Measurement of titres of naturally occurring alloantibodies against feline blood group antigens in the UK

Wild Felids Blood Group System

Wild felids and domestic cats share the AB blood group. However, there have been few studies regarding the characterization and prevalence of the different blood types in wild animals. The erythrocyte membrane glycolipids of the wild cats correspond to the major disialoganglioside patterns observed in domestic cats. Like in domestic cats, type A blood seems to be the most common, although wild felid species seem to exhibit one single blood type. Of the species studied, the wild domestic cats, and the Panthera and ocelot lineages, all had type A blood; the Puma lineage showed almost exclusively type B blood. The prevalence of wild felids blood types show that there seems to be variation between species, but not within species, and no evidence of geographical variation has yet been found, showing apparently no genetic variability. The presence of alloantibodies has also been demonstrated, so the risk of life-threatening transfusion reactions due to mismatched transfusions and neonatal isoerythrolysis is a possibility. Like in other species, the recognition of wild felids blood groups is clinically relevant, as it can also be important in establishing phylogenetic relationships within the Felidae family. We will review the current knowledge on this topic and give insights into the wild felids blood groups potential for zoo transfusion medicine and phylogenetic studies in order to help support reintroduction projects and to preserve genetic diversity.

2021 ISFM Consensus Guidelines on the Collection and Administration of Blood and Blood Products in Cats

PRACTICAL RELEVANCE

Blood and blood products are increasingly available for practitioners to use in the management of haematological conditions, and can be lifesaving and therapeutically useful for patients with anaemia and/or coagulopathies. It is important for feline healthcare that donors are selected appropriately, and transfusions of blood or blood products are given to recipients that will benefit from them. Complications can occur, but can be largely avoided with careful donor management and recipient selection, understanding of blood type compatibility, and transfusion monitoring.

CLINICAL CHALLENGES

Feline blood transfusion, while potentially a lifesaving procedure, can also be detrimental to donor and recipient without precautions. Cats have naturally occurring alloantibodies to red cell antigens and severe reactions can occur with type-mismatched transfusions. Blood transfusions can also transmit infectious agents to the recipient, so donor testing is essential. Finally, donors must be in good health, and sedated as appropriate, with blood collected in a safe and sterile fashion to optimise the benefit to recipients. Transfusion reactions are possible and can be mild to severe in nature. Autologous blood transfusions and xenotransfusions may be considered in certain situations.

EVIDENCE BASE

These Guidelines have been created by a panel of authors convened by the International Society of Feline Medicine (ISFM), based on available literature. They are aimed at general practitioners to provide a practical guide to blood typing, cross-matching, and blood collection and administration.

Molecular characterization of cytidine monophospho-N-acetylneuraminic acid hydroxylase (CMAH) gene and frequency of blood types in stray cats of İzmir, Turkey

Background

Cytidine monophospho-n-acetylneuraminic acid hydroxylase (CMAH) gene associated with blood groups in cats encodes CMAH enzyme that converts Neu5Ac to Neu5Gc. Although variations in CMAH gene of pedigree cats have been revealed, the presence/lack of them in non-pedigree stray cats is unknown. Therefore, the present study aimed to investigate the variations in CMAH gene and the quantity of Neu5Ac and Neu5Gc on erythrocytes of non-pedigree stray cats (n:12) living in İzmir, Turkey. Also, the frequency of blood types was determined in 76 stray cats including 12 cats that were used for CMAH and Neu5A/Neu5Gc analysis.

Results

In total, 14 SNPs were detected in 5’UTR as well as in exon 2, 4, 9, 10, 11 and 12 of CMAH gene. Among these SNPs, -495 C > T in 5’UTR was detected for the first time as heterozygous in type A and AB cats, and homozygous and heterozygous in type B cats. The remaining 13 that have been detected in previous studies were also found as homozygous or heterozygous. Both Neu5Gc and Neu5Ac were detected in type A and AB cats. In type B cats, only Neu5Ac was detected. Among two type AB cats, the level of Neu5Ac was found higher in cat carrying heterozygous form (T/C) of 1392T > C. The prevalence of type B cats (67.1 %) was higher than others.

Conclusions

The presence of a new SNP as well as previous SNPs indicates that more variations can be found in stray cats with a more comprehensive study in the future. Also, the high prevalence of type B cats demonstrates the possible risk of neonatal isoerythrolysis among stray cats living in İzmir, Turkey.

Frequency of Blood Types A, B and AB in a Population of Non-Pedigree Domestic Cats from Central Italy

Simple Summary

This study aimed to evaluate the frequency of AB blood groups in non-pedigree domestic cats in Central Italy. The presence of natural alloantibodies in the feline blood group system can cause life-threatening transfusion reactions due to mismatched transfusion and, depending on the parents’ blood type, can also account for hemolytic reactions in newborn kittens. Based on the frequency of the AB blood groups found in the 483 cats studied, a potential risk (6.5%) of acute hemolytic transfusion or neonatal reactions was calculated. Therefore, determining the blood group in non-pedigree domestic cats from Central Italy before transfusion is strongly recommended, as has been reported for other geographical areas. Moreover, particular attention should be paid to the mating of non-purebred cats.

Abstract

Blood transfusion reactions and neonatal isoerythrolysis are common events in the feline population due to the presence of natural alloantibodies in the AB blood group system. It is known that the frequency of feline blood types varies according to the geographic region and breed. Therefore, the aims of this study were to investigate the frequency of AB blood groups in non-pedigree domestic cats in Central Italy and estimate the risk of a life-threatening transfusion reaction and neonatal isoerythrolysis, caused by mismatched transfusion or incompatible random mating, respectively. The AB blood group was determined on non-pedigree domestic feline patients and potential blood donors submitted at the Veterinary Teaching Hospitals of the Universities of Teramo (Abruzzo Region, Teramo, Italy) and Perugia (Umbria Region, Teramo, Italy), and visited at veterinary practitioners in Rome (Lazio Region, Teramo, Italy) using commercial immunochromatographic cartridges and commercial agglutination cards. There were four hundred and eighty-three cats included in the study. The frequencies of the blood types were: 89.9% type A, 7.0% type B, and 3.1% type AB. The probability of an acute hemolytic transfusion reaction or a neonatal isoerythrolysis was 6.5%. Although the frequency of type B in non-pedigree domestic cats living in Central Italy was relatively low, to reduce the risk of fatal transfusion reactions, blood group typing is recommended before each transfusion.

Prevalence of Blood Types and Alloantibodies of the AB Blood Group System in Non-Pedigree Cats from Northern (Lombardy) and Southern (Sicily) Italy

Simple Summary

The most important blood group system in cats is the AB, in which cats are classified as type-A, B or AB. Cats have antibodies against the blood type they do not possess, called alloantibodies. The aims of this study were to update blood type prevalence in cats from Northern Italy and study for the first time the blood type in cats from an insular region of Southern Italy, Sicily; to detect alloantibodies in these feline populations; to compare results with previous studies performed in Italy and between regions in Northern and Southern Italy. Cats from Southern Italy had the highest prevalence of type-B and type-AB, and the lowest prevalence of type-A blood in Italy. In particular, type-AB prevalence was higher than all previous reports in non-pedigree cats in Europe and the Italian prevalence of anti-type-B alloantibodies in type-A cats was the lowest reported worldwide. These results highlight the usefulness of regional studies to report different prevalences in feline blood types. Compatibility tests such as blood typing and cross matching must be considered fundamental in cats of any origin to ensure safe and efficient blood transfusion and to prevent neonatal isoerythrolysis.

Abstract

The aims of this study were to determine the prevalence of A, B and AB blood types and alloantibodies in non-pedigree cats from two regions, one in Northern and one in Southern Italy (Lombardy and Sicily, respectively). A total of 448 samples (52.0% from Northern and 48.0% from Southern Italy) were blood typed. The prevalence of A, B and AB blood types in northern and southern cats were 91.0%, 5.2%, 3.8%, and 77.2%, 12.1% and 10.7%, respectively. The prevalence of type-A blood in southern cats was significantly lower (p = 0.0001) than in northern cats, while type-B and AB blood were significantly higher (p = 0.0085 and p = 0.0051, respectively) in Southern compared to Northern Italian cats. Alloantibodies against type-A blood were found in 94.1% of type-B cats, 11.2% of type-A cats had alloantibodies against type-B blood, while no type-AB cats had alloantibodies with no significant difference between the two Italian populations. Type-AB prevalence in non-pedigree cats in Southern Italy was the highest reported in Europe. Italian type-A cats had the lowest worldwide prevalence of alloantibodies against type-B blood. These results highlight the usefulness of regional studies to report different prevalences in feline blood types and reinforce the importance of blood typing cats before transfusions and mating.

The Prevalence of Blood Groups in Domestic Cats in the Saskatoon and Calgary Areas of Saskatchewan and Alberta, Canada

The purpose of this study was to evaluate blood types of domestic cats in two cities in Western Canada (Saskatoon, Saskatchewan and Calgary, Alberta), as well as to determine the risk of mismatched transfusion and neonatal isoerythrolysis. Several cat studies around the world have shown variability in the prevalence of blood types in domestic and pedigree cats. Canadian data based on feline blood types is based out of Montreal. In this study the cohort of cats revealed a higher than anticipated prevalence; of 5% type B and 0.6% AB blood types. In our study, blood typing was performed in 400 domestic cats; 200 in Saskatoon and 200 in Calgary. Blood typing was performed using the gel tube method and the risk of transfusion mismatch (MT) was estimated by adding the risk of a major transfusion reaction and the risk of a minor transfusion reaction. The risk of neonatal isoerythrolysis (NI) was estimated according to the equation (p²)(q²) + 2pq(q²), with q being the b allele frequency and p = 1 – q. There was an identical frequency for feline blood types in both Saskatoon and Calgary cats, with 96% type A, 4% type B, and 0% AB. Based on these percentages, the risks of MT and NI in domestic cats were 7.6 and 4 % respectively. The frequency of type B cats in the population was similar to that in the previous Canadian study. These results demonstrate regional differences in prevalence of type B blood in domestic shorthairs across the world and serve to reinforce recommendations to blood type prior to transfusion or mating.

Assessment of risks of feline mismatched transfusion and neonatal isoerythrolysis in the Lyon (France) area

Objectives

The aims of this study were to update the prevalence of different feline blood types in the Lyon (France) area, as well as to determine the risk of mismatched transfusion (MT) and neonatal isoerythrolysis (NI) in kittens with parents of unknown blood type.

Methods

Blood samples were obtained from blood donor cats and cats admitted to an intensive care unit in Lyon. AB blood typing was performed using an immunochromatographic strip. The risk of MT was estimated by adding the risk of a major transfusion reaction and the risk of a minor transfusion reaction. The risk of NI was estimated according the equation (p²)(q²) + 2pq(q²), with q being the b allele frequency and p = 1 - q. The results were analysed by absolute and relative frequency analysis and multivariate analysis.

Results

The cohort study population included 320 non-pedigree cats and 37 pedigree cats. The prevalence of blood types A, B and AB was 84.3%, 14.0% and 1.7%, respectively. Considering non-pedigree cats, the prevalence of types A, B and AB was 83.7%, 14.4% and 1.9%, respectively. There were no significant differences of blood type distribution by sex (P = 0.73) or by breed (P = 0.90). Based on these percentages, the risks of MT and NI in non-pedigree cats were 24.3% and 12.3%, respectively.

Conclusions and relevance

The prevalence of type B cats is high in the Lyon area and associated with high risks of MT and NI. These results confirm the importance of performing blood typing prior to any blood transfusion or mating.

Prevalence of naturally occurring non-AB blood type incompatibilities in cats and influence of crossmatch on transfusion outcomes

BACKGROUND

Recognition of the feline red blood cell (RBC) antigen Mik and the presence of naturally occurring anti-Mik antibodies resulting in acute hemolytic transfusion reactions prompted the recommendation to perform a crossmatch before a cat's first RBC transfusion, but this guideline has not yet become a standard practice.

OBJECTIVE

To determine the prevalence of naturally occurring non-AB alloantibodies detectable by tube crossmatch, and to compare transfusion outcomes in cats with and without a crossmatch performed.

ANIMALS

Three hundred cats that received an RBC transfusion, with or without a major crossmatch performed.

METHODS

Retrospective study.

RESULTS

Major crossmatch incompatibilities were documented in 23 of 154 transfusion-naive cats (14.9%) and in 15 of 55 previously transfused cats (27%; P = 0.042). Type-specific packed RBCs (pRBCs) were administered to 167 and 82 cats with and without a crossmatch, respectively. Median volume of pRBCs administered during the first transfusion was 5.3 mL/kg (range, 2.4-18 mL/kg). Median change in PCV scaled to dose of pRBCs was +0.8%/mL/kg; administration of crossmatch-compatible pRBCs was not associated with a greater increase in PCV. Febrile transfusion reactions occurred more often in cats that received non-crossmatched (10.1%) compared to crossmatched (2.5%) pRBCs (P = 0.022). Seventy-six percent of cats that received pRBC transfusions survived to hospital discharge. A crossmatch was not associated with improved survival to discharge or at 30 or 60 days posttransfusion.

CONCLUSIONS AND CLINICAL IMPORTANCE

The prevalence of naturally occurring non-AB incompatibilities is sufficiently high to justify the recommendation to perform a crossmatch before all (including the first) RBC transfusions in cats.

Distribution of feline AB blood types: a review of frequencies and its implications in the Iberian Peninsula

Objectives

The objective of this study was to document the prevalence of feline blood types in the Iberian Peninsula and to determine the potential risk of incompatibility-related transfusion reactions in unmatched transfusions and the potential risk of neonatal isoerythrolysis (NI) in kittens born to parents of unknown blood type.

Methods

Blood samples were obtained from blood donors of the Animal Blood Bank (BSA-Banco de Sangue Animal). Blood typing was performed using a card method (RapidVet-H Feline Blood Typing; MDS).

Results

The studied population comprised 1070 purebred and non-purebred cats from Portugal and Spain aged between 1 and 8 years. Overall, frequencies of blood types A and B were 96.5% and 3.5%, respectively. No AB cats were found. Based on these data, the potential risks of NI and transfusion reactions in unmatched transfusions were calculated to be 6.8% and 2.8%, respectively.

Conclusions and relevance

Unlike previous studies, no type AB cats were found in this study. Although the calculated potential risks of transfusion reaction in unmatched transfusions and neonatal isoerythrolysis were low, blood typing prior to blood transfusion and blood typing of cats for breeding purposes are highly recommended.

FREQUÊNCIAS DOS TIPOS SANGUÍNEOS E TÍTULOS DOS ALOANTICORPOS EM FELINOS DOMÉSTICOS

Resumo A área da hemoterapia necessita de testes de compatibilidade sanguínea confiáveis, como a tipagem sanguínea, para se evitarem possíveis reações transfusionais, mas em felinos é também importante para se evitar a isoeritrólise neonatal. Transfusões sanguíneas realizadas entre felinos doadores e receptores que não possuem compatibilidade sanguínea podem refletir em reação transfusional aguda, particularmente severa quando o sangue tipo A é transfundido em um gato tipo B, pois geralmente este último possui altos níveis de aloanticorpos de ocorrência natural. Portanto, o conhecimento da frequência dos tipos sanguíneos da população de gatos de uma região pode auxiliar na determinação dos riscos de reações transfusionais e de ocorrência de isoeritrólise neonatal. Tais riscos podem ser prevenidos com a tipagem sanguínea em casos de transfusão. Foram coletadas 100 amostras sanguíneas de felinos para a realização da tipagem sanguínea com plasmas reagentes anti-A e anti-B conhecidas e titulações de aloanticorpos anti-A e anti-B dos plasmas armazenados. A distribuição das frequências dos grupos sanguíneos foi 96% de felinos com tipo sanguíneo A e 4% de felinos com tipo sanguíneo B, não sendo encontrado na amostra populacional de felino tipo AB. Há um grande risco de reação adversa através da transfusão sanguínea randomizada entre felinos não tipados previamente.

Feline blood genotyping versus phenotyping, and detection of non-AB blood type incompatibilities in UK cats

OBJECTIVES

The aim of this study was to determine the agreement between AB blood phenotyping and genotyping and determine whether non-AB blood type incompatibilities exist in UK cats.

METHODS

Blood samples underwent phenotyping (A, B or AB) using microplate agglutination, and genotyping (AA, Ab or bb) using pyrosequencing of a fragment of the cytidine monophospho-N-acetylneuraminic acid hydroxylase gene. Non-AB blood type incompatibilities were investigated by cross-matching against reference blood of the same phenotype.

RESULTS

Of 112 cats tested, 86 (77%) were blood phenotype A, 19 (17%) type B and 7 (6%) type AB. Genotype and initial phenotype agreed in 96% (107 of 112) of cats, but 5 were discordant; these were all B phenotype with either AA (n=2) or Ab (n=3) genotype. Two of the five cats had repeat blood samples tested: one was reclassified as phenotype A; the other remained phenotype B. Two cats had incompatibilities on minor cross-match, but these were attributed to phenotyping errors.

CLINICAL SIGNIFICANCE

Unknown mutation(s) associated with phenotype B, resulting in false AA or Ab genotyping, were evident in a small number of cases in this study. No conclusive evidence for non-AB blood type incompatibilities was found.

Feline blood transfusions: A pinker shade of pale

PRACTICAL RELEVANCE

blood transfusions are a potentially life-saving procedure that are within the reach of most small animal practitioners. Only minimal equipment is required.

PATIENT GROUP

any cat with clinical signs attributable to a reduced red blood cell mass that is affecting oxygen transport (as a result of reduced packed cell volume or acute blood loss) is a potential candidate for a transfusion.

CLINICAL CHALLENGES

although the principles of transfusion medicine are not complicated, there can be fatal consequences if certain steps are omitted.

DIAGNOSTICS

blood typing kits and blood filters are readily available from veterinary wholesalers, laboratories and blood banking services.

EVIDENCE BASE

over the past three decades, a substantial body of clinical research and reports has built up covering feline blood types and transfusion medicine. This article draws on that research to provide clinical guidance aimed at all veterinarians in feline or small animal practice who either currently practise transfusion medicine or plan to do so.

Blood types in Bengal cats in the UK

Blood samples from 100 adult Bengal cats from the UK were submitted for assessment of blood type using RapidVet-H Feline blood typing cards (dms Laboratories), with further assessment by standard blood typing in a microtitre plate assay when card typing was inconclusive or revealed blood type B or AB. Ninety-eight cats were found to be type A when assessed using the blood typing cards. One cat initially tested as type AB but was found to be type A on testing a second blood sample using the blood typing cards. One cat initially tested as type B but was found to be type A when a second sample was tested by standard blood typing assay. Finding that 100% of the cats were blood type A is in contrast with previous studies that reported 10 Bengal cats to be type A, four to be type AB and one to be type B.

Frequencies of feline blood types at a referral hospital in the south east of England

OBJECTIVES

To determine the prevalence of blood types in the feline patients and blood donors of the Queen Mother Hospital for Animals (The Royal Veterinary College, London, UK), that were typed between 2000 and 2004.

METHODS

A retrospective study was performed using files of patients and blood donors of the Queen Mother Hospital for Animals seen between January 2000 and November 2004. Commercial blood typing cards were used to determine the blood type.

RESULTS

One hundred and fifty-six cats were included in the study; 51 (32.7 per cent) were pedigree and 105 (67.3 per cent) non-pedigree. Of the 51 pedigree cats, the prevalence of blood types was as follows: type A, 42 (82.4 per cent); type B, seven (13.7 per cent) and type AB, two (3.9 per cent). Of the 105 non-pedigree cats, the prevalence of blood types was as follows: type A, 71 (67.6 per cent); type B 32 (30.5 per cent) and type AB two (1.9 per cent).

CLINICAL SIGNIFICANCE

The prevalence of type B blood in non-pedigree cats is higher than previously suggested and shows high variability within the UK; because of this, blood typing all feline patients, not only the ones of a breed typically known to have higher prevalence of type B blood before transfusion, is absolutely necessary to avoid a fatal transfusion reaction.

Frequencies of blood type A, B and AB in non-pedigree domestic cats in Turkey

OBJECTIVES

To determine the distribution of blood types and to estimate the proportion of matings at risk for neonatal isoerythrolysis in non-pedigree domestic cats.

METHODS

The present survey determined the frequency of blood types in 301 cats from four distinct regions of Turkey. Ethylenediaminetetraacetic acid-anticoagulated blood samples were typed by simple tube and slide agglutination assays. Serum obtained from type B cats and an anti-B solution, prepared with Triticum vulgaris, were used to determine type A and type B blood, respectively.

RESULTS

Of the 301 cats typed, 220 had type A blood, 74 had type B and seven had type AB. There was a significant difference (P<0.01) between the locations of the cats, with fewer type B cats in the eastern than in the western parts of Turkey. Risk for the development of neonatal isoerythrolysis due to A-B mismatch was estimated to be 18.6 per cent.

CLINICAL SIGNIFICANCE

The overall type B frequency in Turkish domestic cats is high. Thus, untyped transfusions in these cats carry a high risk of life-threatening acute haemolytic transfusion reactions and neonatal isoerythrolysis. It is therefore strongly recommended that blood typing be performed before breeding or transfusing in order to minimise blood type incompatibility risks.

A newly recognized blood group in domestic shorthair cats: the Mik red cell antigen

BACKGROUND

Naturally occurring alloantibodies produced against A and B red cell antigens in cats can cause acute hemolytic transfusion reactions. Blood incompatibilities, unrelated to the AB blood group system, have also been suspected after blood transfusions through routine crossmatch testing or as a result of hemolytic transfusion reactions.

HYPOTHESIS

Incompatible crossmatch results among AB compatible cats signify the presence of a naturally occurring alloantibody against a newly identified blood antigen in a group of previously never transfused blood donor cats. The associated alloantibody is clinically important based upon a hemolytic transfusion reaction after inadvertent transfusion of red cells expressing this red cell antigen in a feline renal transplant recipient that lacks this red cell antigen.

METHODS

Blood donor and nonblood donor cats were evaluated for the presence of auto- and alloantibodies using direct antiglobulin and crossmatch tests, respectively, and were blood typed for AB blood group status. Both standard tube and novel gel column techniques were used.

RESULTS

Plasma from 3 of 65 cats and 1 feline renal transplant recipient caused incompatible crossmatch test results with AB compatible erythrocytes indicating these cats formed an alloantibody against a red cell antigen they lack, termed Mik. The 3 donors and the renal transplant recipient were crossmatch-compatible with one another. Tube and gel column crossmatch test results were similar.

CONCLUSIONS AND CLINICAL IMPORTANCE

The absence of this novel Mik red cell antigen can be associated with naturally occurring anti-Mik alloantibodies and can elicit an acute hemolytic transfusion reaction after an AB-matched blood transfusion.

Titres of alloantibodies against A and B blood types in non-pedigree domestic cats in Turkey: assessing the transfusion reaction risk

The severity of a transfusion reaction depends on alloantibody titres within the recipients' blood. Determination of an agglutination titre of naturally occurring alloantibody may help to assess the risk of transfusion reactions following an unmatched transfusion in a cat population. In this group of 312 cats 227 had blood type A, 78 had blood type B, and seven had type AB blood. All type B cats tested showed gross evidence of agglutinating anti-A antibody with plasma titres ranging from 2 to 256. Among the 227 type A domestic cats tested for plasma anti-B alloantibody titres, 70% had gross agglutination with titres ranging from 2 to 16, while 17.6% had microscopic agglutination. The remaining 12.4% of the type A cats were negative for both gross and microscopic agglutination. Based on agglutinating titres, the relative risk of a transfusion reaction when type A or AB blood was given to a type B cat was 6.4% with acute severe reaction, acute mild reactions in 85.9% and premature red cell destruction in 7.7%. On the other hand, transfusion of type AB blood or type B blood to type A cats carries a potential risk of acute mild transfusion reaction in 4.4% and premature red cell destruction in 83.3%. Transfusion of type A or B blood to type AB cats results in no apparent clinical transfusion reactions.

Titres of naturally occurring alloantibodies against feline blood group antigens in Turkish Van cats

Seventy-eight Turkish Van cats were examined for alloantibody titres, of which 42.3 per cent had type A blood and 57.7 per cent had type B blood. No type AB cats were found. All type B cats (n = 45) showed gross evidence of agglutinating anti-A antibody, with titres ranging from 2 to 256. Sixty-seven per cent of type B cats had anti-A antibody in their plasma, with titres ranging from 8 to 32. However, 13 per cent of type B cats had plasma alloantibody titres of less than 8 and 20 per cent had titres that were higher than 32. A total of 33 type A cats were also tested for anti-B alloantibody titres in their plasma. Among the type A plasma, gross agglutination at titres of 2 and greater than 2 were determined in 24 per cent and 36 per cent of samples, respectively. Microscopic agglutination was seen in an additional 18 per cent of plasma samples. There was no significant association between gender and plasma alloantibody titres of cats (P > 0.05).