‐prevalence RhD negative and weak D types. Vox Sang 2018; 113:694-700. [DOI: 10.1111/vox.12701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/27/2018] [Accepted: 07/16/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Araitz Molano
- R&D Area Progenika Biopharma A Grifols Company Derio Spain
| | - Izaskun Apraiz
- R&D Area Progenika Biopharma A Grifols Company Derio Spain
| | | | - Maria Azkarate
- Centro Vasco de Transfusiones y Tejidos Humanos Galdakao Spain
| | | | | | | | | | | | - Ellen Schoot
- Sanquin Blood Supply Research Amsterdam the Netherlands
| | - Diego Tejedor
- R&D Area Progenika Biopharma A Grifols Company Derio Spain
| | - Mónica López
- R&D Area Progenika Biopharma A Grifols Company Derio Spain
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45
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Webb J, Delaney M. Red Blood Cell Alloimmunization in the Pregnant Patient. Transfus Med Rev 2018; 32:213-219. [PMID: 30097223 DOI: 10.1016/j.tmrv.2018.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/22/2018] [Accepted: 07/05/2018] [Indexed: 12/13/2022]
Abstract
Alloimmunization to red blood cell (RBC) antigens represents a challenge for physicians caring for women of child bearing potential. Exposure to non-self RBC antigens may occur during transfusion or pregnancy leading to the development of antibodies. If a subsequent fetus bears that antigen, maternal antibodies may attack the fetal red blood cells causing red cell destruction and clinically significant hemolytic disease of the fetus and newborn (HDFN). In the most severe cases, HDFN may result in intrauterine fetal demise due to high output cardiac failure, effusions and ascites, known as "hydrops fetalis". This article reviews strategies for management and prevention of RBC alloimmunization in women of child bearing potential.
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Affiliation(s)
- Jennifer Webb
- Children's National Health System, Washington, D.C., USA; The George Washington University, Departments of Pediatrics & Pathology, Washington, DC, USA.
| | - Meghan Delaney
- Children's National Health System, Washington, D.C., USA; The George Washington University, Departments of Pediatrics & Pathology, Washington, DC, USA
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46
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Dezan MR, Oliveira VB, Gomes ÇN, Luz F, Gallucci AJ, Bonifácio SL, Alencar CS, Sabino EC, Pereira AC, Krieger JE, Rocha V, Mendrone-Junior A, Dinardo CL. High frequency of variant RHD genotypes among donors and patients of mixed origin with serologic weak-D phenotype. J Clin Lab Anal 2018; 32:e22596. [PMID: 29943480 DOI: 10.1002/jcla.22596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/31/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The current transfusion policy recommended for individuals with serologic weak-D phenotype is based on data derived from European-descent populations. Data referring to the distribution of RH alleles underlying weak-D phenotype among people of mixed origin are yet incomplete, and the applicability of European-based transfusion guidelines to this specific population is questionable. GOAL To evaluate the distribution of RHD variant genotype among individuals with serologic weak-D phenotype of both African and European descent. METHODS Donors and patients of mixed origin and with serologic weak-D phenotype were selected for the study. They were investigated using conventional RHD-PCR assays and RHD whole-coding region direct sequencing. RESULTS One hundred and six donors and 58 patients were included. There were 47 donors and 29 patients with partial-D genotype (47/106, 44.3%, and 29/58, 50%, respectively). RHD*DAR and RHD*weak D type 38 represented the most common altered RHD alleles among donors (joint frequency of 39.6%), while weak D types 1-3 accounted for 10.4% of the total D variant samples. RHD*DAR was the most common allele identified in the patient group (frequency of 31%), and weak D types 1-3 represented 29.3% of the total. CONCLUSION The frequency of partial D among mixed individuals with serologic weak-D phenotype is high. They should be managed as D-negative patients until molecular tests are complete.
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Affiliation(s)
- Marcia Regina Dezan
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil
| | - Valéria B Oliveira
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil
| | - Çarolina Nunes Gomes
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil
| | - Fabio Luz
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil
| | - Antônio J Gallucci
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil
| | - Silvia L Bonifácio
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil
| | - Cecília Salete Alencar
- Laboratório de Medicina Laboratorial, Divisão de Laboratório Central Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ester C Sabino
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), São Paulo, Brazil
| | - Jose E Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), São Paulo, Brazil
| | - Vanderson Rocha
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil.,Discipline of Hematology, University of São Paulo School of Medicine, São Paulo, Brazil.,Churchill Hospital, NHSBT, Oxford University, Oxford, UK
| | | | - Carla L Dinardo
- Immunohematology, Fundação Pró-Sangue Hemocentro de São PauloSão Paulo, São Paulo, Brazil.,Laboratório de Medicina Laboratorial, Divisão de Laboratório Central Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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47
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Srivastava K, Stiles DA, Wagner FF, Flegel WA. Two large deletions extending beyond either end of the RHD gene and their red cell phenotypes. J Hum Genet 2018; 63:27-35. [PMID: 29215093 PMCID: PMC5764804 DOI: 10.1038/s10038-017-0345-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 01/22/2023]
Abstract
Only two partial deletions longer than 655 nucleotides had been reported for the RHD gene, constrained within the gene and causing DEL phenotypes. Using a combination of quantitative PCR and long-range PCR, we examined three distinct deletions affecting parts of the RHD gene in three blood donors. Their RHD nucleotide sequences and exact boundaries of the breakpoint regions were determined. DEL phenotypes were caused by a novel 18.4 kb deletion and a previously published 5.4 kb deletion of the RHD gene; a D-negative phenotype was caused by a novel 7.6 kb deletion. Examination of the deletion-flanking regions suggested microhomology-mediated end-joining, replication slippage, and non-homologous end-joining, respectively, as the most likely mechanisms for the three distinct deletions. We described two new deletions affecting parts of the RHD gene, much longer than any previously reported partial deletion: one was the first deletion observed at the 5' end of the RHD gene extending into the intergenic region, and the other the second deletion observed at its 3' end. Large deletions present at either end are a mechanism for a much reduced RhD protein expression or its complete loss. Exact molecular characterization of such deletions is instrumental for accurate RHD genotyping.
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Affiliation(s)
- Kshitij Srivastava
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, MSC 1184, 10 Center Drive, Bethesda, 20892, MD, USA
| | - David Alan Stiles
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, MSC 1184, 10 Center Drive, Bethesda, 20892, MD, USA
| | - Franz Friedrich Wagner
- Red Cross Blood Service NSTOB, Institute Springe, Eldagsener Strasse 38, 31830, Springe, Germany
| | - Willy Albert Flegel
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, MSC 1184, 10 Center Drive, Bethesda, 20892, MD, USA.
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48
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Lopez GH, Turner RM, McGowan EC, Schoeman EM, Scott SA, O'Brien H, Millard GM, Roulis EV, Allen AJ, Liew YW, Flower RL, Hyland CA. A DEL phenotype attributed to RHD Exon 9 sequence deletion: slipped-strand mispairing and blood group polymorphisms. Transfusion 2017; 58:685-691. [PMID: 29214630 DOI: 10.1111/trf.14439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The RhD blood group antigen is extremely polymorphic and the DEL phenotype represents one such class of polymorphisms. The DEL phenotype prevalent in East Asian populations arises from a synonymous substitution defined as RHD*1227A. However, initially, based on genomic and cDNA studies, the genetic basis for a DEL phenotype in Taiwan was attributed to a deletion of RHD Exon 9 that was never verified at the genomic level by any other independent group. Here we investigate the genetic basis for a Caucasian donor with a DEL partial D phenotype and compare the genomic findings to those initial molecular studies. STUDY DESIGN AND METHODS The 3'-region of the RHD gene was amplified by long-range polymerase chain reaction (PCR) for massively parallel sequencing. Primers were designed to encompass a deletion, flanking Exon 9, by standard PCR for Sanger sequencing. Targeted sequencing of exons and flanking introns was also performed. RESULTS Genomic DNA exhibited a 1012-bp deletion spanning from Intron 8, across Exon 9 into Intron 9. The deletion breakpoints occurred between two 25-bp repeat motifs flanking Exon 9 such that one repeat sequence remained. CONCLUSION Deletion mutations bordered by repeat sequences are a hallmark of slipped-strand mispairing (SSM) event. We propose this genetic mechanism generated the germline deletion in the Caucasian donor. Extensive studies show that the RHD*1227A is the most prevalent DEL allele in East Asian populations and may have confounded the initial molecular studies. Review of the literature revealed that the SSM model explains some of the extreme polymorphisms observed in the clinically significant RhD blood group antigen.
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Affiliation(s)
- Genghis H Lopez
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Robyn M Turner
- Red Cell Reference Laboratory, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Eunike C McGowan
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Elizna M Schoeman
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Stacy A Scott
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Helen O'Brien
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Glenda M Millard
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Eileen V Roulis
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Amanda J Allen
- Medical Services, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Yew-Wah Liew
- Red Cell Reference Laboratory, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Robert L Flower
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Catherine A Hyland
- Research and Development, Clinical Services and Research Division, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
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Ouchari M, Srivastava K, Romdhane H, Jemni Yacoub S, Flegel WA. Transfusion strategy for weak D Type 4.0 based on RHD alleles and RH haplotypes in Tunisia. Transfusion 2017; 58:306-312. [PMID: 29193104 DOI: 10.1111/trf.14411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND With more than 460 RHD alleles, this gene is the most complex and polymorphic among all blood group systems. The Tunisian population has the largest known prevalence of weak D Type 4.0 alleles, occurring in one of 105 RH haplotypes. We aimed to establish a rationale for the transfusion strategy of weak D Type 4.0 in Tunisia. STUDY DESIGN AND METHODS Donors were randomly screened for the serologic weak D phenotype. The RHD coding sequence and parts of the introns were sequenced. To establish the RH haplotype, the RHCE gene was tested for characteristic single-nucleotide positions. RESULTS We determined all RHD alleles and the RH haplotypes coding for the serologic weak D phenotype among 13,431 Tunisian donations. A serologic weak D phenotype was found in 67 individuals (0.50%). Among them, 60 carried a weak D Type 4 allele: 53 weak D Type 4.0, six weak D Type 4.2.2 (DAR), and one weak D Type 4.1. An additional four donors had one variant allele each: DVII, weak D Type 1, weak D Type 3, and weak D type 100, while three donors showed a normal RHD sequence. The weak D Type 4.0 was most often linked to RHCE*ceVS.04.01, weak D Type 4.2.2 to RHCE*ceAR, and weak D Type 4.1 to RHCE*ceVS.02, while the other RHD alleles were linked to one of the common RHCE alleles. CONCLUSIONS Among the weak D phenotypes in Tunisia, no novel RHD allele was found and almost 90% were caused by alleles of the weak D Type 4 cluster, of which 88% represented the weak D Type 4.0 allele. Based on established RH haplotypes for variant RHD and RHCE alleles and the lack of adverse clinical reports, we recommend D+ transfusions for patients with weak D Type 4.0 in Tunisia.
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Affiliation(s)
- Mouna Ouchari
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | | | | | - Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
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50
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Raud L, Le Maréchal C, Férec C, Fichou Y. WeakDtype 1, 2 and 3 subtype alleles are rare in the Western French population. Transfus Med 2017; 29:209-210. [DOI: 10.1111/tme.12485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/15/2017] [Accepted: 10/17/2017] [Indexed: 12/19/2022]
Affiliation(s)
- L. Raud
- Faculté de Médecine et des Sciences de la Santé; Université de Bretagne Occidentale (UBO); Brest France
- Institut National de la Santé et de la Recherche Médicale (Inserm); Brest France
| | - C. Le Maréchal
- Faculté de Médecine et des Sciences de la Santé; Université de Bretagne Occidentale (UBO); Brest France
- Institut National de la Santé et de la Recherche Médicale (Inserm); Brest France
- Laboratoire de Génétique Moléculaire et d'Histocompatibilité; Centre Hospitalier Régional Universitaire (CHRU); Brest France
- Etablissement Français du Sang (EFS) - Bretagne; Brest France
| | - C. Férec
- Faculté de Médecine et des Sciences de la Santé; Université de Bretagne Occidentale (UBO); Brest France
- Institut National de la Santé et de la Recherche Médicale (Inserm); Brest France
- Laboratoire de Génétique Moléculaire et d'Histocompatibilité; Centre Hospitalier Régional Universitaire (CHRU); Brest France
- Etablissement Français du Sang (EFS) - Bretagne; Brest France
| | - Y. Fichou
- Institut National de la Santé et de la Recherche Médicale (Inserm); Brest France
- Etablissement Français du Sang (EFS) - Bretagne; Brest France
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