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Clayton S, Leeper CM, Yazer MH, Spinella PC. Survey of policies at US hospitals on the selection of RhD type of low-titer O whole blood for use in trauma resuscitation. Transfusion 2024. [PMID: 38501231 DOI: 10.1111/trf.17789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Low-titer group O whole blood (LTOWB) use is increasing due to data suggesting improved outcomes and safety. One barrier to use is low availability of RhD-negative LTOWB. This survey examined US hospital policies regarding the selection of RhD type of blood products in bleeding emergencies. STUDY DESIGN AND METHODS A web-based survey of blood bank directors was conducted to determine their hospital's RhD-type selection policies for blood issued for massive bleeding. RESULTS There was a 61% response rate (101/157) and of those responses, 95 were complete. Respondents indicated that 40% (38/95) use only red blood cells (RBCs) and 60% (57/95) use LTOWB. For hospitals that issue LTOWB (N = 57), 67% are supplied only with RhD-positive, 2% only with RhD-negative, and 32% with both RhD-positive and RhD-negative LTOWB. At sites using LTOWB, RhD-negative LTOWB is used exclusively or preferentially more commonly in adult females of childbearing potential (FCP) (46%) and pediatric FCP (55%) than in men (4%) and boys (24%). RhD-positive LTOWB is used exclusively or preferentially more commonly in men (94%) and boys (54%) than in adult FCP (40%) or pediatric FCP (21%). At sites using LTOWB, it is not permitted for adult FCPs at 12%, pediatric FCP at 21.4%, and boys at 17.1%. CONCLUSION Hospitals prefer issuing RhD-negative LTOWB for females although they are often ineligible to receive RhD-negative LTOWB due to supply constraints. The risk and benefits of LTOWB compared to the rare occurrence of hemolytic disease of the fetus/newborn (HDFN) need further examination in the context of withholding a therapy for females that has the potential for improved outcomes.
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Affiliation(s)
- Skye Clayton
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christine M Leeper
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Philip C Spinella
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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2
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Malone JR. Ethical considerations in the use of RhD-positive blood products in trauma. Transfusion 2024. [PMID: 38491917 DOI: 10.1111/trf.17787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Prehospital and early in-hospital use of low titer group O whole blood (LTOWB) for life-threatening bleeding has been independently associated with improved survival compared to component therapy. However, when RhD-positive blood products are administered to RhD-negative females of childbearing potential (FCP), there is a small future risk of hemolytic disease of the fetus and newborn (HDFN). This raises important ethical questions that must be explored in order to justify the use of RhD-positive blood products, including LTOWB, both in clinical practice and research. METHODS This essay explores the ethical challenges related to RhD-positive blood product administration to RhD-negative or RhD-unknown FCPs as a first-line resuscitation fluid in the trauma setting. These ethical issues include: issues related to decision-making, ethical analysis based on the doctrine of double effect (DDE), and attendant obligations incurred by hospitals that administer RhD-positive blood to FCPs. RESULTS Ethical analysis through the use of the DDE demonstrates that utilization of RhD-positive blood products, including LTOWB, in the early resuscitation of FCPs is an ethically appropriate approach. By accepting the risk of HDFN, hospitals generate obligations to promote blood donation, evaluate for alloimmunization and counsel patients on the future risk of HDFN, and maintain an understanding of the ethical rationale for RhD-positive blood transfusion.
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Affiliation(s)
- Jay R Malone
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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3
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Yazer MH, Leeper C, Spinella PC, Emery SP, Horvath S, Seheult JN. Maternal and child life years gained by transfusing low titer group O whole blood in trauma: A computer simulation. Transfusion 2024. [PMID: 38404198 DOI: 10.1111/trf.17767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Using low titer group O whole blood (LTOWB) is increasingly popular for resuscitating trauma patients. LTOWB is often RhD-positive, which might cause D-alloimmunization and hemolytic disease of the fetus and newborn (HDFN) if transfused to RhD-negative females of childbearing potential (FCP). This simulation determined the number of life years gained by the FCP and her future children if she was resuscitated with LTOWB compared with conventional component therapy (CCT). METHODS The model simulated 500,000 injured FCPs of each age between 0 and 49 years with LTOWB mortality relative reductions (MRRs) compared with components between 0.1% and 25%. For each surviving FCP, number of life years gained was calculated using her age at injury and average life expectancy for American women. The number of expected future pregnancies for FCPs that did not survive was also based on her age at injury; each future child was assigned the maximum lifespan unless they suffered perinatal mortality or serious neurological events from HDFN. RESULTS The LTOWB group with an MRR 25% compared with CCT had the largest total life years gained. The point of equivalence for RhD-positive LTOWB compared to CCT, where life years lost due to severe HDFN was equivalent to life years gained due to FCP survival/future childbearing, occurred at an MRR of approximately 0.1%. CONCLUSION In this model, RhD-positive LTOWB resulted in substantial gains in maternal and child life years compared with CCT. A >0.1% relative mortality reduction from LTOWB offset the life years lost to HDFN mortality and severe neurological events.
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Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christine Leeper
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Philip C Spinella
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stephen P Emery
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sarah Horvath
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Yazer MH, Panko G, Holcomb JB, Kaplan A, Leeper C, Seheult JN, Triulzi DJ, Spinella PC. Not as "D"eadly as once thought - the risk of D-alloimmunization and hemolytic disease of the fetus and newborn following RhD-positive transfusion in trauma. Hematology 2023; 28:2161215. [PMID: 36607150 DOI: 10.1080/16078454.2022.2161215] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The use of blood products to resuscitate injured and massively bleeding patients in the prehospital and early in-hospital phase of the resuscitation is increasing. Using group O red blood cells (RBC) and low titer group O whole blood (LTOWB) avoids an immediate hemolytic reaction from recipient's naturally occurring anti-A and - B, but choosing the RhD type for these products is more nuanced and requires the balancing of product availability and survival benefit against the risk of D-alloimmunization, especially in females of childbearing potential (FCP) due to the possible future occurrence of hemolytic disease of the fetus and newborn (HDFN). Recent models have estimated the risk of fetal/neonatal death from HDFN resulting from D-alloimmunization of an FCP during her trauma resuscitation at between 0-6.5% depending on her age at the time of the transfusion and other societal factors including trauma mortality, her age when she becomes pregnant, frequency of different RHD genotypes in the population, and the probability that the woman will have children with different fathers; this is counterbalanced by an approximately 24% risk of death from hemorrhagic shock. This review will discuss the different models of HDFN outcomes following RhD-positive transfusion as well as the results of recent surveys where the public was asked about their preferences for urgent transfusion in light of the risks of fetal/neonatal adverse events.
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Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - John B Holcomb
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alesia Kaplan
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christine Leeper
- Department of Surgery, University of Pittsburgh, Pittsburgh PA, USA
| | - Jansen N Seheult
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Darrell J Triulzi
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Philip C Spinella
- Departments of Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Andrews J, Josephson CD, Young P, Spinella PC, Yazer MH. Weighing the risk of hemolytic disease of the newborn versus the benefits of using of RhD-positive blood products in trauma. Transfusion 2023; 63 Suppl 3:S4-S9. [PMID: 37070798 DOI: 10.1111/trf.17352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Jennifer Andrews
- Department of Pathology, Microbiology and Immunology, Division of Transfusion Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cassandra D Josephson
- Cancer and Blood Disorders Institute, Blood Bank and Transfusion Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pampee Young
- Department of Pathology, Microbiology and Immunology, Division of Transfusion Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- American Red Cross, Biomedical Services Headquarters, Washington, DC, USA
| | - Philip C Spinella
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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8
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Younes R, Spinella PC, Shea SM, Bailey-Kroll L, Neal MD, Leeper C, Yazer MH. A rapid ABO and RhD test demonstrates high fidelity to blood bank testing for RhD typing. Transfusion 2023; 63 Suppl 3:S208-S212. [PMID: 37067381 DOI: 10.1111/trf.17326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND The rapid provision of blood products is life-saving for patients with massive hemorrhage. Ideally, RhD-negative blood products would be supplied to a woman of childbearing potential whose Rh type is unknown due to the risk of D-alloimmunization and the potential for hemolytic disease of the fetus and newborn to occur if RhD-positive blood products are transfused. Therefore, there is a need for a test that rapidly determines her RhD type. This study compared the RhD type determined using a rapid ABO and RhD test to the RhD type determined by an immunohematology reference laboratory. METHODS After receiving ethics review board approval, 200 random, unique, deidentified patient samples that had undergone routine pretransfusion testing in an immunohematology reference laboratory using column agglutination technology were collected and tested using a rapid ABO and RhD test (Eldoncard Home kit 2511). The RhD typing results from these two methods were compared to determine the accuracy of the rapid ABO and RhD test. RESULTS The rapid ABO and RhD test produced results that were concordant with the transfusion service's results in 199/200 (99.5%) of cases, with a negative predictive value of 98.2% and 99.3% sensitivity. The single outlier was likely an RhD variant due to its serological characteristics. DISCUSSION These data indicate that this rapid ABO and RhD test could be used for the rapid determination of a patient's RhD type, perhaps even in the emergency department, which could guide the selection of blood products provided during their resuscitation.
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Affiliation(s)
- Reem Younes
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Philip C Spinella
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan M Shea
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lilith Bailey-Kroll
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew D Neal
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christine Leeper
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Yazer MH, Spinella PC, Sperry J, Triulzi DJ, Leeper C. Timing of RhD-positive red blood cell administration is associated with D-alloimmunization in injured patients. Transfusion 2023; 63 Suppl 3:S54-S59. [PMID: 37067374 DOI: 10.1111/trf.17330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/19/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND The D-alloimmunization rate in trauma patients does not appear to depend on the number of RhD-positive units transfused. The effect of the timing and pattern of RhD-positive transfusions has not been evaluated. METHODS RhD-negative trauma patients who were transfused with RhD-positive red blood cells (RBC) or low titer group O whole blood (collectively called RBCs) on at least two separate calendar days and who had antibody detection tests performed at least 14 days after the second RhD-positive RBC transfusion without receiving RhIg were included in the analysis. Patients whose anti-D was detected within 14 days of the index RhD-positive RBC transfusion were excluded. Patient demographics and the dates of RhD-positive RBC transfusions and results of antibody detection tests performed after the index transfusion were collected on eligible patients. RESULTS There were 44/61 (72.1%) patients in whom anti-D was not detected (non-alloimmunized) and 17/61 (27.9%) in whom anti-D was detected (alloimmunized). The patients had similar demographics with trends towards higher median admission heart rates and lower median admission Glasgow Coma Scale values in the alloimmunized group. Both groups received statistically identical median quantities of RhD-positive RBCs (non-alloimmunized 5 vs. alloimmunized 4 units, p = .53), however, the alloimmunized group received all their RhD-positive RBCs over a significantly shorter period of time compared to the non-alloimmunized (median 4 vs. 15 days, respectively, p = .01). CONCLUSION Receipt of all RhD-positive RBCs over a shorter period of time was associated with higher D-alloimmunization rates. These results need to be confirmed in larger studies.
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Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Vitalant, Pittsburgh, Pennsylvania, USA
| | - Philip C Spinella
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Darrell J Triulzi
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Vitalant, Pittsburgh, Pennsylvania, USA
| | - Christine Leeper
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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10
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Yu G, Siegler J, Hayes J, Yazer MH, Spinella PC. Attitudes of American adult women toward accepting RhD-mismatched transfusions in bleeding emergencies. Transfusion 2022; 62 Suppl 1:S211-S217. [PMID: 35753036 DOI: 10.1111/trf.16981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is an increasing literature demonstrating the benefits of prehospital and early in-hospital transfusions. RhD-positive products might only be available during these phases, which could pose consequences for future pregnancies if D-alloimmunization occurs. This survey measured the willingness of females to accept urgent but incompatible transfusions in light of the potential for future pregnancy complications. METHODS A survey was designed to assess the willingness of females ≥18 years of age to accept urgent incompatible transfusions when different absolute risk reductions in maternal mortality were presented along with a static rate of 0.3%-4.0% risk of harm to future pregnancies. The survey was sent electronically to women who are part of the Washington University Research Enhancement Core database. RESULTS A total of 4896 delivered survey email invitations were distributed and 325 (6.6%) responses were received; 16 responses were excluded leaving 309 responses for analysis. Most of the responding women were White, college-educated, and lived in Missouri. At least 90% of the respondents would accept an urgent incompatible transfusion when the absolute risk reduction in maternal mortality was ≥4%. Women without a college degree, who lived in Illinois, who were not able to have children appeared to be less willing than their counterparts to receive an incompatible transfusion when the absolute risk reduction in maternal mortality was low. CONCLUSION This survey demonstrated that adult women are highly likely to be open to accept urgent incompatible blood transfusions during a bleeding emergency when the absolute risk reduction in maternal mortality was ≥4%.
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Affiliation(s)
- Gabriel Yu
- Department of Emergency Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Jeffrey Siegler
- Department of Emergency Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Jane Hayes
- Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Philip C Spinella
- Departments of Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Nasif WA, Ali AS, Khogeer AA, Mukhtar MH, NourEldein MM, Shebly AY, Alqahtani SH, Alnashri YA, Khouj GE, Gadah ZI, Althubiti MA. Emphasizing the link between blood types in multi-ethnic disparities and COVID-19 infection in Makkah, Saudi Arabia. Saudi Med J 2022; 43:177-186. [PMID: 35110343 PMCID: PMC9127910 DOI: 10.15537/smj.2022.43.2.20210847] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/26/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives: To analyze the impact and distribution of blood groups in different ethnicities and the extent of susceptibility to infection with COVID-19 in Makkah, Saudi Arabia. Methods: A retrospective study was performed on 4,609 COVID-19 patients from five ethnic groups to assess the impact and distribution of different blood types and susceptibility to COVID-19 infection. The study was carried out between November 2020 and June 2021 in the College of Medicine, Umm Al-Qura University in collaboration with the General Directorate of Health Affairs, Makkah, Saudi Arabia. Results: Blood group (A, B, and O) distributions in 2,617 COVID-19 patients with local control populations was done. Our study found that in both Saudi and non-Saudi populations, blood groups O and A were associated with higher infection rates, whereas blood group AB was associated with lower infection rates (p=0.0001). COVID-19 seems to be associated with blood groups A, B, and AB (RR=3.23, 95% CI=2.702-3.821, p=0.0001). COVID-19 risk was lower in people with O blood group (RR=0.783, 95% CI=0.733-0.836, p=0.0001). South Asians had higher odds of COVID-19 infection when compared to Saudi cases and other ethnic groups (OR=1.12, 95 % CI: 1.074-1.24, p=0.04). Conclusion: We emphasize that COVID-19 infection is not proportional among ethnically related blood groups. Notably, RhD-negative protect against COVID-19, whereas A and O blood types are more susceptible. Thus, when assessing COVID-19 prognosis and vaccination priority, blood groups A and O are critical.
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Affiliation(s)
- Wesam A. Nasif
- From Biochemistry Department (Nasif, Mukhtar, Nour Eldein, Althubiti), From Pathology Department (Ali), from the College of Medicine (Alqahtani, Alnashri, Khouj, Gadah), Umm Al-Qura University; From Plan and Research Department (Khogeer), General Directorate of Health Affairs Makkah Region, Ministry of Health; From Ajyad Emergency Hospital (Shebly), Ministry of Health, Makkah, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Wesam A. Nasif, Professor of Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0002-5119-0137
| | - Abeer S.E. Ali
- From Biochemistry Department (Nasif, Mukhtar, Nour Eldein, Althubiti), From Pathology Department (Ali), from the College of Medicine (Alqahtani, Alnashri, Khouj, Gadah), Umm Al-Qura University; From Plan and Research Department (Khogeer), General Directorate of Health Affairs Makkah Region, Ministry of Health; From Ajyad Emergency Hospital (Shebly), Ministry of Health, Makkah, Kingdom of Saudi Arabia.
| | - Asim A. Khogeer
- From Biochemistry Department (Nasif, Mukhtar, Nour Eldein, Althubiti), From Pathology Department (Ali), from the College of Medicine (Alqahtani, Alnashri, Khouj, Gadah), Umm Al-Qura University; From Plan and Research Department (Khogeer), General Directorate of Health Affairs Makkah Region, Ministry of Health; From Ajyad Emergency Hospital (Shebly), Ministry of Health, Makkah, Kingdom of Saudi Arabia.
| | - Mohammed H. Mukhtar
- From Biochemistry Department (Nasif, Mukhtar, Nour Eldein, Althubiti), From Pathology Department (Ali), from the College of Medicine (Alqahtani, Alnashri, Khouj, Gadah), Umm Al-Qura University; From Plan and Research Department (Khogeer), General Directorate of Health Affairs Makkah Region, Ministry of Health; From Ajyad Emergency Hospital (Shebly), Ministry of Health, Makkah, Kingdom of Saudi Arabia.
| | - Mohamed M. NourEldein
- From Biochemistry Department (Nasif, Mukhtar, Nour Eldein, Althubiti), From Pathology Department (Ali), from the College of Medicine (Alqahtani, Alnashri, Khouj, Gadah), Umm Al-Qura University; From Plan and Research Department (Khogeer), General Directorate of Health Affairs Makkah Region, Ministry of Health; From Ajyad Emergency Hospital (Shebly), Ministry of Health, Makkah, Kingdom of Saudi Arabia.
| | - Ahmed Y. Shebly
- From Biochemistry Department (Nasif, Mukhtar, Nour Eldein, Althubiti), From Pathology Department (Ali), from the College of Medicine (Alqahtani, Alnashri, Khouj, Gadah), Umm Al-Qura University; From Plan and Research Department (Khogeer), General Directorate of Health Affairs Makkah Region, Ministry of Health; From Ajyad Emergency Hospital (Shebly), Ministry of Health, Makkah, Kingdom of Saudi Arabia.
| | - Shumukh H. Alqahtani
- From Biochemistry Department (Nasif, Mukhtar, Nour Eldein, Althubiti), From Pathology Department (Ali), from the College of Medicine (Alqahtani, Alnashri, Khouj, Gadah), Umm Al-Qura University; From Plan and Research Department (Khogeer), General Directorate of Health Affairs Makkah Region, Ministry of Health; From Ajyad Emergency Hospital (Shebly), Ministry of Health, Makkah, Kingdom of Saudi Arabia.
| | - Yahya A. Alnashri
- From Biochemistry Department (Nasif, Mukhtar, Nour Eldein, Althubiti), From Pathology Department (Ali), from the College of Medicine (Alqahtani, Alnashri, Khouj, Gadah), Umm Al-Qura University; From Plan and Research Department (Khogeer), General Directorate of Health Affairs Makkah Region, Ministry of Health; From Ajyad Emergency Hospital (Shebly), Ministry of Health, Makkah, Kingdom of Saudi Arabia.
| | - Ghaidaa E. Khouj
- From Biochemistry Department (Nasif, Mukhtar, Nour Eldein, Althubiti), From Pathology Department (Ali), from the College of Medicine (Alqahtani, Alnashri, Khouj, Gadah), Umm Al-Qura University; From Plan and Research Department (Khogeer), General Directorate of Health Affairs Makkah Region, Ministry of Health; From Ajyad Emergency Hospital (Shebly), Ministry of Health, Makkah, Kingdom of Saudi Arabia.
| | - Ziyad I. Gadah
- From Biochemistry Department (Nasif, Mukhtar, Nour Eldein, Althubiti), From Pathology Department (Ali), from the College of Medicine (Alqahtani, Alnashri, Khouj, Gadah), Umm Al-Qura University; From Plan and Research Department (Khogeer), General Directorate of Health Affairs Makkah Region, Ministry of Health; From Ajyad Emergency Hospital (Shebly), Ministry of Health, Makkah, Kingdom of Saudi Arabia.
| | - Mohammad A. Althubiti
- From Biochemistry Department (Nasif, Mukhtar, Nour Eldein, Althubiti), From Pathology Department (Ali), from the College of Medicine (Alqahtani, Alnashri, Khouj, Gadah), Umm Al-Qura University; From Plan and Research Department (Khogeer), General Directorate of Health Affairs Makkah Region, Ministry of Health; From Ajyad Emergency Hospital (Shebly), Ministry of Health, Makkah, Kingdom of Saudi Arabia.
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13
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Woldu B, Melku M, Shiferaw E, Biadgo B, Abebe M, Gelaw Y. Phenotype, Allele and Genotype Frequency of ABO and Rhesus D Blood Groups of Blood Donors at the North Gondar District Blood Bank, Northwest Ethiopia. J Blood Med 2022; 13:11-19. [PMID: 35023982 PMCID: PMC8747761 DOI: 10.2147/jbm.s346904] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background Knowledge of the ABO and RhD group distribution is essential for blood banks inventory and assuring quality blood transfusion services. The objective of this study was to determine the frequency of ABO and RhD phenotype, allele, and genotype among blood donors at North Gondar District Blood Bank from 2010 to 2012, Northwest Ethiopia. Methods The data of the current study were obtained from registration logbooks of blood donors registered. The ABO and RhD grouping was done by using commercially available monoclonal antibodies (anti-A, anti-B and anti-D) by slide methods. Results with no agglutination by anti-D antibody were confirmed using anti-human globulin test. Descriptive statistics were analyzed using SPSS version 20. The allele and genotype frequency of the donors was determined by Hardy–Weinberg equilibrium assumption. The difference between the observed and expected frequency was tested by online Chi-square calculator. P-value of <0.05 was considered statistically significant. Results Among 6471 blood donors, 82.1%, 94.1% and 55.4% were males, replacement donors and in the age group of 21–30 years, respectively. Blood group O (47.04%) and blood group AB (4.81%) were the dominant and least common, respectively. The distribution of the RhD negative blood group was 5.76%. The distribution of A, B and O alleles was 0.1714, 0.1433 and 0.6859, respectively. Moreover, the genotype frequency of AA, AO, BB, BO, AB and OO was 0.0294, 0.2350, 0.0205, 0.1966, 0.0491 and 0.4704, respectively. The genotype frequency of DD, Dd and dd was 0.5774, 0.3649 and 0.0576, respectively. The result showed that there was no statistically significant difference between observed and expected allele and genotype frequency (P-value >0.05). Conclusion Blood group O and AB were the most and least prevalent, respectively. The allele and genotype frequency of the population was fulfilled the Hardy–Weinberg equilibrium assumption. This finding might be useful for blood transfusion services.
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Affiliation(s)
- Berhanu Woldu
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Elias Shiferaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belete Biadgo
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Molla Abebe
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yemataw Gelaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Yazer MH, Dunbar NM, Delaney M. Survey of the RhD selection and issuing practices for uncrossmatched blood products at pediatric trauma hospitals in the United States: The BEST collaborative study. Transfusion 2021; 61:3328-3334. [PMID: 34595764 DOI: 10.1111/trf.16692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND As evidence demonstrating the importance of early transfusions in trauma resuscitation accumulates, when RhD-negative products might not be available, it is important to understand the nature of the RhD-type of products provided to bleeding pediatric patients of potentially unknown RhD-type. METHODS A survey link was electronically sent to the transfusion service medical director and/or laboratory manager at American pediatric Level I and Level II hospitals inquiring about their practices for selecting RhD-type of uncrossmatched red blood cells (RBC) or low titer group O whole blood (LTOWB) for boys and girls. RESULTS There were 55/117 (47.0%) analyzable responses; 43/55 (78.2%) from Level I and 12/55 (21.8%) from Level II hospitals. For in hospital transfusions, 51/55 (92.7%) of centers use only RhD-negative blood products to resuscitate girls ≤18 years old while 30/55 (54.5%) of centers do the same for boys ≤18 years old. Most centers 41/55(74.5%) store RBCs and/or LTOWB in in-hospital remote refrigerators; 27 store only RhD-negative RBCs and 2 store only RhD-negative LTOWB units in these refrigerators. A total of 24/55 (43.6%) centers have RBCs and/or LTOWB available on road ambulances or helicopters for prehospital transfusion; 12 transport only RhD-negative RBCs and two transport only RhD-negative LTOWB. Most centers, 35/55 (63.6%), address the prophylaxis of an RhD-negative female recipient of RhD-positive transfusion on a case-by-case basis. CONCLUSION While there is some variability, most of the responding pediatric trauma centers routinely utilized RhD-negative RBCs for emergency transfusion for patients ≤18 years old of unknown RhD-type.
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Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - 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
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15
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Yazer MH, Gorospe J, Cap AP. Mixed feelings about mixed-field agglutination: A pathway for managing females of childbearing potential of unknown RhD-type who are transfused RhD-positive and RhD-negative red blood cells during emergency hemorrhage resuscitation. Transfusion 2021; 61 Suppl 1:S326-S332. [PMID: 34269449 DOI: 10.1111/trf.16459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/12/2021] [Accepted: 01/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jose Gorospe
- San Antonio Military Medical Center, JBSA-FT Sam Houston, San Antonio, Texas, USA
| | - Andrew P Cap
- U.S. Army Institute of Surgical Research, JBSA-FT Sam Houston, San Antonio, Texas, USA.,Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
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16
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Yazer MH, Triulzi DJ, Sperry JL, Seheult JN. Rate of RhD-alloimmunization after the transfusion of multiple RhD-positive primary red blood cell-containing products. Transfusion 2021; 61 Suppl 1:S150-S158. [PMID: 34269438 DOI: 10.1111/trf.16495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Early transfusion reduces mortality in bleeding patients. In this setting, RhD-positive blood products might be transfused. This study determined the association between the RhD-alloimmunization rate and the number of RhD-positive products transfused. METHODS RhD-negative patients between 13 and 50 years who were transfused with ≥1 RhD-positive red blood cell (RBC) or whole blood units between January 1, 2000 and December 31, 2019 in a healthcare network were identified. Study patients had to have had at least one antibody detection test performed ≥14 days after the index RhD-positive transfusion and not receive RhIg. Patients were stratified into groups that received 1, 2, 3-5, 6-10, 11-20, and >20 RhD-positive transfusions and the RhD-alloimmunization rate was determined for each group. RESULTS There were 335 patients included; 52/335 (15.5%) were females. Overall, there were 117/335 (34.9%, CI: 29.8%-40.3%) recipients who became RhD-alloimmunized. There was no significant dosage effect in the RhD-alloimmunization rates as the exposure to RhD-positive units increased from one RhD-positive unit to more than 20 RhD-positive units (p = .270 for non-parametric trend test). In an exploratory analysis, patients who received 100% of their RhD-positive transfusions within 72 h of the index transfusion had a significantly higher rate of RhD-alloimmunization compared to those who were transfused over a longer period of time (42.3% vs. 21.4%, respectively; p = .001). CONCLUSION These results suggest that there may not be an increased RhD-alloimmunization risk with transfusing multiple RhD-positive units after one RhD-positive unit has been transfused. These findings need confirmation in larger studies.
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Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Darrell J Triulzi
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason L Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jansen N Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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17
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Uhlich R, Hu P, Yazer M, Jansen JO, Patrician P, Reynolds L, Marques MB, Stephens SW, Gelbard RB, Kerby J, Holcomb JB. Perception of risk in massive transfusion as it relates to fetal outcomes: A survey of surgeons and nurses at one American trauma center. Transfusion 2021; 61 Suppl 1:S159-S166. [PMID: 34269430 DOI: 10.1111/trf.16492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The use of blood products early in the resuscitation of bleeding trauma patients is widely accepted, but made difficult by limited supplies of D- red blood cell (RBC)-containing products. Use of D+ RBC-containing products would alleviate this issue, but could lead to alloimmunization. Risk associated with transfusing D+ RBC in emergency bleeding situations is being reconsidered. The level of concern surrounding emergency transfusion as it relates to future fetal harm was surveyed among surgeons and nurses. METHODS Faculty and staff in the Departments of Surgery and Nursing were surveyed on the risks of receiving an emergency RBC transfusion and the subsequent potential for fetal harm. Answers were grouped as likely to accept (likely/very likely) or refuse transfusion (unlikely/very unlikely). Participants were compared by sex, and women by child-bearing age, ([15-50 years] vs. [>50 years]). RESULTS Ninety surveys were initiated with 76 fully completed. Male (n = 39) and female (n = 37) respondents were comparable. Most female respondents (30/37, 81%) were of childbearing age. Overall, both males (38/39, 95%) and females (33/37, 89%; p = .19) were likely to accept a transfusion in an emergency. There was no difference in transfusion acceptance if the risk of fetal harm was presented as 1% (p = .73) or 0.1% (p = .51). Most females (34/37, 92%) were not opposed to transfusion even if there was an unspecified risk of future fetal harm. CONCLUSION Most of the surgeons and nurses who responded would accept a transfusion in an emergency situation even if it might lead to harming a future fetus.
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Affiliation(s)
- Rindi Uhlich
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Parker Hu
- Center for Injury Science and Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jan O Jansen
- Center for Injury Science and Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Patricia Patrician
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lindy Reynolds
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marisa B Marques
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shannon W Stephens
- Center for Injury Science and Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rondi B Gelbard
- Center for Injury Science and Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey Kerby
- Center for Injury Science and Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John B Holcomb
- Center for Injury Science and Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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18
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Yazer M, Triulzi D, Sperry J, Corcos A, Seheult J. Rate of RhD-alloimmunization after the transfusion of RhD-positive red blood cell containing products among injured patients of childbearing age: single center experience and narrative literature review. ACTA ACUST UNITED AC 2021; 26:321-327. [PMID: 33775237 DOI: 10.1080/16078454.2021.1905395] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To determine the rate of RhD-alloimmunization in injured RhD-negative patients in the age range of childbearing potential who were transfused with at least one unit of RhD-positive red blood cells (RBC) or low titer group O whole blood (LTOWB). METHODS Injured RhD-negative patients between the ages of 13-50 at an American Level 1 trauma center who were transfused with at least one unit of RBCs or LTOWB during their resuscitation and who had an antibody detection test performed at least 14 days afterwards were included. RESULTS Over a 20-year period, 96 study-eligible patients were identified, of which 90/96 (93.8%) were male. The median age of these 96 patients was 33 (5th-95th percentiles: 19-49) years. The majority of these patients (71/96, 74.0%) had an injury severity score (ISS) greater than 15. Overall, 41/96 (42.7%; 95% CI: 32.7%-53.2%) of these patients became alloimmunized after receipt of a median of 3 (5th-95th percentiles: 1-35) units of RhD-positive RBCs and/or LTOWB. There was no association between receipt of leukoreduced RBCs or receipt of LTOWB and the RhD-alloimmunization rate. DISCUSSION The rate of RhD-alloimmunization in this study was at the higher end of rates that have been reported. None of the previous studies focused exclusively on trauma patients in the childbearing age range. CONCLUSION The 42.7% rate of RhD-alloimmunization in a predominantly male trauma population could probably be extrapolated to women in the same age range when estimating their risk of RhD-alloimmunization following RhD-positive transfusion.
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Affiliation(s)
- Mark Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Darrell Triulzi
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jason Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alain Corcos
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jansen Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
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19
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Polavarapu I, Mishra G, Shastry S, Kulkarni S. Molecular characterization of RhD variant phenotypes among blood donors: A study from the coastal region of India. Transfus Apher Sci 2021; 60:103142. [PMID: 33962886 DOI: 10.1016/j.transci.2021.103142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND RhD expression varies with population and ethnicity. Accurate typing of RhD antigen among blood donors is important to prevent development of anti-D among recipients of blood transfusion. We aimed to screen blood donors for variant D phenotypes and accurately characterize them by genotyping. MATERIAL AND METHODS We have done prospective study on blood donors by performing RhD typing using three different commercial monoclonal anti-D reagents by both column agglutination and conventional tube techniques. Samples that showed ambiguous results were further screened with the Bio-Rad Partial RhD typing kit. Minor phenotyping for C, c, E, e antigens was performed. Multiplex PCR and Sequencing of all RHD exons with Sanger's sequencing was performed for molecular characterization of variant D. RESULTS A total of 16,974 blood donors were screened during the study period. Among them, 31 (0.18 %) donors were found to have a RhD variant phenotype. The male to female ratio was 10:1. The presence of 'C' antigen was noted among all RhD variant samples. Serological typing identified two samples as DV phenotype and the rest could not be characterized. Molecular genotyping characterized 90.3 % of the samples as Indian specific weak D type 150 variants. Three samples were subjected to Sangers sequencing and showed wild type pattern. CONCLUSION The present study showed that the most common variant in this population was Weak D type 150. This study highlights that serological methods may serve as a screening tool, however, molecular techniques are essential for characterization of RhD variants.
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Affiliation(s)
- Isha Polavarapu
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Garima Mishra
- Department of Transfusion Medicine, ICMR-National Institute of Immunohaematology, Mumbai, Maharashtra, India.
| | - Shamee Shastry
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Swati Kulkarni
- Department of Transfusion Medicine, ICMR-National Institute of Immunohaematology, Mumbai, Maharashtra, India.
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Wang J, Que W, Xing Y, Li Q, Zhan T, Yu Z. A novel RHD allele, with c.491A > T (p.Asp164Val) mutation, identified via family pedigree analysis. Transfusion 2021; 61:E46-E48. [PMID: 33745157 DOI: 10.1111/trf.16377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/26/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
A Chinese Han man was confirmed to carry an RHD variation by serological tests, and exons 1 through 10 of the RHD gene were analyzed by sequence-specific primer-polymerase chain reaction. To clarify the nature of this mutation, Sanger sequencing was used and a c.491A > T mutation was identified in exon 4. The proband inherited this mutation from his father, as determined from a family pedigree.
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Affiliation(s)
- Jing Wang
- Department of Blood Transfusion, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenjun Que
- Department of Blood Transfusion, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Xing
- Department of Blood Transfusion, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Li
- Department of Blood Transfusion, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tingxi Zhan
- Department of Blood Transfusion, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zebo Yu
- Department of Blood Transfusion, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Poston JN, Sugalski J, Gernsheimer TB, Marc Stewart F, Pagano MB. Mitigation strategies for anti-D alloimmunization by platelet transfusion in haematopoietic stem cell transplant patients: a survey of NCCN ® centres. Vox Sang 2020; 115:334-338. [PMID: 32080868 DOI: 10.1111/vox.12899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/23/2020] [Accepted: 02/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES D-negative patients are at risk of developing an alloantibody to D (anti-D) if exposed to D during transfusion. The presence of anti-D can lead to haemolytic transfusion reactions and haemolytic disease of the newborn. Anti-D alloimmunization can also complicate allogeneic haematopoietic stem cell transplantation (HSCT) with haemolysis and increased transfusion requirements. The goal of this study was to determine whether cancer centres have transfusion practices intended to prevent anti-D alloimmunization with special attention in patients considered for HSCT. METHODS AND MATERIALS To understand transfusion practices regarding D-positive platelets in D-negative patients with large transfusion needs, we surveyed the 28 cancer centres that are members of the National Comprehensive Cancer Network® (NCCN® ). RESULTS Nineteen centres responded (68%). Most centres (79%) avoid transfusing D-positive platelets to RhD-negative patients when possible. Four centres (21%) avoid D-positive platelets only in D-negative women of childbearing age. If a D-negative patient receives a D-positive platelet transfusion, 53% of centres would consider treating with Rh immune globulin (RhIg) to prevent alloimmunization in women of childbearing age. Only one centre also gives RhIg to all D-negative patients who are HSCT candidates including adult men and women of no childbearing age. CONCLUSION There is wide variation in platelet transfusion practices for supporting D-negative patients. The majority of centres do not have D-positive platelet transfusion policies focused on preventing anti-D alloimmunization specifically in patients undergoing HSCT. Multicentre, longitudinal studies are needed to understand the clinical implications of anti-D alloimmunization in HSCT patients.
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Affiliation(s)
- Jacqueline N Poston
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,BloodworksNW Research Institute, Seattle, WA, USA
| | - Jessica Sugalski
- National Comprehensive Cancer Network, Plymouth Meeting, PA, USA
| | - Terry B Gernsheimer
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - F Marc Stewart
- Seattle Cancer Care Alliance, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Monica B Pagano
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Department of Laboratory Medicine, Transfusion Medicine Division, University of Washington, Seattle, WA, USA
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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23
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Jelavic B, Marković J, Klarić S, Martinac M, Selak S, Baudoin T. ABO and RhD Blood Groups in Nasal Polyposis. Turk Arch Otorhinolaryngol 2018; 56:21-24. [PMID: 29988267 PMCID: PMC6017208 DOI: 10.5152/tao.2018.3048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 12/16/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine ABO and RhD blood group distribution in nasal polyposis (NP) patients and whether there is a specific ABO or RhD blood phenotype associated with susceptibility to or protection with respect to development of NP. METHODS The study group comprised 126 consecutive patients with chronic rhinosinusitis and bilateral NP. The control group comprised 126 healthy blood donors. All participants were from the same geographical region. Distribution of ABO and RhD phenotypes in all participants was studied. RESULTS There were no significant differences between patients and controls in the distribution of the A (p=0.520), B (p=0.306), AB (p=0.673), O (p=0.894), and RhD (p=0.742) phenotypes. CONCLUSION According to the present results, the ABO and RhD blood group systems are not associated with development of NP.
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Affiliation(s)
- Boris Jelavic
- Department of Otorhinolaryngology, Mostar University Hospital, Mostar, Bosnia and Herzegovina
- Mostar University School of Medicine, Mostar, Bosnia and Herzegovina
| | - Josipa Marković
- Department of Otorhinolaryngology, Mostar University Hospital, Mostar, Bosnia and Herzegovina
| | - Sanja Klarić
- Center for Transfusion Medicine, Mostar University Hospital, Mostar, Bosnia and Herzegovina
| | - Marko Martinac
- Mostar University School of Medicine, Mostar, Bosnia and Herzegovina
| | - Sanja Selak
- Mostar University School of Medicine, Mostar, Bosnia and Herzegovina
| | - Tomislav Baudoin
- Department of Otolaryngology-Head and Neck Surgery, Sestre Milosrdnice University Hospital, Zagreb, Croatia
- Zagreb University School of Medicine, Zagreb, Croatia
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24
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McCarthy WA, Popek EJ. Persistence of Villous Immaturity in Term Deliveries Following Intrauterine Transfusion for Parvovirus B19 Infection and RhD-associated Hemolytic Disease of the Fetus and Newborn. Pediatr Dev Pathol 2017; 20:469-474. [PMID: 29187036 DOI: 10.1177/1093526617698598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Common causes of fetal anemia and hydrops include parvovirus B19 infection during the first 2 trimesters of pregnancy, as well as maternal alloimmunization to RhD with subsequent hemolytic disease of the fetus and newborn (HDFN) in an RhD positive fetus. Although both of these conditions have historically caused significant fetal morbidity and mortality, the advent of intrauterine transfusion (IUT) over the last few decades has dramatically improved outcomes. Prior literature has extensively documented placental changes associated with untreated parvovirus infection and RhD HDFN in intrauterine fetal demises and preterm births; however, histopathologic changes in term placentas from term infants treated with IUT have not been reported. We present placental findings in 2 cases of parvovirus B19-associated hydrops and 2 cases of RhD HDFN-associated hydrops in term infants after IUT, highlighting unique aspects that may be diagnostically useful for the examining pathologist.
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Affiliation(s)
- Whitney A McCarthy
- 1 Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Edwina J Popek
- 1 Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA.,2 Department of Pathology, Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
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25
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Hsu K, Kuo MS, Yao CC, Cheng HC, Lin HJ, Chan YS, Lin M. The MNS glycophorin variant GP.Mur affects differential erythroid expression of Rh/RhAG transcripts. Vox Sang 2017; 112:671-677. [PMID: 28836328 DOI: 10.1111/vox.12555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 06/10/2017] [Accepted: 06/26/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND The band 3 macrocomplex (also known as the ankyrin-associated complex) on the red cell membrane comprises two interacting subcomplexes: a band 3/glycophorin A subcomplex, and a Rh/RhAG subcomplex. Glycophorin B (GPB) is a component of the Rh/RhAG subcomplex that is also structurally associated with glycophorin A (GPA). Expression of glycophorin B-A-B hybrid GP.Mur enhances band 3 expression and is associated with lower levels of Rh-associated glycoprotein (RhAG) and Rh polypeptides. The goal of this study was to determine whether GP.Mur influenced erythroid Rh/RhAG expression at the transcript level. MATERIALS AND METHODS GP.Mur was serologically determined in healthy participants from Taitung County, Taiwan. RNA was extracted from the reticulocyte-enriched fraction of peripheral blood, followed by reverse transcription and quantitative PCR for RhAG, RhD and RhCcEe. RESULTS Quantification by real-time PCR revealed significantly fewer RhAG and RhCcEe transcripts in the reticulocytes from subjects with homozygous GYP*Mur. Independent from GYP.Mur, both RhAG and RhD transcript levels were threefold or higher than that of RhCcEe. Also, in GYP.Mur and the control samples alike, direct quantitative associations were observed between the transcript levels of RhAG and RhD, but not between that of RhAG and RhCcEe. CONCLUSION Erythroid RhD and RhCcEe were differentially expressed at the transcript levels, which could be related to their different degrees of interaction or sensitivity to RhAG. Further, the reduction or absence of glycophorin B in GYP.Mur erythroid cells affected transcript expressions of RhAG and RhCcEe. Thus, GPB and GP.Mur differentially influenced Rh/RhAG expressions prior to protein translation.
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Affiliation(s)
- K Hsu
- Transfusion Medicine Laboratory, Mackay Memorial Hospital, Tamsui, Taiwan
| | - M-S Kuo
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taitung, Taiwan
| | - C-C Yao
- Transfusion Medicine Laboratory, Mackay Memorial Hospital, Tamsui, Taiwan
| | - H-C Cheng
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taitung, Taiwan
| | - H-J Lin
- Transfusion Medicine Laboratory, Mackay Memorial Hospital, Tamsui, Taiwan
| | - Y-S Chan
- Mackay Memorial Hospital Blood Bank, Taipei, Taiwan
| | - M Lin
- Transfusion Medicine Laboratory, Mackay Memorial Hospital, Tamsui, Taiwan
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26
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Campos FCA, Mota MA, Aravechia MG, Torres KB, Bub CB, Kutner JM, Castilho L. Variant RHD Types in Brazilians With Discrepancies in RhD Typing. J Clin Lab Anal 2016; 30:845-848. [PMID: 27076392 DOI: 10.1002/jcla.21946] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/14/2015] [Accepted: 01/13/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The knowledge of D variants in patients and donors is important because anti-D alloimmunization can occur in some but not all individuals who express a variant RHD allele. Serologic distinction of RhD discrepancies is not always straightforward, which makes molecular analysis highly desirable. METHODS A group of 223 subjects, 129 patients, and 94 blood donors was identified and analyzed on the basis of a D typing discrepancy. The D antigen expression was evaluated by tube and gel hemagglutination with four anti-D reagents. PCR-single specific primer (SSP), multiplex PCR, RHD BeadChip (Immucor), or sequencing were used for molecular analysis. RESULTS In total, 168/223 (75%) weak D and 55/223 (25%) partial D variants were identified. Hemagglutination results varied in methods and anti-D reagents used in this process. There was no standard serologic reactivity identified, which could predict what type of D variant would be identified. Among weak D samples, types 1-3 were the most common, while DAR and DVI were most prevalent among partial D samples. CONCLUSION Our results show that discrepancies found in the serologic typing should be investigated by molecular methods in order to determine the D variant involved and also to distinguish between weak D and partial D. The knowledge of the distribution of weak D types and partial D among populations is important for D- patients and pregnant women management.
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Affiliation(s)
| | - Mariza Aparecida Mota
- Departamento de Hemoterapia e Terapia Celular, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Maria Giselda Aravechia
- Departamento de Hemoterapia e Terapia Celular, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Kelyan Bertani Torres
- Departamento de Hemoterapia e Terapia Celular, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Carolina Bonet Bub
- Departamento de Hemoterapia e Terapia Celular, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
| | - José Mauro Kutner
- Departamento de Hemoterapia e Terapia Celular, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Lilian Castilho
- Departamento de Hemoterapia e Terapia Celular, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Hemocentro Unicamp, Campinas, SP, Brazil
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27
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Valsami S, Dimitroulis D, Gialeraki A, Chimonidou M, Politou M. Current trends in platelet transfusions practice: The role of ABO- RhD and human leukocyte antigen incompatibility. Asian J Transfus Sci 2015; 9:117-23. [PMID: 26420927 PMCID: PMC4562128 DOI: 10.4103/0973-6247.162684] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Platelet transfusions have contributed to the revolutionary modern treatment of hypoproliferative thrombocytopenia. Despite the long-term application of platelet transfusion in therapeutics, all aspects of their optimal use (i.e., in cases of ABO and/or Rh (D incompatibility) have not been definitively determined yet. We reviewed the available data on transfusion practices and outcome in ABO and RhD incompatibility and platelet refractoriness due to anti-human leukocyte antigen (HLA) antibodies. Transfusion of platelets with major ABO-incompatibility is related to reduced posttransfusion platelet (PLT) count increments, compared to ABO-identical and minor, but still are equally effective in preventing clinical bleeding. ABO-minor incompatible transfusions pose the risk of an acute hemolytic reaction of the recipient that is not always related to high anti-A, B donor titers. ABO-identical PLT transfusion seems to be the most effective and safest therapeutic strategy. Exclusive ABO-identical platelet transfusion policy could be feasible, but alternative approaches could facilitate platelet inventory management. Transfusion of platelets from RhD positive donors to RhD negative patients is considered to be effective and safe though is associated with low rate of anti-D alloimmunization due to contaminating red blood cells. The prevention of D alloimmunization is recommended only for women of childbearing age. HLA alloimmunization is a major cause of platelet refractoriness. Managing patients with refractoriness with cross-matched or HLA-matched platelets is the current practice although data are still lacking for the efficacy of this practice in terms of clinical outcome. Leukoreduction contributes to the reduction of both HLA and anti-D alloimmunization.
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Affiliation(s)
- Serena Valsami
- Department of Blood Transfusion, Aretaieion Hospital, Athens University Medical School, Athens, Greece
| | - Dimitrios Dimitroulis
- Department of Propedeutic Surgery, Laiko Hospital, Athens University Medical School, Athens, Greece
| | - Argyri Gialeraki
- Haematology Laboratory and Blood Bank Department, Attikon Hospital, Athens University Medical School, Athens, Greece
| | - Maria Chimonidou
- Department of Blood Transfusion, Aretaieion Hospital, Athens University Medical School, Athens, Greece
| | - Marianna Politou
- Department of Blood Transfusion, Aretaieion Hospital, Athens University Medical School, Athens, Greece
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28
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Walsh CA, Doyle B, Quigley J, McAuliffe FM, Fitzgerald J, Mahony R, Higgins S, Carroll S, McParland P. Reassessing critical maternal antibody threshold in RhD alloimmunization: a 16-year retrospective cohort study. Ultrasound Obstet Gynecol 2014; 44:669-673. [PMID: 24706487 DOI: 10.1002/uog.13383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/02/2014] [Accepted: 03/26/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the critical maternal antibody threshold for specialist referral in cases of RhD alloimmunization. METHODS This was a retrospective cohort study, covering a 16-year period at the national tertiary fetal medicine center for management of alloimmunization. Data concerning RhD alloimmunized pregnant women were extracted from an institutional database and maternal anti-D antibody levels were cross-checked with the national reference laboratory. Fetal hemoglobin (Hb) levels were determined only at the first intrauterine transfusion (IUT) and were compared with the pretransfusion maternal anti-D antibody level (IU/mL). Sensitivity, specificity and positive and negative predictive values of maternal antibody thresholds for detecting moderate to severe (Hb ≤ 0.64MoM) fetal anemia were calculated. RESULTS Between 1996 and 2011, 66 women underwent a first IUT for RhD alloimmunization at our institution. The highest serum anti-D antibody level was extracted for 208 RhD alloimmunized women who did not require IUT during the last 10 years of the study period. The traditional maternal antibody threshold of > 15 IU/mL failed to detect 20% of cases of moderate to severe fetal anemia. The ≥ 4 IU/mL threshold had 100% sensitivity but a 45% false-positive rate. The optimal anti-D antibody threshold for specialist referral in our population was ≥ 6 IU/mL; at this level, no case of moderate to severe anemia was missed and specificity was 61%. Use of this threshold would have eliminated 10% of referrals to our fetal medicine unit without compromising fetal outcomes. CONCLUSIONS Setting the critical maternal RhD antibody level at >15 IU/mL does not provide sufficient sensitivity. The lower threshold of ≥ 4 IU/mL, though sensitive, is associated with a 45% false-positive rate. In our population, a threshold of ≥ 6 IU/mL minimizes false-positive referrals while maintaining 100% sensitivity for moderate to severe fetal anemia.
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Affiliation(s)
- C A Walsh
- Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland
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29
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Li G, Chen F, Rao S, Hu L. Faulty blood typing misled by auto anti-D in AIHA. Transfus Apher Sci 2014; 50:269-70. [PMID: 24508149 DOI: 10.1016/j.transci.2014.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 01/06/2014] [Indexed: 12/01/2022]
Abstract
Pre-transfusion testing is a vital link to enhance patients' safety but may be influenced by heterotypic blood transfusion and disease. Previous history of blood transfusion most of time help us determine the blood type. On the other hand, it can also mislead technicians to a wrong conclusion. Anti-D, which is clinically important in hemolytic transfusion reaction, is either alloimmunized by transfusion, pregnancy or induced in certain diseases. Here, we reported a rare case with false blood identification interfered by heterotypic blood transfusion and auto anti-D in autoimmune hemolytic anemia (AIHA).
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Affiliation(s)
- Guining Li
- Union Hospital of Tongji Medical College, No. 1277 Jie Fang Road, 430022 Wuhan City, Hubei Province, PR China.
| | - Fenghua Chen
- Union Hospital of Tongji Medical College, No. 1277 Jie Fang Road, 430022 Wuhan City, Hubei Province, PR China.
| | - Shenzong Rao
- Union Hospital of Tongji Medical College, No. 1277 Jie Fang Road, 430022 Wuhan City, Hubei Province, PR China.
| | - Lihua Hu
- Union Hospital of Tongji Medical College, No. 1277 Jie Fang Road, 430022 Wuhan City, Hubei Province, PR China.
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