1
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Yin Q. DEL variants: review of molecular mechanisms, clinical consequences and molecular testing strategy. Funct Integr Genomics 2023; 23:318. [PMID: 37840046 DOI: 10.1007/s10142-023-01249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
Patients with DEL phenotype, a D variant with a low number of D antigens per red blood cell, are routinely typed as RhD-negative in serology testing and are detectable only by adsorption and elution techniques or molecular methods. DEL is of clinical importance worldwide, as indicated by its genotype-phenotype discrepancies among different populations and its potential to cause anti-D alloimmunization when DEL phenotype individuals are inadvertently managed as RhD-negative. This narrative review summarized the DEL alleles causing DEL phenotype and the underlying mechanisms. The clinical consequences and current molecular testing approach were discussed to manage the transfusion needs of patients and donors with DEL phenotype.
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Affiliation(s)
- Qinan Yin
- Henan Engineering Research Center of Digital Pathology and Artificial Intelligence Diagnosis, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
- Precision Medicine Laboratory, School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China.
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2
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Ohto H, Albert Flegel W, Safic Stanic H. When should RhD-negative recipients be spared the transfusion of DEL red cells to avoid anti-D alloimmunization? Transfusion 2022; 62:2405-2408. [PMID: 36156264 PMCID: PMC9643616 DOI: 10.1111/trf.17122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hitoshi Ohto
- Department of Mesenchymal Stem Cell Research, and Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Hana Safic Stanic
- Department of Immunohematology, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
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3
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Floch A, Pirenne F, Barrault A, Chami B, Toly-Ndour C, Tournamille C, de Brevern AG. Insights into anti-D formation in carriers of RhD variants through studies of 3D intraprotein interactions. Transfusion 2021; 61:1286-1301. [PMID: 33586199 DOI: 10.1111/trf.16301] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/04/2020] [Accepted: 01/13/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Many RhD variants associated with anti-D formation (partial D) in carriers exposed to the conventional D antigen carry mutations affecting extracellular loop residues. Surprisingly, some carry mutations affecting transmembrane or intracellular domains, positions not thought likely to have a major impact on D epitopes. STUDY DESIGN AND METHODS A wild-type Rh trimer (RhD1 RhAG2 ) was modeled by comparative modeling with the human RhCG structure. Taking trimer conformation, residue accessibility, and position relative to the lipid bilayer into account, we redefine the domains of the RhD protein. We generated models for RhD variants carrying one or two amino acid substitutions associated with anti-D formation in published articles (25 variants) or abstracts (12 variants) and for RHD*weak D type 38. We determined the extracellular substitutions and compared the interactions of the variants with those of the standard RhD. RESULTS The findings of the three-dimensional (3D) analysis were correlated with anti-D formation for 76% of RhD variants: 15 substitutions associated with anti-D formation concerned extracellular residues, and structural differences in intraprotein interactions relative to standard RhD were observed in the others. We discuss the mechanisms by which D epitopes may be modified in variants in which the extracellular residues are identical to those of standard RhD and provide arguments for the benignity of p.T379M (RHD*DAU0) and p.G278D (RHD*weak D type 38) in transfusion medicine. CONCLUSION The study of RhD intraprotein interactions and the precise redefinition of residue accessibility provide insight into the mechanisms through which RhD point mutations may lead to anti-D formation in carriers.
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Affiliation(s)
- Aline Floch
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - France Pirenne
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Aurélie Barrault
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Btissam Chami
- Etablissement francais du sang Ile-de-France, Creteil, France
| | - Cécile Toly-Ndour
- Unité Fonctionnelle d'expertise en Immuno-Hémobiologie Périnatale, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Service de Médecine Fœtale, Pôle Périnatalité, Hôpital Trousseau, GH HUEP, APHP, Paris, France
| | - Christophe Tournamille
- Univ Paris Est Creteil, INSERM U955, Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France.,Etablissement francais du sang Ile-de-France, Creteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Alexandre G de Brevern
- Laboratoire d'Excellence GR-Ex, Paris, France.,Université de Paris, Biologie Intégrée du Globule Rouge UMR_S1134, Inserm, Université de la Réunion, Université des Antilles, Paris, France.,Institut National de la Transfusion Sanguine (INTS), Paris, France
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4
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Matteocci A, Monge-Ruiz J, Stef M, Apraiz I, Herrera-Del-Val L, Mancuso T, Fennell K, Lopez M, Larizgoitia-Martin Y, Nespoli G, Rubia-Tejero M, Collaretti A, Pierelli L, Ochoa-Garay G. Two new RHD alleles with deletions spanning multiple exons. Transfusion 2020; 61:682-686. [PMID: 33241598 DOI: 10.1111/trf.16199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/29/2020] [Accepted: 10/11/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The most common large-deletion RHD allele (RHD*01N.01) includes the entire coding sequence, intervening regions and untranslated regions. The rest of large-deletion RHD alleles reported to-date consist of single-exon deletions, such as RHD*01N.67 which includes exon 1. MATERIALS AND METHODS Samples from two donors with RhD-negative serology yielded unclear or inconclusive results when subject to confirmatory testing on RHD genotyping arrays. To determine their RHD genotypes, genomic DNA was analyzed with a combination of allele-specific PCR, long-range PCR, Sanger sequencing, and next-generation sequencing assays. RESULTS Allele-specific PCR failed to detect products for RHD exons 1 to 3 in one sample and RHD exons 1 to 5 in the other. A quantitative next-generation sequencing assay confirmed deletion of exons 1 to 3 and 1 to 5 respectively, and detected the absence of an RHD gene in trans in both samples. Long-range PCR and Sanger sequencing enabled identification of the breakpoints for both alleles. Both deletions start within the 5' Rhesus box (upstream of the identity region for the 1-to-3 deletion, downstream of it for the 1-to-5 deletion), and end within introns. CONCLUSIONS Resolution of unclear or inconclusive results from targeted genotyping arrays often leads to the discovery of new alleles. The 5' Rhesus box may be a hot spot for genetic recombination events, such as the large deletions described in this report.
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Affiliation(s)
| | - Jorge Monge-Ruiz
- Osakidetza, Basque Center for Blood Transfusion and Human Tissues, Galdakao, Spain.,Biocruces Bizkaia Health Research Institute, Cell Therapy, Stem Cells and Tissues Group, Barakaldo, Spain
| | - Marianne Stef
- Grifols Immunohematology Center, San Marcos, Texas, USA
| | | | - Lara Herrera-Del-Val
- Osakidetza, Basque Center for Blood Transfusion and Human Tissues, Galdakao, Spain.,Biocruces Bizkaia Health Research Institute, Cell Therapy, Stem Cells and Tissues Group, Barakaldo, Spain
| | | | - Katie Fennell
- Grifols Immunohematology Center, San Marcos, Texas, USA
| | | | | | - Guido Nespoli
- Transfusion Medicine Unit, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Angela Collaretti
- Transfusion Medicine Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Luca Pierelli
- Transfusion Medicine Unit, San Camillo Forlanini Hospital, Rome, Italy.,Department of Experimental Medicine, Sapienza University, Rome, Italy
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5
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Safic Stanic H, Dogic V, Herceg I, Jagnjic S, Bingulac‐Popovic J, Babic I, Corusic A, Jukic I. D variants in the population of D‐negative blood donors in the north‐eastern region of Croatia. Transfus Med 2020; 31:43-47. [DOI: 10.1111/tme.12726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Hana Safic Stanic
- Department of Molecular Diagnostics Croatian Institute of Transfusion Medicine Zagreb Croatia
| | - Vesna Dogic
- Department of Molecular Diagnostics Croatian Institute of Transfusion Medicine Zagreb Croatia
| | - Ivona Herceg
- Department of Molecular Diagnostics Croatian Institute of Transfusion Medicine Zagreb Croatia
| | - Sandra Jagnjic
- Department of Immunohematology Croatian Institute of Transfusion Medicine Zagreb Croatia
| | - Jasna Bingulac‐Popovic
- Department of Molecular Diagnostics Croatian Institute of Transfusion Medicine Zagreb Croatia
| | - Ivana Babic
- Department of Molecular Diagnostics Croatian Institute of Transfusion Medicine Zagreb Croatia
| | - Ante Corusic
- Directory University Hospital Centre Zagreb Zagreb Croatia
- School of Medicine University of Zagreb Zagreb Croatia
| | - Irena Jukic
- Medical Department Croatian Institute of Transfusion Medicine Zagreb Croatia
- Faculty of Medicine Josip Juraj Strossmayer University of Osijek Osijek Croatia
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6
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Matteocci A, Mancuso T, Pirelli F, Hailemariam T, Moscetti A, Castagna K, Collaretti A, Rogai L, Nespoli G, Grammatico P, Pierelli L. Two novel RHD
alleles encoding truncated, nonfunctional D polypeptides. Transfusion 2018; 58:2082-2083. [DOI: 10.1111/trf.14657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/08/2018] [Accepted: 03/18/2018] [Indexed: 10/17/2022]
Affiliation(s)
| | | | - Federica Pirelli
- Transfusion Medicine Unit; San Camillo Forlanini Hospital; Rome Italy
| | | | | | | | - Angela Collaretti
- Transfusion Medicine Unit; San Camillo Forlanini Hospital; Rome Italy
| | - Letizia Rogai
- Transfusion Medicine Unit; San Camillo Forlanini Hospital; Rome Italy
| | - Guido Nespoli
- Transfusion Medicine Unit; San Camillo Forlanini Hospital; Rome Italy
| | - Paola Grammatico
- Medical Genetics Unit; San Camillo Forlanini Hospital; Rome Italy
- Department of Molecular Medicine; Sapienza University; Rome Italy
| | - Luca Pierelli
- Transfusion Medicine Unit; San Camillo Forlanini Hospital; Rome Italy
- Department of Experimental Medicine; Sapienza University; Rome Italy
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7
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Dezan MR, Guardalini LGO, Pessoa E, Ribeiro IH, Oliveira VB, Luz F, Novac DR, Gallucci A, Bonifácio S, Gomes F, Levi JE, Pereira AC, Krieger JE, Mendrone-Junior A, Rocha V, Dinardo CL. Evaluation of the applicability and effectiveness of a molecular strategy for identifying weak D and DEL phenotype among D- blood donors of mixed origin exhibiting high frequency ofRHD*Ψ. Transfusion 2017; 58:317-322. [DOI: 10.1111/trf.14425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/01/2017] [Accepted: 10/22/2017] [Indexed: 01/28/2023]
Affiliation(s)
| | | | - Elaine Pessoa
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
| | | | | | - Fabio Luz
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
| | | | - António Gallucci
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
| | - Silvia Bonifácio
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
| | - Francisco Gomes
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
| | - José E. Levi
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
| | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology; Heart Institute (InCor), University of São Paulo School of Medicine
| | - Jose E. Krieger
- Laboratory of Genetics and Molecular Cardiology; Heart Institute (InCor), University of São Paulo School of Medicine
| | | | - Vanderson Rocha
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
- Discipline of Hematology; University of São Paulo School of Medicine; São Paulo Brazil
| | - Carla Luana Dinardo
- Immunohematology Division; Fundação Pró-Sangue, Hemocentro de São Paulo
- Laboratory of Genetics and Molecular Cardiology; Heart Institute (InCor), University of São Paulo School of Medicine
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8
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Granier T, Chiaroni J, Bailly P, Silvy M. First description of a D-CE-D hybrid gene on a weak D Type 2 molecular background. Transfusion 2017; 57:1248-1253. [PMID: 28164316 DOI: 10.1111/trf.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/12/2016] [Accepted: 12/16/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND RhD phenotypes that express a significantly reduced amount of RhD antigen per red blood cell may be mistyped as RhD-negative by standard serologic methods. The molecular identification of weak D Type 1, 2, or 3 carriers allows managing them as RhD-positive and, thus, rationalizes the use of RhD-negative stock units and the administration of Rh-immunoglobulin prophylaxis, avoiding unnecessary costs and possible side effects. STUDY DESIGN AND METHODS One sample was investigated for confirming a D-C-E+c+e- phenotype. Rh phenotyping was performed with the microplate direct hemagglutination test. DNA array analysis was performed using the BeadChip wRhD kit, and the RHD gene was explored by sequencing to determine the molecular background associated with RhD-negative phenotype. RESULTS Molecular investigations showed a lack of amplification of Exons 3 through 7 and c.1154G>T transversion in Exon 9, suggesting an RHD-CE-D composite on a weak D Type 2 background. We attempted to precisely identify the two recombination sites generating this hybrid allele. The 5' and 3' breakpoints were located in Introns 2 and 7, which showed concentration of mobile Alu sequences most likely involved in the RHD-cE(3-7)-weak D Type 2 allele. CONCLUSION Altogether, we identified the first example of an RHD-CE-D large hybrid allele on a weak D Type 2 background associated with an RhD-negative phenotype. By investigating the RHCE-D breakpoint zones, we suggest a mobile element-mediated recombination.
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Affiliation(s)
- Thomas Granier
- Etablissement Français du Sang Alpes Méditerranée.,Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguin,", Marseille, France
| | - Jacques Chiaroni
- Etablissement Français du Sang Alpes Méditerranée.,Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguin,", Marseille, France
| | - Pascal Bailly
- Etablissement Français du Sang Alpes Méditerranée.,Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguin,", Marseille, France
| | - Monique Silvy
- Etablissement Français du Sang Alpes Méditerranée.,Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguin,", Marseille, France
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9
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Abstract
The clinical importance of blood group antigens relates to their ability to evoke immune antibodies that are capable of causing hemolysis. The most important antigens for safe transfusion are ABO and D (Rh), and typing for these antigens is routinely performed for patients awaiting transfusion, prenatal patients, and blood donors. Typing for other blood group antigens, typically of the Kell, Duffy, Kidd, and MNS blood groups, is sometimes necessary, for patients who have, or are likely to develop antibodies to these antigens. The most commonly used typing method is serological typing, based on hemagglutination reactions against specific antisera. This method is generally reliable and practical for routine use, but it has certain drawbacks. In recent years, molecular typing has emerged as an alternative or supplemental typing method. It is based on detecting the polymorphisms and mutations that control the expression of blood group antigens, and using this information to predict the probable antigen type. Molecular typing methods are useful when traditional serological typing methods cannot be used, as when a patient has been transfused and the sample is contaminated with red blood cells from the transfused blood component. Moreover, molecular typing methods can precisely identify clinically significant variant antigens that cannot be distinguished by serological typing; this capability has been exploited for the resolution of typing discrepancies and shows promise for the improved transfusion management of patients with sickle cell anemia. Despite its advantages, molecular typing has certain limitations, and it should be used in conjunction with serological methods.
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10
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Silva-Malta MCF, Araujo NCF, Vieira OVN, Schmidt LC, Gonçalves PDC, Martins ML. Dried blood spots of pooled samples for RHD gene screening in blood donors of mixed ancestry. Transfus Med 2015; 25:337-41. [PMID: 26287575 DOI: 10.1111/tme.12235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/09/2015] [Accepted: 07/28/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In this study, we present a strategy for RHD gene screening based on real-time polymerase chain reaction (PCR) using dried blood spots of pooled samples. BACKGROUND Molecular analysis of blood donors may be used to detect RHD variants among the presumed D-negative individuals. RHD genotyping using pooled samples is a strategy to test a large number of samples at a more reasonable cost. MATERIALS AND METHODS RHD gene detection based on real-time PCR using dried blood spots of pooled samples was standardised and used to evaluate 1550 Brazilian blood donors phenotyped as RhD-negative. Positive results were re-evaluated by retesting single samples using real-time PCR and conventional multiplex PCR to amplify five RHD-specific exons. PCR-sequence-specific primers was used to amplify RHDψ allele. RESULTS We devised a strategy for RHD gene screening using dried blood spots of five pooled samples. Among 1550 serologically D-negative blood donors, 58 (3.74%) had the RHD gene. The non-functional RHDψ allele was detected in 47 samples (3.02%). CONCLUSION The present method is a promising strategy to detect the RHD gene among presumed RhD-negative blood donors, particularly for populations with African ancestry.
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Affiliation(s)
- M C F Silva-Malta
- Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Hemominas, Minas Gerais, Brazil
| | - N C Fidélis Araujo
- Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Hemominas, Minas Gerais, Brazil
| | - O V Neves Vieira
- Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Hemominas, Minas Gerais, Brazil
| | - L Cayres Schmidt
- Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Hemominas, Minas Gerais, Brazil
| | - P de Cassia Gonçalves
- Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Hemominas, Minas Gerais, Brazil
| | - M Lobato Martins
- Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Hemominas, Minas Gerais, Brazil
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11
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Affiliation(s)
- T. Peyrard
- Département Centre National de Référence pour les Groupes Sanguins; Institut National de la Transfusion Sanguine (INTS); Paris France
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12
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Meyer S, Trost N, Frey BM, Gassner C. Parallel donor genotyping for 46 selected blood group and 4 human platelet antigens using high-throughput MALDI-TOF mass spectrometry. Methods Mol Biol 2015; 1310:51-70. [PMID: 26024625 DOI: 10.1007/978-1-4939-2690-9_5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Most blood group antigens are defined by single nucleotide polymorphisms (SNPs). Highly accurate MALDI-TOF MS has proven its potential in SNP genotyping and was therefore chosen for blood donor oriented genotyping with high-throughput capability, e.g., 380 samples per day. The Select Module covers a total of 36 SNPs in two single-tube reactions, representative of 46 blood group and 4 human platelet antigens. Using this tool, confirmatory blood group typing for RhD, RhCE, Kell, Kidd, Duffy, MN, Ss, and selected rare antigens is performed on a routine basis.
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Affiliation(s)
- Stefan Meyer
- Department of Molecular Diagnostics and Research (MOC), Swiss Red Cross Blood Transfusion Service Zurich, Rütistrasse 19, 8952, Schlieren, Switzerland
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