Blood group phenotype frequencies in blood donors from a tertiary care hospital in north India

Harnessing the potential of blood donors negative for high prevalence Rh antigens: A Database Initiative for Thalassaemia Care

BACKGROUND AND OBJECTIVES

With increasing life expectancy and prevalence of thalassaemia, it has led to a greater need for safe blood, yet the current supply from voluntary donors is insufficient to meet this demand. Thalassaemia recipients face a significant risk of alloimmunization because of repeated exposure to foreign red cell antigens. Study aims to determine high prevalent Rh antigen negative donors in western India donor population along with what percentage of these donors are willing to become dedicated voluntary donors for thalassaemia patients. Study also aims to examine factors influencing their willingness and challenges faced in mobilizing dedicated donors.

METHOD

700 whole blood donors from western India, following screening for inclusion & exclusion criteria as per Drugs and Cosmetic Act (DCA) 2020 amendment guidelines & were sero-negative for transfusion transmitted infections were enrolled for the study. Red cell phenotyping was performed using Conventional Tube Technique (CTT) for "D", "C", "E", "c", "e" and "K" antigen using known antisera. Donors that were "C" AND/OR "e" antigen negative were contacted telephonically and were counseled and motivated for becoming voluntary blood donors. Statistical analysis assessed correlation between donation frequency, donor's occupation and education.

RESULT

Among 700 donors, 96.6% (n=676) were males and 3.4% (n=24) were females. The most predominant blood group was B > O > A > AB. Rh(D) antigen was present in 91.44% (n = 640) and absent in 8.6% (n=60). Prevalence of other Rh antigens is as follows: "e" (99%) > "C" (85.4%) > "c" (59.1%) > "E" (18.0%). Only 1.15% had "K" antigen positive. The commonest Rh phenotype R1R1 (DCe/DCe) was expressed by 40.57% (n=283), and the least common r"r (cE/ce), r''r''(cE/cE) and r'r' (Ce/Ce) was found in 0.14% (n=1), respectively. 'C' negative, 'e' negative, 'C' and 'e' antigen negative donors constituted 14.8% (n = 104) with 93.2% (n=97) C-antigen negative, 1.92% (n=2) e-antigen negative and 4.8% (n=5) both "C" and "e" antigen negative donors. The commonest phenotypes among C-antigen and e-antigen negative donors were rr (50%) and RzR2 (1.94%) respectively. Likewise, the most common phenotype amongst both C- and e-antigens negative donors was R2R2 (3.84%). 61.5% of the donors agreed to enroll for voluntary blood donation following telephonic invitation, while 6.8% of them refused permanently. Approximately, 3.9% of the blood donors were willing to donate blood only when needed and 27.8% of them could not be contacted.

CONCLUSION

Creating a database of voluntary donors with known phenotype, especially who lack very common antigens like "C" and "e" and are willing to become dedicated, regular voluntary donors for thalassemic patients can ensure timely administration of safe blood. One of the major challenges for this noble initiative was lack of awareness which can be circumvent effectively with proper counseling efforts.

Prevalence of blood group antigens among regular blood donors: A single center study from South India with a review of national literature

BACKGROUND AND OBJECTIVES

The antigen frequencies vary across different regions and ethnic groups. Hence, we aimed to study the prevalence of blood group antigens in our population and to systemize the zone-wise prevalence of the same across India.

MATERIALS AND METHODS

Regular voluntary O group blood donors were screened for 21 blood group antigens; C, c, E, e, K, k, Kpa, Kpb, Jka, Jkb, Fya, Fyb, Lea, Leb, Lua, Lub, P1, M, N, S, s, using commercially available monoclonal antisera by column agglutination technology. A literature search was performed to identify all the studies that reported blood group antigens prevalence to estimate the zone-wise prevalence of these antigens in the country.

RESULTS

A total of 521 participants of 9248 O group donors meeting all the inclusion criteria were included. Among the study group, the male-to-female ratio was 9:1 with a mean age of 32.6 years (±10.01) ranging from 18-60 years. The majority of the donors 446 (85.6%) were D positive. The most common phenotypes among Rh, Lewis, Kell, Duffy, Kidd, Lutheran and MNSs were CcDee (34.93%), Le(a-b+) (61.80%), K-k+(98.27%), Fy(a+b-) 43.19%, Jk(a+b+) 42.61%, Lu(a-b+) ( 99.61%), M+N+ (48.17%), S-s+ (45.29%) respectively. The prevalence of D and E antigens was significantly lower in the South zone compared to other zones of India.

CONCLUSION

Significant difference in the prevalence of blood group antigens is observed between the South and other zones of India. Zone-wise prevalence of blood group phenotypes is essential in the timely management of alloimmunized patients.

Assessment of Minor Blood Group System Antigens and Their Phenotype among Voluntary Blood Donors in Ethiopian Blood and Tissue Bank Service, Addis Ababa, Ethiopia

Background

Red blood cell antigens are numerous in structural and functional diversity; some are proteins while others are carbohydrates. The international society of blood transfusion currently recognized 43 blood group systems containing 349 red cell antigens. It also acknowledged 9 blood group systems (ABO, Rhesus, Kell, Duffy, Kidd, MNS, P, Lewis, and Lutheran) that are clinically significant and associated with hemolytic transfusion reactions as well as hemolytic disease of fetuses and newborns. The objective of this study was to assess the distribution of minor blood group antigens and their phenotype among voluntary blood donors in Ethiopian blood and tissue bank service in Addis Ababa.

Method

A cross-sectional study was conducted from January to March 2022 among 260 volunteer blood donors to determine minor blood group antigens and their phenotype at EBTBS, Addis Ababa, Ethiopia. Tests were performed using Galileo Neo Immucor, which is fully automated Immunohematology analyzer.

Result

A total of 260 blood donors were screened of which 153 (59%) were males. The antigen frequencies of minor blood group systems were: Fy(a), Fy(b), Jk(a), Jk(b), k, S, s were 33.5%, 43.5%, 97.7%), 40.4%), 100%, 45%, 90%, respectively. Regarding phenotype distribution, the most common phenotypes were: Duffy Fy (a-b+) 36.9%, MNS S-s+ 55% and Kidd Jk (a+b-) 59.6%.

Conclusion

This study highlights the frequencies of Fy(a), Fy(b), Jk(a), Jk(b), k, S and s blood group antigens and their phenotypes in volunteer blood donors at EBTBS, Addis Ababa. For the management of alloimmunization cases in transfused patients, knowledge of these minor blood group antigens is relevant.

Phenotyping of clinically significant blood group antigens among the South Indian donor population

INTRODUCTION

Data on the prevalence of clinically significant antigens (Rh, Kell, Kidd, Duffy, MNSs, Lewis, P and Lutheran) among the Indian donor population is sparse.

OBJECTIVE

This prospective study was aimed at determining the prevalence of 21 clinically significant antigens for the first time in the South Indian donor population.

METHOD

A total of 672 regular O group blood donors were enrolled for Rh (C,c, E, e) and Kell (K) antigens typing. Of these, 188 donors were typed for other clinically significant antigens (k, Kpa, Kpb, Jka, Jkb, Fya, Fyb, M, N, S, s, P1, Lea, Leb, Lua and Lub).

RESULTS

Antigen frequencies were expressed in percentages. In our study, R1R1 and rr were the most common phenotypes among D+ and D- donors, respectively. Among the Rh antigens, the e antigen was expressed by 97.5% and 100% of D+ and D- donors, respectively. The K antigen was found in only 0.15% of donors. In the Duffy and Kidd blood group system, Fy (a+b+) and Jk (a+b+) were the most frequent phenotypes, respectively. In the MNSs blood group system, M+N+ and S-s+ were the most common phenotypes reported. The Le (a-b+) was found to be the phenotype with the highest prevalence in the Lewis blood group system. The Lu (a-b+) was the only phenotype found in the Lutheran blood group system.

CONCLUSION

Knowledge regarding the prevalence of antigens in a given population is essential in developing cost-effective in-house panels and a rare donor registry comprising donors typed negative for a high-frequency antigen or a combination of common multiple antigens.

An assessment of clinical and laboratory impact in a resource constraint setting: Does Rh and Kell phenotyping of donor units complement type and screen method of compatibility testing?

BACKGROUND AND AIM

Despite knowing benefits of extended phenotyping, a vast majority feel that phenotype matched units add to the cost of blood banking. The purpose of this study was to discuss advantages and disadvantages of performing Rh Kell phenotyping in Indian scenario.

MATERIALS AND METHODS

This was a prospective, observational study conducted at a tertiary healthcare center between July 2014 and February 2020. All consecutive whole blood donors and all consecutive patients whose samples were sent for Rh-Kell phenotyping were included for calculating antigen, phenotype and gene frequencies. For rate of alloimmunization in patients transfused with phenotype matched units, all patients who were given Rh-Kell phenotype matched transfusions were included in the prophylactic antigen matched (PAM) category and those who were given random units were included in the non-PAM category.

RESULTS

A total of 37,588 donors and 258 patients were included in the study for calculation of antigen, phenotype and gene frequencies. Percentage similarity of phenotypes between patient and donor populations was 33.8%. For rate of alloimmunization, results of a total of 31,991 patient samples revealed 0.94% prevalence of unexpected antibodies; highest against the Rh system. Three patients in the non-PAM category and one in the PAM category were alloimmunized during follow-up. Significant clinical and laboratory impact of phenotyping was observed in terms of reduced turnaround time and consumption of resources.

CONCLUSION

Rh-Kell phenotyping of donors can prevent alloimmunization, reduce cost burden on the patient and the laboratory and help the laboratory personnel in smooth routine testing.

Anti-D Alloimmunization After RhD Positive Red Cell Transfusion to Selected RhD Negative Patients

Transfusion of RhD positive red cells to RhD negative individuals is not routine transfusion practice for the fear of alloimmunization. Aim of this study was to prospectively evaluate rate of alloimmunization after transfusion of RhD positive red cells in RhD negative individuals and to assess delay in transfusion due to decision making. This was a prospective, observational study conducted from 2014 to 2018. All patients were followed up for a period of three months, at 3, 14, 45 and 90 days with antibody screening. In addition, patients who were immunosuppressed and alloimmunized were followed up at 6 months and one year. During the period of the study, there were a total of 57 RhD negative patients (52 males and five females) who received a mean of 4.42 ± 2.85 transfusions. Alloimmunization was detected in 8 (14.03%) patients at a mean interval of 25.63 ± 16.04 days. Anti-D was detected in seven and one patient developed anti-E alloantibody. Mean number of red cell units transfused in alloimmunized was 1.7 ± 0.26 while it was 5.4 ± 1.82 in non-alloimmunized group. There was no delay in providing units to these patients. The TAT was found to be 68 min. Rate of alloimmunization after transfusion of RhD positive red cells to RhD negative individuals was found to be 12.3%. In life saving conditions, RhD negative patients can be transfused RhD positive red cells without delay in decision making.

Red blood cell alloimmunization among recipients of blood transfusion in India: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

There is a varied prevalence of red cell alloimmunization being reported from different parts of India. This study aimed to estimate the overall prevalence of alloimmunization in India by performing a systematic review of the literature and to establish the most suitable antigen-matching strategy to reduce the red blood cell (RBC) alloimmunization rate among transfusion recipients.

MATERIALS AND METHODS

A systematic search of all the original articles published in English on RBC alloimmunization among transfusion recipients from India in MEDLINE, SCOPUS, CINAHL and Google Scholar bibliographic databases was conducted. After screening the articles as per inclusion/exclusion criteria, data extraction was done independently by two sets of investigators. Meta-analysis was performed by the binary random-effects model using the restricted maximum likelihood method.

RESULTS

A total of 44 studies on RBC alloimmunization, with a cumulative sample size of 309,986 patients, were grouped into hospital-based and multiply-transfused patients, which yielded a prevalence of 0.5 (95% confidence interval; 0.3-0.8) and 4.8 (95% confidence interval; 3.9-5.7) per 100 patients, respectively. As many as 1992 alloantibodies were identified among the 1846 alloimmunized patients. The most common antibody identified was anti-E (127; 31.99%), followed by anti-c (75; 18.89%) in multiply-transfused patients.

CONCLUSION

The rate of alloimmunization was 0.5 per 100 patients tested for antibodies and 4.8 per 100 patients receiving transfusion. Considering E- and c-antigen-matched red cells along with ABO and RhD matching may significantly reduce the overall occurrence of alloimmunization among Indian population who are transfusion-dependent.

Prevalence of major blood group antigens in blood donors at a main donation center in United Arab Emirates

Blood transfusion is a common practice in hospitals. In many diseases, transfusion of red blood cells can be a life-saving measure. Knowing the blood group phenotypes of the donors in any population is important to improve health care services and to better serve patients. We aimed to determine the blood group phenotypes of the regular donors visiting the main blood donation center in Sharjah, United Arab Emirates (UAE). A total of 500 regular blood donors were included, and blood group antigens were tested using serologic methods. Major blood group systems included in this testing were ABO, Rh, Kell, Kidd, Duffy, Lewis, Lutheran, MNS, and P1PK. The most prevalent ABO/D blood type was group O, D+ (29.6%), with the most prevalent phenotype in the Rh blood group system reported as R₁r (34.4%). In the Kell system, the K-k+ phenotype was reported in 92.4 percent of individuals tested. The rare Duffy null phenotype, Fy(a-b-), was reported in 11.0 percent of the cohort. Most donors (99.0%) were Lu(b+). In the Lewis system, the phenotype Le(a-b+) was seen in 61.8 percent of the donors. MNS system phenotypes were comparable to the reports from Saudi Arabia and India, with M+N+S-s+ being the most prevalent (21.2%). The prevalence of many major blood group phenotypes in the UAE blood donor population showed similarities to results from populations in neighboring countries, but other phenotype prevalences were unique to this population. This finding can be used to build a blood group registry for the local population that can better serve hospitals' transfusion requirements.

Blood transfusion is a common practice in hospitals. In many diseases, transfusion of red blood cells can be a life-saving measure. Knowing the blood group phenotypes of the donors in any population is important to improve health care services and to better serve patients. We aimed to determine the blood group phenotypes of the regular donors visiting the main blood donation center in Sharjah, United Arab Emirates (UAE). A total of 500 regular blood donors were included, and blood group antigens were tested using serologic methods. Major blood group systems included in this testing were ABO, Rh, Kell, Kidd, Duffy, Lewis, Lutheran, MNS, and P1PK. The most prevalent ABO/D blood type was group O, D+ (29.6%), with the most prevalent phenotype in the Rh blood group system reported as R₁r (34.4%). In the Kell system, the K–k+ phenotype was reported in 92.4 percent of individuals tested. The rare Duffy null phenotype, Fy(a–b–), was reported in 11.0 percent of the cohort. Most donors (99.0%) were Lu(b+). In the Lewis system, the phenotype Le(a–b+) was seen in 61.8 percent of the donors. MNS system phenotypes were comparable to the reports from Saudi Arabia and India, with M+N+S–s+ being the most prevalent (21.2%). The prevalence of many major blood group phenotypes in the UAE blood donor population showed similarities to results from populations in neighboring countries, but other phenotype prevalences were unique to this population. This finding can be used to build a blood group registry for the local population that can better serve hospitals’ transfusion requirements.

The association of ABO blood group with the asymptomatic COVID-19 cases in India

The COVID-19 pandemic resulted in multiple waves of infection worldwide. The large variations in case fatality rate among different geographical regions suggest that the human susceptibility against this virus varies substantially. Several studies from different parts of the world showed a significant association of ABO blood group and COVID-19 susceptibility. It was demonstrated that individuals with blood group O are at the lower risk of coronavirus infection. To establish the association of ABO blood group in SARS-CoV-2 susceptibility, we for the first time analysed SARS-CoV-2 neutralising antibodies among 509 individuals, collected from three major districts of Eastern Uttar Pradesh region of India. Interestingly, we found neutralising antibodies in a significantly higher percentage of people with blood group AB (0.36) followed by B (0.31), A (0.22) and lowest in people with blood group O (0.11). We further estimated that people with blood group AB are at comparatively higher risk of infection than other blood groups. Thus, among the asymptomatic SARS-CoV-2 recovered people blood group AB has highest, whilst individuals with blood group O has lowest risk of infection.

Association of ABO and Rh Blood Group in Susceptibility, Severity, and Mortality of Coronavirus Disease 2019: A Hospital-Based Study From Delhi, India

Background

ABO and Rh blood group systems are associated with many diseases including cancerous, infectious, non-infectious, bacterial and viral diseases. Studies have shown association of blood groups A and O with higher and lower odds for coronavirus disease 2019 positivity, respectively.

Methods

This is a single-center, retrospective study conducted at Sir Ganga Ram Hospital, Delhi. We investigated the association of ABO and Rh blood groups with susceptibility to coronavirus disease 2019 infection, severity of disease, recovery period, and mortality of patients. Patients were enrolled from April 8, 2020 to October 4, 2020. A total of 2,586 real-time PCR (RT-PCR)-confirmed coronavirus disease 2019 (COVID-19) patients were recruited. Data was analyzed using chi-square test, odds ratio, and Mann–Whitney test to determine the association of blood groups.

Results

In the 2,586 COVID-19-infected patients, the frequencies of A, B, O, and AB were 29.93%, 41.80%, 21.19%, and 7.98%, respectively. Of the patients, 98.07% were Rh positive. Blood group A (odds ratio, 1.53; CI, 1.40–1.66; p < 0.001) and B (odds ratio, 1.15; CI, 1.06–1.24; p < 0.001) is observed to be significantly associated with COVID-19 susceptibility, whereas blood group O (odds ratio, 0.65; CI, 0.59–0.71; p < 0.001) and AB (odds ratio, 0.66; CI, 0.59–0.71; p < 0.001) have low risk of COVID-19 infection.

Conclusion

A, B, and Rh+ are found to be more susceptible to COVID-19 infection, whereas blood groups O, AB, and Rh− are at a lower risk of COVID-19 infection. No association was found between blood groups and susceptibility to severity of disease and mortality.

Major and minor blood group phenotyping and database generation for recruits : A pilot study

Background

Alloimmunization to minor blood group antigens is a problem that has for long befuddled the blood bankers, requiring blood group phenotyping of target populations worldwide. However, the same exercise had been lacking in our Armed Forces population necessitating this pilot study.

Methods

A total of 2000 recruits of a regimental center in northern India were phenotyped for major and minor blood group antigens including ABO, Rhesus (D, C, c, E, and e antigens), Kell (K), MNSs (S and s antigens), Kidd (Jka and Jkb), and Duffy (Fya and Fyb) using commercially prepared polyclonal antisera on a fully automated system based on electromagnetic technology. Typing for M and N antigens (MNSs system) was performed using the tube method using company provided specific polyclonal antisera. The results were also compared with that of Indian and other populations of the world.

Results

Blood group antigen frequencies observed in our study population were mostly in sync with the prevalence rates of major and minor blood group antigens reported in other studies; however, in certain cases, they were also at variance. In our study, Rh D-negative antigen, JKa-Jkb- phenotype frequency were comparatively much higher than those reported in other Indian studies.

Conclusion

To conclude, ours was a pilot study to establish the database of major and minor antigens of Armed Forces combatants. However, it is recommended that if the same effort can be replicated at the other transfusion centers and major hospitals of Armed Forces, it will vastly benefit their alloimmunized patient clientele needing lifesaving transfusions.

Variable reactivity of Rh D antigen and its serological characterization

Background: Variation in the reactivity on Rh D typing may pose challenges in interpretation and ambiguity in further patient management.Materials and Methods: A prospective study was conducted in the department of transfusion medicine for a period of 18 months. Blood grouping was performed by fully automated equipment employing column agglutination technique. All the samples with Rh D negative or discrepant reactions were subjected to weak D testing by the antihuman globulin testing method. Samples that tested positive were categorized as serological weak D type or Variant D and were further phenotyped with Partial D typing set with 6 monoclonal anti D antisera.Results: A total of 82,824 samples were tested for Rh D type during the study period. Of the study population, 65.7% were males. On Rh D type majority were Rh D positive (93%), 6.9% were negative, and the result was discrepant in 0.1% (70) samples. The overall prevalence of variant D was 1.28% (75) of the Rh D negative population and 0.09% of the total study population. The detection rate of variant D phenotype was significantly higher by the Column agglutination technique. Upon testing with Partial D kit, the partial D variant in the majority reacted wil all the 6 antisera and hence we could not rule out DIII(60%), in rest it was inconclusive. In 43% of subjects with Rh D discrepancy 'C' antigen was found in a homozygous state.Conclusion: The introduction of partial D typing kit alone may not help in the absolute characterization of variant D. Extended serological testing and selective integration of molecular testing is the need of the hour.

Safety assessment of RhD-positive red cell transfusion in RhD-negative liver-transplant recipients: Single-centre report from India

Background & objectives:

The number of blood components required during a liver-transplant surgery is significant. It is challenging for blood transfusion services to provide the required RhD-negative red blood cells (RBCs) for recipients during the peri-operative period. This retrospective study presents safety data of transfusing RhD-positive RBCs in RhD-negative living donor liver-transplant (LDLT) recipients during the peri-operative period with six-month follow up for risk of developing alloantibodies.

Methods:

All RhD-negative patients who underwent LDLT and were transfused ABO-compatible but RhD-positive RBC units between January 2012 and May 2018 were included in the study. Twenty one RhD-negative patients who received a total of 167 RhD-positive RBCs peri-operatively were chosen for alloantibody screening. All the patients were started on triple immunosuppression drugs as per the standard hospital protocol. Blood grouping, cross-match and antibody screening were done by column agglutination technique.

Results:

Post-transplant antibody screen (weekly for 12 wk) was negative, and none of the patients developed anti-D alloantibodies till their last follow up (mean 21 months).

Interpretation & conclusions:

Our observations suggest that it may be safe to use RhD-positive RBCs peri-operatively in RhD-negative LDLT recipients with low risk of alloimmunization.

Distribution of Kell antigens K, k, Kpa, and Kpb among blood donors in Jeddah city of Western Saudi Arabia

CONTEXT:

Kell blood group system is considered as the third clinically significant blood group in blood transfusion due to the highly immunogenetic of their antigens. No data are available regarding the frequencies of the Kell blood group antigens in Jeddah city. Knowledge of the antigen and phenotype frequencies is crucial to assess the risk of alloimmunization and to guide the probability of finding antigen-negative donor blood, which can be useful when blood transfusion is required for a patient who has multiple red cell alloantibodies.

AIMS:

The aim of this study was to determine the distribution of Kell blood group: K, k, Kp^a, and Kp^b antigens and phenotypes among blood donors in Jeddah city, western Saudi Arabia, to improve the transfusion services in the area.

SUBJECTS AND METHODS:

Seven hundred and fifty-eight blood samples from blood donors were used in the study. The samples were collected from different national blood bank centers in Jeddah city hospitals. Kell antigens were typed through gel card method using commercial antisera.

STATISTICAL ANALYSIS USED:

The gathered data were analyzed using the SPSS program. Frequency and crosstab tests were completed to achieve the objectives of the current study.

RESULTS:

The most frequent Kell phenotype in this study was Kp^(a−b+), followed by K−k+, K+k+, and then Kp^(a+b+), and the less frequent was K+k−. K−k− and Kp^(a+b−) phenotypes were not observed in studied donors.

CONCLUSIONS:

This study is the first report to determine the frequency of Kell antigens and phenotypes among blood donors in Jeddah city. These results appear to be useful in providing better care for patients by implementing tests that should become a routine in blood banks. The Kell system is very important in transfusion medicine practice.

Divergence in phenotyping and genotyping analysis of the Lewis histo-blood group system

OBJECTIVES

This study evaluated the red blood cell (RBC) Lewis phenotypes by simple haemagglutination technique and molecular genotyping in healthy individuals.

BACKGROUND

The expression of Lewis antigen on RBCs is dependent on the interaction of FUT3 and FUT2 genes. Complexity of the genetic control of Lewis antigen expression and the error-prone nature of Lewis phenotyping result in non-genuine RBC Lewis phenotypes, which could be misleading.

MATERIALS AND METHODS

ABO blood group and RBC Lewis phenotypes were determined by conventional haemagglutination tube techniques. FUT2 and FUT3 genotypes were analysed by polymerase chain reaction and direct DNA sequencing. The RBC Lewis phenotypes were also inferred from the FUT2 and FUT3 genotyping results.

RESULTS

The frequencies of RBC Lewis phenotypes typed by the conventional tube test were Le(a+b-) 19.63%, Le(a-b+) 49.32% and Le(a-b-) 31.05%, whereas the frequencies inferred from the FUT2 and FUT3 genotypes were Le(a+b-) 20.09%, Le(a-b+), 59.82%; Le(a-b-), 17.81%; and Le(a+b+), 5 (2.28%). The Le(a+b+) phenotype was not detected by the tube test, and a significant difference was observed in the frequencies of the determined Le(a-b-) and Le(a-b+) phenotypes.

CONCLUSION

The phenotyping and genotyping of Lewis blood group system reveal a high rate of discordance in the frequencies of Lewis phenotypes among the healthy individuals.

ABO, Rh, and kell blood group antigen frequencies in blood donors at the tertiary care hospital of Northwestern India

BACKGROUND:

This study was performed to provide information on frequencies of ABO, Rh & Kell antigens/alleles, phenotype in blood donors at Blood Bank, SMS hospital, Jaipur and to compare them with other races.

METHODOLOGY:

This study was conducted on blood donors from April 2016 to March 2017 using a fully automated system for ABO,Rh & Kell typing of blood cells. D, C, c, E, e & K antigens were typed using monoclonal antisera from Immucor The data were collected and calculations done to determine the antigen/allele, phenotype. The chi square test 3 degree of freedom with P < 0.001 (S) was used for comparisons between the results of our study and those of other studies.

RESULTS:

A total of 8067 donors were included in this study. Maximum donors was of B blood group (39.4%) of age 18-25(35.5%) with 60-69kg weight (65%). The most common Rh antigen found was e(99.3%) followed by D (93.8%), C (85.4%), c (60.1%), E (17.5%). R1r (DCCee) was the most common phenotype in our study (39.5%). Kell (K+) antigen was present in 2.7% of donors.

CONCLUSION:

We have determined the prevalence of Rh antigens and Rh phenotypes in blood donor at our hospital and derived the allele frequencies in the same population.

The risk to future pregnancies of transfusing Rh(D)-negative females of childbearing potential with Rh(D)-positive red blood cells during trauma resuscitation is dependent on their age at transfusion

BACKGROUND

A risk assessment model for predicting the risk of haemolytic disease of the fetus and newborn (HDFN) in future pregnancies following the transfusion of Rh(D)-positive red blood cell (RBC)-containing products to females of childbearing potential (FCP) was developed, accounting for the age that the FCP is transfused in various countries.

METHODS

The HDFN risk prediction model included the following inputs: risk of FCP death in trauma, Rh(D) alloimmunization rate following Rh(D)-positive RBC transfusion, expected number of live births following resuscitation, probability of carrying an Rh(D)-positive fetus, the probability of HDFN in an Rh(D)-positive fetus carried by an alloimmunized mother. The model was implemented in Microsoft R Open, and one million FCPs of each age between 18 and 49 years old were simulated. Published data from eight countries, including the United States, were utilized to generate country-specific HDFN risk estimates.

RESULTS

The risk predictions showed similar characteristics for each country in that the overall risk of having a pregnancy affected by HDFN was higher if the FCP was younger when she received her Rh(D)-positive transfusion than if she was older. In the United States, the overall risk of HDFN if the FCP was transfused at age 18 was 3·4% (mild: 1·20%, moderate: 0·45%; severe: 1·15%; IUFD: 0·57%); the risk was approximately 0% if the FCP was 43 years or older at the time of transfusion.

CONCLUSION

This model can be used to predict HDFN outcomes when establishing transfusion policies as it relates to the administration of Rh(D)-positive products for massively bleeding FCPs.

Patient blood management in a patient with multiple red cell antibodies (anti-C, anti-e, and anti-K) undergoing liver transplant in South India: A team approach

End-stage liver disease (ESLD) patients undergoing liver transplant (LT) surgery are often multiply alloimmunized and pose significant challenges to the transfusion services in terms of red cell cross-match incompatibility, unpredictable blood requirements, and often lead to significant delays in availing compatible red cell units. We report a case of a 64-year-old female from Bahrain, a known case of hepatitis C-related ESLD referred for LT surgery. She had a history of multiple uneventful transfusions in the preceding year. Her blood group was A-positive, direct antiglobulin test, and cold antibodies were negative. Indirect antiglobulin test was positive, and antibody identification confirmed the presence of anti-C, anti-e, and anti-K. Her red cell phenotype was R₂R₂ and Kell negative (C-c+E+e-K-). The patient was started on erythropoietin. Requests for R₂R₂ and Kell negative units were sent to various blood banks across the country. After >800 A/O group units phenotyping and a waiting period of 6 weeks, two compatible R₂R₂ phenotypes and Kell negative could be arranged in-house and three units were received from Gurgaon, North India. Intraoperative management included blood preservation techniques including cell salvage, antifibrinolytic drug, and monitoring using thromboelastography. The estimated blood loss was 350 ml with pre- and postoperative Hb 10.4 gm% and 9.2 gm%, respectively. She received intraoperatively two units of single-donor platelet and four units of fresh frozen plasma and postoperatively one unit of leukocyte-depleted-packed red cells and doing well at 12-month follow-up. This case highlights the importance of advance immunohematology for timely detection of alloimmunization and providing antigen-negative compatible units, proper communication between the transfusion specialists, and the clinical team for proper patient blood management as well as the need for central rare donor registry program to avoid delays in providing compatible blood in such inevitable cases.

Red cell antigen phenotypes in blood donors & thalassaemia patients for creation of red cell antigen-matched inventory

Background & objectives:

Patients with thalasssaemia are at a risk of alloimmunization and the presence of RBC alloantibodies further complicates transfusion therapy. Matching for the critical antigens of Rh, Kell, Kidd and Duffy blood group systems has been shown to minimize alloimmunization. The aim of the present study was to create a database of extensively typed donors for clinically significant and common blood group antigens of Rh, Kidd, Kell and Duffy systems for transfusion therapy of multitransfused thalassaemic patients.

Methods:

Five hundred O group regular blood donors were phenotyped for Rh, Kell, Duffy and Kidd blood group antigens using haemagglutination technique. Eighty four non-alloimmunized and 15 alloimmunized thalassaemia major patients with known antigenic profiles (determined by polymerase chain reaction with sequence-specific primers) were selected for this study.

Results:

By analyzing antigen profiles of 500 O group regular donors, a database of 193 donors matching perfectly for Rh, Duffy, Kell and Kidd antigens was prepared for 15 alloimmunized patients. For non-alloimmunized 84 thalassaemic patients, a database of 405 donors was created.

Interpretation & conclusions:

A database of 500 regular blood donors phenotyped for common antigens of Rh, Duffy, Kell and Kidd blood group systems was created, which would be useful in providing extended antigen-matched RBCs for thalassaemia patients. This will improve the quality and effectiveness of transfusion therapy.

The frequent and the unusual red cell phenotypes in Indian blood donors: A quest for rare donors

A clinically significant red cell alloantibody is capable of accelerated destruction of red cells bearing the corresponding antigen. Knowledge of prevalence of these antigens is necessary for performing day to day work and for research in immunohematology. The primary aim of this study was to find the prevalence of 18 clinically significant blood group antigens in blood donors. Secondary objectives were to motivate and create a database of accessible, volunteer O blood group donors and to register rare donors with existing registries. A cross-sectional observational study was conducted in the department of Transfusion Medicine at a large tertiary care hospital in India from October 2016 to May 2018 with a planned sample size of 4800. Study population included healthy blood donors of either gender coming for blood donation to the blood centre. A total of 6678 samples were included in the study. First time donors were 21.41 % while 78.59 % were repeat donors. Voluntary donors constituted 15.81 % while replacement donors were 84.19 %. Male donors were 89.82 % while female donors were 10.18 %. The antigen, phenotype and gene frequencies were calculated. An extended phenotyped voluntary donor database was created and four rare donors were identified. One of these rare donors was registered with the International Rare Donor Panel (IRDP) and rest were registered in a local registry. This study might help enhance the confidence of blood banks in finding appropriate units for patients with unexpected antibodies or with rare phenotypes. It also paves a way for registering rare donors locally and internationally.

Phenotype frequencies of Rh (C, c, E, e), M, Mia and Kidd blood group systems among ethnic Thai blood donors from the north-east of Thailand

We here report the first study of antigen and phenotype frequencies of Rh (C, c, E, e), M, Mi^a and Kidd antigens in north-east Thai blood donors. Blood transfusion services aim to ensure availability of adequate and safe blood to minimize the development of transfusion reactions. For pre-transfusion testing, the most important blood group systems are ABO and RhD. The transfusion of ABO-compatible otherwise unknown phenotype blood may result in alloimmunization, especially in multi-transfused patients. Extended red blood cell (RBC) phenotyping and selection of blood negative for specific antigens reduce post-transfusion complications and allow for effective blood transfusion regimens to be achieved. A total of 13,567 regular repeated, voluntary Thai blood donors were included for red-cell antigen typing of Rh (D, C, E, c, e). Samples from 12,768, 9,389 and 13,059 donors were typed for Kidd, M and Mi^a antigens, respectively. Amongst Rh antigens, e was the most common (96.80%) followed by C (95.50%), c (34.40%) and E (32.20%) with CCDee (60.00%) being the most common phenotype. For Kidd phenotypes, Jk(a+b+) was the most common (46.73%) and Jk(a-b-) was rare (0.07%). For the M and Mi^a antigen, M(+) was most frequently found (94.96%) and Mi^a (+) was found in 17.97% of individuals. Knowledge of red-cell antigen phenotype frequencies in a population is helpful for creating a phenotype database of blood donors which can provide antigen-negative compatible blood to patients with multiple alloantibodies. Moreover, provision of antigen-matched blood can prevent alloimmunization in multi-transfused patients.

Evolution of technology for molecular genotyping in blood group systems

The molecular basis of the blood group antigens was identified first in the 1980s and 1990s. Since then the importance of molecular biology in transfusion medicine has been described extensively by several investigators. Molecular genotyping of blood group antigens is one of the important aspects and is successfully making its way into transfusion medicine. Low-, medium- and high-throughput techniques have been developed for this purpose. Depending on the requirement of the centre like screening for high- or low-prevalence antigens where antisera are not available, correct typing of multiple transfused patients, screening for antigen-negative donor units to reduce the rate of alloimmunization, etc. a suitable technique can be selected. The present review discusses the evolution of different techniques to detect molecular genotypes of blood group systems and how these approaches can be used in transfusion medicine where haemagglutination is of limited value. Currently, this technology is being used in only a few blood banks in India. Hence, there is a need for understanding this technology with all its variations.

Determination of the frequency of the most immunogenic Rhesus antigens among Saudi donors in King Abdulaziz Medical City - Riyadh

BACKGROUND

The Rhesus (Rh) blood group system is one of the most polymorphic and immunogenic systems known in humans, because of its immunogenicity along with ABO grouping, RhD antigen testing was made mandatory before issuing a compatible blood. At present, there are five major antigens, i.e., D, C, E, c, and e in Rh blood group system.

AIMS

The aim of this study is to provide essential data about the distribution of the major Rh antigens and the most common phenotype among the Saudi population.

MATERIALS AND METHODS

This is a retrospective study to evaluate the Rh grouping and Rh sub-groups performed among some donors who donated blood or blood products at the department of donation center at King Abdulaziz Medical City Riyadh, Saudi Arabia from January 1, 2014 to December 31, 2014. Sample size included 600 donors. Donors are males and females and their ages are above 18 years.

RESULTS

The incidence of RhD was 84.8% and only 15.2% of samples were negative for D antigen. The Incidence of other Rh antigens C, E, c, and e were 62.3%, 23.5%, 74.3%, and 95.0%, respectively. The most common phenotype among RhD positive donors was DCcee (28.7%) and among RhD negative donors was dccee (13.7%). However, three donors (0.5%) were negative for antithetical antigens C and c.

CONCLUSION

This study shows that there is a wide racial and geographical variation in the distribution of Rh antigens and phenotypes among study participants. The Rh blood group system has a vital role in population genetic study and in resolving medical legal issues and more importantly in transfusion medicine practice.

The Kidd (JK) Blood Group System

The Kidd blood group system was discovered in 1951 and is composed of 2 antithetical antigens, Jk^a and Jk^b, along with a third high-incidence antigen, Jk3. The Jk3 antigen is expressed in all individuals except those with the rare Kidd-null phenotype. Four Kidd phenotypes are therefore possible: Jk(a+b-), Jk(a-b+), Jk(a+b+), and Jk(a-b-). The glycoprotein carrying the Kidd antigens is a 43-kDa, 389-amino acid protein with 10 membrane-spanning domains which functions as a urea transporter on endothelial cells of the renal vasa recta as well as erythrocytes. The HUT11/UT-B/JK (SLC14A1) gene encoding this glycoprotein is located on chromosome 18q12-q21. The Jk^a and Jk^b antigens are the result of a single-nucleotide polymorphism present at nucleotide 838 resulting in an aspartate or asparagine amino acid at position 280, respectively. The Kidd blood group can create several difficult transfusion situations. Besides the typical acute hemolytic transfusion reactions common to all clinically relevant blood group antigens, the Kidd antigens are notorious for causing delayed hemolytic transfusion reactions due to the strong anamnestic response exhibited by antibodies directed against Kidd antigens. The Kidd-null phenotype is extremely rare in most ethnic groups, but is clinically significant due to the ability of those with the Kidd-null phenotype to produce antibodies directed against the high-incidence Jk3 antigen. Anti-Jk3 antibodies behave in concordance with anti-Jk^a or anti-Jk^b possessing the capability to cause both acute and delayed hemolytic reactions. Antibodies against any of the 3 Kidd antigens can also be a cause of hemolytic disease of the fetus and newborn, although this is generally mild. In this review, we will outline the makeup of the Kidd system from its historical discovery to the details of the Kidd gene and glycoprotein, and then discuss the practical aspects of Kidd antibodies and transfusion reactions with an extended focus on the Kidd-null phenotype. We will end with a brief discussion of the donor aspects related to the screening and supply management of blood from donors with the rare Jk(a-b-) phenotype.

Antigen negative red blood cell inventory of Indian blood donors

BACKGROUND

Screening the donor population for clinically important antigens and creating a database of phenotyped donors will eliminate the tedious task of large scale screening for antigen negative units. The aim of the present study is to identify donors lacking common antigens and a combination of common antigens to establish an antigen negative inventory.

MATERIALS AND METHODS

Blood samples of 1221 regular blood donors were phenotyped for the clinically important common antigens of the Rh, Duffy, Kell, Kidd and MNS blood group systems using standard tube technique.

RESULTS

Out of 1221 total donors tested, we observed that 261 donors lacked a combination of clinically important common antigens (C, D, e, Fya, Jka, s). After excluding the RhD negative donors in this study 15.56% lacked a combination of two or three common antigens. Of all donors, 3.2% lacked Fya and Jka antigens, 1.96% Fya and s, 1.88% Jka and s antigens and 0.57% lacked three common antigens.

DISCUSSION

An antigen negative inventory of donors who lack a single common antigen or a combination of common antigens was prepared from regular donors which will prove useful for efficient management of transfusion therapy in patients with multiple antibodies against common antigens.

Distribution of ABO and Rh types in voluntary Blood donors in Jharkhand area as a study conducted by RIMS, Ranchi

Background:

This study was done to know the distribution and frequencies of blood groups among blood donors attending voluntary blood donation camps organized by the Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand so that demand and supply ratio of the four blood groups can be maintained so that no patient dies due to lack of a particular blood group.

Context:

Up till now about 400 red cells antigen have been identified. The majority follow Mendelian inheritance. The ABO and Rhesus (Rh) blood group system are most important for blood transfusion purposes, parental testing, legal medicine, and in population genetic study.

Aims:

This study was conducted to determine and compare the frequency and distribution of ABO and Rh blood groups among voluntary blood donors attending blood donation camps in Jharkhand organized by RIMS. The aim is to know the demand and supply ratio of a particular blood group in light of their distribution in the society so that no patient dies due to the deficient supply of blood.

Settings and Design:

It is a retrospective study carried out at blood bank. Materials and Methods: A study was conducted at Blood bank, RIMS, Ranchi, Jharkhand, over a period of 4 years from January 1, 2012, to December 31, 2015. Blood group of the blood donors was determined by commercially available standard monoclonal antisera by test tube agglutination technique accompanied by reverse grouping.

Results:

Out of 20,455 subjects, 18,717 (91.73%) were male and 1738 (8.27%) were female subjects. The ABO blood group present was B (35.15%) followed by O (34.73%), A (22.09%), and AB (8.03%) in blood donors while in Rh system, (96.46%) donors were Rh +ve and (3.54%) donors were Rh −ve. The study has a significant implication regarding the inventory management of blood bank and transfusion services for the indoor patients of RIMS and for emergency supply to other hospitals of Jharkhand in dire need of blood.

Conclusions:

The knowledge of distribution of blood group is very important for blood banks and transfusion services which play an important role in the patient's health care. This study will also throw light on the reasons of deficiency of a particular group in a particular area so that deficient group donors may be encouraged to donate more frequently.

Blood groups systems

International Society of Blood Transfusion has recently recognized 33 blood group systems. Apart from ABO and Rhesus system, many other types of antigens have been noticed on the red cell membranes. Blood grouping and cross-matching is one of the few important tests that the anaesthesiologist orders during perioperative period. Hence, a proper understanding of the blood group system, their clinical significance, typing and cross-matching tests, and current perspective are of paramount importance to prevent transfusion-related complications. Nonetheless, the knowledge on blood group system is necessary to approach blood group-linked diseases which are still at the stage of research. This review addresses all these aspects of the blood groups system.

Prevalence and Specificity of RBC Alloantibodies in Indian Patients Attending a Tertiary Care Hospital

Background. Red blood cell (RBC) alloimmunization results from genetic disparity of RBC antigens between donor and recipients. Data about alloimmunization rate in general patient population is scarce especially from resource limited countries. We undertook this study to determine prevalence and specificity of RBC alloantibodies in patients admitted in various clinical specialties at a tertiary care hospital in North India. Methods. Antibody screening was carried out in 11,235 patients on automated QWALYS 3 platform (Diagast, Loos, France). Antibody identification was carried out with an 11-cell identification panel (ID-Diapanel, Diamed GmbH, Switzerland). Results. The overall incidence of RBC alloimmunization in transfused patients was 1.4% (157/11235), with anti-E being the most common specificity (36.3%), followed by anti-D (16%), anti-c (6.4%), anti-c + E (6.4%), anti-C + D (5.1%), and anti-K (4.5%). The highest incidence of alloimmunization was observed in hematology/oncology patients (1.9%), whereas in other specialties the range was 0.7–1%. Conclusion. As alloimmunization complicates the transfusion outcomes, authors recommend pretransfusion antibody screening and issue of Rh and Kell matched blood to patients who warrant high transfusion requirements in future.

Phenotypic Profile of Rh and Kell Blood Group Systems among Blood Donors in Cote d'Ivoire, West Africa

Few countries in sub-Saharan Africa make systematic searches for antigens C, c, E, and e of the Rh and Kell system antigens in the donor and recipient, thereby exposing transfused patients. Purpose and Objectives. In this paper, we propose to determine the red cell Rh and Kell blood groups among blood donors from traditional techniques to improve medical care of transfused patients. This study will allow us to assess the frequency of blood group antigens in these systems. Study Design and Methods. We carried out a study on the red cell typing in the blood donor population of the National Blood Transfusion Center in Abidjan. This study was performed on 651 blood donors. Results. For the Rh system, the antigen frequencies of D, c, e, C, and E are, respectively, 92.93%, 99.85%, 99.85%, 21.97%, and 13.82%. K antigen is found in 0.77% of donors. Discussion and Conclusion. Although the frequencies of the most immunogenic antigens are lower than in the white race, lack of preventive measures makes the immunological risk high in Africa. Furthermore, Africa is full of specificities that are important to note for a better care of our patients.

Genogroup IV and VI canine noroviruses interact with histo-blood group antigens

Human noroviruses (HuNV) are a significant cause of viral gastroenteritis in humans worldwide. HuNV attaches to cell surface carbohydrate structures known as histo-blood group antigens (HBGAs) prior to internalization, and HBGA polymorphism among human populations is closely linked to susceptibility to HuNV. Noroviruses are divided into 6 genogroups, with human strains grouped into genogroups I (GI), II, and IV. Canine norovirus (CNV) is a recently discovered pathogen in dogs, with strains classified into genogroups IV and VI. Whereas it is known that GI to GIII noroviruses bind to HBGAs and GV noroviruses recognize terminal sialic acid residues, the attachment factors for GIV and GVI noroviruses have not been reported. This study sought to determine the carbohydrate binding specificity of CNV and to compare it to the binding specificities of noroviruses from other genogroups. A panel of synthetic oligosaccharides were used to assess the binding specificity of CNV virus-like particles (VLPs) and identified α1,2-fucose as a key attachment factor. CNV VLP binding to canine saliva and tissue samples using enzyme-linked immunosorbent assays (ELISAs) and immunohistochemistry confirmed that α1,2-fucose-containing H and A antigens of the HBGA family were recognized by CNV. Phenotyping studies demonstrated expression of these antigens in a population of dogs. The virus-ligand interaction was further characterized using blockade studies, cell lines expressing HBGAs, and enzymatic removal of candidate carbohydrates from tissue sections. Recognition of HBGAs by CNV provides new insights into the evolution of noroviruses and raises concerns regarding the potential for zoonotic transmission of CNV to humans.

IMPORTANCE Infections with human norovirus cause acute gastroenteritis in millions of people each year worldwide. Noroviruses can also affect nonhuman species and are divided into 6 different groups based on their capsid sequences. Human noroviruses in genogroups I and II interact with histo-blood group antigen carbohydrates, bovine noroviruses (genogroup III) interact with alpha-galactosidase (α-Gal) carbohydrates, and murine norovirus (genogroup V) recognizes sialic acids. The canine-specific strains of norovirus are grouped into genogroups IV and VI, and this study is the first to characterize which carbohydrate structures they can recognize. Using canine norovirus virus-like particles, this work shows that representative genogroup IV and VI viruses can interact with histo-blood group antigens. The binding specificity of canine noroviruses is therefore very similar to that of the human norovirus strains classified into genogroups I and II. This raises interesting questions about the evolution of noroviruses and suggests it may be possible for canine norovirus to infect humans.