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Latour C, Gaussen A, Beaudoin J, Leiva-Torres GA, Rochette S, Robitaille N. Incidence of acute haemolytic transfusion reaction among ABO-incompatible recipients transfused with A 3 blood: A case series. Vox Sang 2023; 118:854-862. [PMID: 37589206 DOI: 10.1111/vox.13503] [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: 05/04/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND AND OBJECTIVES ABO antigens are among the most immunogenic, but the haemolytic risks of ABO incompatibilities involving a donor with a weak ABO phenotype are little documented. MATERIALS AND METHODS This retrospective case series assessed the incidence of acute haemolytic transfusion reaction (AHTR) among ABO-incompatible recipients of A3 blood in Québec (Canada). Transfusion safety officers reported laboratory AHTR indicators measured ≤24 h pre- and post-transfusion. Because the AHTR case definition of Québec's Hemovigilance System (QHS) leaves significant room for clinical judgement, a two-step approach was used to assess potential cases: Step 1 consisted in a highly sensitive-but unspecific-initial screen that identified all candidate cases per QHS case definition, and Step 2 consisted in a detailed review of candidate cases by two haematologists. RESULTS Nine donors initially typed as Group B (N = 1) or O (N = 8) were subsequently found to display an A3 B or A3 O phenotype. Eighty-one recipients received ABO-incompatible blood, including 53 (65.4%) with interpretable data. Of these, 29 (54.7%) were classified as candidate cases after Step 1. Following Step 2, no conclusive evidence of AHTR was found: Abnormal pre- versus post-transfusion changes appeared modest, within normal range, insufficient to ascertain AHTR, or were consistent with a pre-existing condition unrelated to AHTR. Two candidate cases had a QHS-reported transfusion reaction; both were unrelated to AHTR. CONCLUSION In this case series, no conclusive evidence of serious AHTR was found among ABO-incompatible recipients who were inadvertently transfused with A3 blood.
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Affiliation(s)
| | - Amaury Gaussen
- Medical Affairs and Innovation, Héma-Québec, Québec City, Quebec, Canada
| | - Julie Beaudoin
- Quality Control and Development, Héma-Québec, Montréal, Quebec, Canada
| | | | - Samuel Rochette
- Medical Affairs and Innovation, Héma-Québec, Montréal, Quebec, Canada
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Opi DH, Ndila CM, Uyoga S, Macharia AW, Fennell C, Ochola LB, Nyutu G, Siddondo BR, Ojal J, Shebe M, Awuondo KO, Mturi N, Peshu N, Tsofa B, Band G, Maitland K, Kwiatkowski DP, Rockett KA, Williams TN, Rowe JA. Non-O ABO blood group genotypes differ in their associations with Plasmodium falciparum rosetting and severe malaria. PLoS Genet 2023; 19:e1010910. [PMID: 37708213 PMCID: PMC10522014 DOI: 10.1371/journal.pgen.1010910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 09/26/2023] [Accepted: 08/08/2023] [Indexed: 09/16/2023] Open
Abstract
Blood group O is associated with protection against severe malaria and reduced size and stability of P. falciparum-host red blood cell (RBC) rosettes compared to non-O blood groups. Whether the non-O blood groups encoded by the specific ABO genotypes AO, BO, AA, BB and AB differ in their associations with severe malaria and rosetting is unknown. The A and B antigens are host RBC receptors for rosetting, hence we hypothesized that the higher levels of A and/or B antigen on RBCs from AA, BB and AB genotypes compared to AO/BO genotypes could lead to larger rosettes, increased microvascular obstruction and higher risk of malaria pathology. We used a case-control study of Kenyan children and in vitro adhesion assays to test the hypothesis that "double dose" non-O genotypes (AA, BB, AB) are associated with increased risk of severe malaria and larger rosettes than "single dose" heterozygotes (AO, BO). In the case-control study, compared to OO, the double dose genotypes consistently had higher odds ratios (OR) for severe malaria than single dose genotypes, with AB (OR 1.93) and AO (OR 1.27) showing most marked difference (p = 0.02, Wald test). In vitro experiments with blood group A-preferring P. falciparum parasites showed that significantly larger rosettes were formed with AA and AB host RBCs compared to OO, whereas AO and BO genotypes rosettes were indistinguishable from OO. Overall, the data show that ABO genotype influences P. falciparum rosetting and support the hypothesis that double dose non-O genotypes confer a greater risk of severe malaria than AO/BO heterozygosity.
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Affiliation(s)
- D. Herbert Opi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Carolyne M. Ndila
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Sophie Uyoga
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Alex W. Macharia
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Clare Fennell
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Lucy B. Ochola
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Gideon Nyutu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bethseba R. Siddondo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - John Ojal
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mohammed Shebe
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kennedy O. Awuondo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Neema Mturi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Norbert Peshu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Benjamin Tsofa
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Gavin Band
- Wellcome Centre for Human Genetics, Oxford, United Kingdom
| | - Kathryn Maitland
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Institute for Global Health Innovation, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | | | | | - Thomas N. Williams
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Institute for Global Health Innovation, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - J. Alexandra Rowe
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Nair R, Gogri H, Kulkarni S, Gupta D. Detection of a rare subgroup of A phenotype while resolving ABO discrepancy. Asian J Transfus Sci 2020; 13:129-131. [PMID: 31896920 PMCID: PMC6910028 DOI: 10.4103/ajts.ajts_118_17] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/08/2018] [Indexed: 11/04/2022] Open
Abstract
Weaker subgroups of ABO blood group system give rise to discrepancies between forward and reverse grouping and cause diagnostic difficulties in routine blood banking. Weaker subgroups of A blood group that have been reported so far include A3, Aend, Ax, Am, Ay, and Ael. We report a case of a 54-year-old patient whose red cells showed a discrepancy between cell and serum grouping on initial testing. Serological investigation included absorption elution tests and saliva testing after performing initial blood grouping. Molecular genotyping of the ABO gene was performed by DNA sequencing of exons 6 and 7 of the ABO gene. The serological characteristics of the patient's red cells were similar to Ax subtype. The patient was a secretor and only H substance was present in the saliva. Serum did not show the presence of anti-A1. Molecular genotyping confirmed the ABO status as Aw06/O13. The weak A phenotype identified in the propositus had serological characteristics similar to Ax and showed the ABO genotype Aw06/O13. Although Aw06 allele has been previously reported in the Indian population, this is the first study to report O13 allele in the Indian population.
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Affiliation(s)
- Revathy Nair
- Department of Transfusion Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Harita Gogri
- Department of Transfusion Medicine, National Institute of Immunohaematology, Mumbai, Maharashtra, India
| | - Swati Kulkarni
- Department of Transfusion Medicine, National Institute of Immunohaematology, Mumbai, Maharashtra, India
| | - Debasish Gupta
- Department of Transfusion Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Kaur G, Kaur P, Basu S, Kaur R. Blood group discrepancies at a tertiary care centre - analysis and resolution. Int J Lab Hematol 2013; 36:481-7. [DOI: 10.1111/ijlh.12176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 10/24/2013] [Indexed: 12/01/2022]
Affiliation(s)
- G. Kaur
- Department of Transfusion Medicine; Government Medical College and Hospital; Chandigarh India
| | - P. Kaur
- Department of Transfusion Medicine; Government Medical College and Hospital; Chandigarh India
| | - S. Basu
- Department of Transfusion Medicine; Government Medical College and Hospital; Chandigarh India
| | - R. Kaur
- Department of Transfusion Medicine; Government Medical College and Hospital; Chandigarh India
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Svensson L, Bindila L, Angström J, Samuelsson BE, Breimer ME, Rydberg L, Henry SM. The structural basis of blood group A-related glycolipids in an A3 red cell phenotype and a potential explanation to a serological phenomenon. Glycobiology 2010; 21:162-74. [PMID: 20926599 DOI: 10.1093/glycob/cwq143] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Glycolipids from the red cells of a rare blood group A subgroup individual, expressing the blood group A(3) phenotype with the classical mixed-field agglutination phenomenon, A(2(539G>A))/O(1) genotype, and an unusual blood group A glycolipid profile, were submitted to a comprehensive biochemical and structural analysis. To determine the nature of blood group A glycolipids in this A(3) phenotype, structural determination was carried out with complementary techniques including proton nuclear magnetic resonance (1D and 2D), mass spectrometry (MS) (nano-electrospray ionization/quadrupole time-of-flight and tandem mass spectrometry) and thin layer chromatography with immunostaining detection. As expected, total blood group A structures were of low abundance, but contrary to expectations extended-A type 2 and A type 3 glycolipids were more dominant than A hexaglycosylceramides based on type 2 chain (A-6-2 glycolipids), which normally is the major A glycolipid. Several para-Forssman (GalNAcβ3GbO(4)) structures, including extended forms, were identified but surmised not to contribute to the classic mixed-field agglutination of the A(3) phenotype. It is proposed that the low level of A antigen combined with an absence of extended branched glycolipids may be the factor determining the mixed-field agglutination phenomenon in this individual.
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Affiliation(s)
- Lola Svensson
- Department of Clinical Chemistry and Transfusion Medicine, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Shastry S, Bhat S. Imbalance in A₂ and A₂B phenotype frequency of ABO group in South India. Blood Transfus 2010; 8:267-70. [PMID: 20967168 PMCID: PMC2957492 DOI: 10.2450/2010.0147-09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 05/04/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND The heterogeneity of A and B alleles results in weak variants of these antigens. Subgroups of A differ from each other quantitatively and qualitatively. The expected frequencies of A₁ and A₂ subtypes will be in Hardy-Weinberg equilibrium for the Mendelian inheritance of the allelic A₁ and A₂ genes. The frequency of A subgroups in the population from south India is not known. The aim of our study was to study the frequency of A subtypes and the prevalence of anti-A₁ antibody among this population. METHODS Over a period of 3 years, patients' blood group was typed using a standard tube technique. Anti-A₁ lectin studies were done for all patients with groups A and AB. Based on serological reactivity the samples were classified into A₁/A₁B, A₂/A₂B and weak A subgroups. The prevalence of A subgroups was determined. The significance of differences in proportions was analysed using the chi-square test. RESULTS A total of 40,113 patients' samples were typed for ABO, Rh group and A subgroups in our blood bank attached to a tertiary care hospital. Among 10,325 group A samples, 98.14% classified as A₁, 1.07% as A₂, and 0.01% as weak A; the remaining group A samples were from neonates and reacted poorly with anti A₁-lectin. The majority of AB samples (n=2,667) were of A₁B type (89.28%). However, the proportion of A₂B (8.99%) among AB samples was significantly higher than that of A(2) in group A samples (p < 0.0001). The prevalence of anti-A(1) antibodies among A₂ and A₂B samples was 1.8% and 3.75%, respectively, and none of them showed reactivity at 37°C. CONCLUSION The results of our study show a significantly higher proportion of A₂B subtypes than A₂ subgroups. A similar imbalance is seen in blacks and Japanese. The incidence of anti-A₁ antibodies is also higher among A₂B patients.
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Affiliation(s)
- Shamee Shastry
- Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
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Abstract
PURPOSE OF REVIEW This review describes the current state-of-the-art with respect to the modification of red blood cells for creating quality controls for use in immunohaematology. RECENT FINDINGS The author has identified five technologies able to create modified red blood cells potentially suitable for use in quality control. Two of the technologies use enzymes, glycosidases or glycosyltransferases, to modify red blood cells and create ABO quality control cells. A third technology uses polyethylene glycol to reduce antigen expression by masking epitopes, whereas a fourth technology is speculative and involves the in-vitro generation of genetically modified erythroid cells. None of these four technologies are in routine use to make commercially available quality controls. A fifth commercially available technology creates quality controls by adding synthetic blood group A and B antigens (FSLs) to group O red blood cells, creating what are referred to as 'kodecytes'. This technology is also being used to add blood group peptides onto red cells for use in the future in a range of diagnostic applications. SUMMARY Transducing cell-derived erythroid populations with blood group encoding or silencing vectors, and the use of FSLs to create kodecytes, are two technologies with the potential to provide quality controls for laboratory use.
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Svensson L, Rydberg L, Hellberg A, Gilliver LG, Olsson ML, Henry SM. Novel glycolipid variations revealed by monoclonal antibody immunochemical analysis of weak ABO subgroups of A. Vox Sang 2005; 89:27-38. [PMID: 15938737 DOI: 10.1111/j.1423-0410.2005.00642.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The chemical basis of the subgroups of A is largely unknown. We used thin-layer chromatography immunochemical staining techniques together with a range of characterized monoclonal reagents to analyse glycolipids isolated from a variety of weak subgroups. MATERIALS AND METHODS Glycolipids isolated from red cells collected from nine genetically defined individuals of the rare subgroups of A, including a novel A(3) allele (A(2) 539G>A) not described previously, were subjected to a highly sensitive thin-layer chromatographic immunochemical analysis. RESULTS Semicharacterized monoclonal antibodies revealed that, in addition to the expected quantitative differences between common phenotypes and the weak subgroups, qualitative glycolipid differences (or at least an apparent qualitative basis), caused by major changes in the ratios of different structures exist. Specifically it was found that the weakest A-expressing samples (A(el) phenotype) appeared to express an unusual A structure in the 8-12 sugar region. Variable expression of several structures in one of the A weak samples were suggestive of novel blood group A structures. CONCLUSIONS Although no structural characterization could be undertaken, the results are clearly indicative that the variant glycosyltransferases of the rare ABO subgroups are not only inefficient, but they may potentially synthesize novel ABO structures.
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Affiliation(s)
- L Svensson
- Blood Centre, Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Hansen T, Namork E, Olsson ML, Alan Chester M, Heier HE. Different Genotypes Causing Indiscernible Patterns of A Expression on A el Red Blood Cells as Visualized by Scanning Immunogold Electron Microscopy. Vox Sang 1998. [DOI: 10.1046/j.1423-0410.1998.7510047.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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