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Ji Y, Luo G, Fu Y. Incidence of anti-D alloimmunization in D-negative individuals receiving D-positive red blood cell transfusion: A systematic review and meta-analysis. Vox Sang 2022; 117:633-640. [PMID: 35014050 DOI: 10.1111/vox.13232] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 10/30/2021] [Accepted: 12/04/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES The transfusion of D-negative red blood cells (RBCs) to D-negative patients has been widely adopted to prevent anti-D alloimmunization, especially in women of childbearing age. Still, transfusion of D-positive RBCs to D-negative recipients is occasionally inevitable in practice, and the resulting incidence of anti-D in different D-negative groups of patients has not been well summarized. MATERIALS AND METHODS We searched the relevant literature using PubMed, Cochrane Library, and Embase databases from inception date to 30 September 2021. We looked for studies of anti-D occurring in D-negative recipients who received D-positive RBC transfusions. The anti-D incidence was summarized with 95% confidence intervals (CIs). Data with similar characteristics were combined using a random-effects model. RESULTS About 42 studies (2226 cases), which found anti-D, the exact volume of D-positive RBC transfused, and the follow-up time for anti-D detection, met the inclusion criteria. The pooled anti-D incidence was 64% (95% CI, range 55%-74%) in volunteers receiving small volumes of D-positive RBCs, 84% (95% CI, 74%-94%) in those receiving whole units, 26% (95% CI, 19%-32%) in mixed patients, 12% (95% CI, 8%-16%) in oncology patients, 27% (95% CI, 13%-40%) in trauma patients, 4% (95% CI, 0%-8%) in immune-compromised transplant patients, and 6% (95% CI, 1%-39%) in those with AIDS. CONCLUSION Compared with the high frequency of anti-D in healthy D-negative volunteers given D-positive RBCs, we found a lower rate of anti-D immunization in various D-negative patients and almost none in transplant and AIDS patients.
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Affiliation(s)
- Yanli Ji
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China
| | - Guangping Luo
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China
| | - Yongshui Fu
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China
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2
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Miranda MR, Dos Santos TD, Castilho L. Systematic RHD genotyping in Brazilians reveals a high frequency of partial D in transfused patients serologically typed as weak D. Transfus Apher Sci 2021; 60:103235. [PMID: 34389204 DOI: 10.1016/j.transci.2021.103235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The discrimination between weak D types and partial D can be of clinical importance because carriers of partial D antigen may develop anti-D when transfused with D-positive red blood cell units. The aim of this study was to determine by molecular analysis the type of D variants among Brazilian patients requiring transfusions with serologic weak D phenotypes. MATERIAL AND METHODS Samples from 87 patients (53 with sickle cell disease, 10 with thalassemia and 24 with myelodysplastic syndrome), serologic typed as weak D by manual tube indirect antiglobulin test or gel test were first RHD genotyped by using the RHD BeadChip Kit (BioArray, Immucor). Sanger sequencing was performed when necessary. RESULTS RHD molecular analysis revealed 32 (36.8 %) variant RHD alleles encoding weak D phenotypes and 55 (63.2 %) alleles encoding partial D antigens. RHD variant alleles were present in the homozygous state or as a single RHD allele, one variant RHD allele associated with the RHDΨ allele, or two different variant RHD alleles in compound heterozygosity with each other in 70 patients, 4 patients and 13 patients, respectively. Alloanti-D was found in 9 (16.4 %) cases with RHD alleles predicting a partial D. DISCUSSION The frequency of partial D was higher than weak D types in Brazilian patients serologically typed as weak D, showing the importance to differentiate weak D types and partial D in transfused patients to establish a transfusion policy recommendation.
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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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Vege S, Sprogøe U, Lomas-Francis C, Jakobsen MA, Antonsen B, Aeschlimann J, Yazer M, Westhoff CM. Impact of RHD genotyping on transfusion practice in Denmark and the United States and identification of novel RHD alleles. Transfusion 2020; 61:256-265. [PMID: 32975828 DOI: 10.1111/trf.16100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Reduced D antigen on red blood cells (RBCs) may be due to "partial" D phenotypes associated with loss of epitope(s) and risk for alloimmunization or "weak" D phenotypes that do not lack major epitopes with absence of clinical complications. Genotyping of samples with weak and discrepant D typing is recommended to guide transfusion and RhIG prophylaxis. The goal was to compare the impact of RHD genotyping on transfusion practice in two centers serving different populations. STUDY DESIGN AND METHODS Fifty-seven samples from Denmark and 353 from the United States with weak or discrepant D typing were genotyped. RBC typing was by multiple methods and reagents. DNA isolated from white blood cells was tested with RBC-Ready Gene D weak or CDE in Denmark or RHD BeadChip in the United States. RHD was sequenced for those unresolved. RESULTS Of Caucasian samples from Denmark, 90% (n = 51) had weak D types 1, 2, or 3; two had other weak D, two partial D, and two new alleles. In diverse ethnic U.S. samples, 44% (n = 155) had weak D types 1, 2, or 3 and 56% (n = 198) had other alleles: uncommon weak D (n = 13), weak 4.0 (n = 62), partial D (n = 107), no RHD (n = 9), and new alleles (n = 7). CONCLUSION Most samples with weak or variable D typing from Denmark had alleles without risk for anti-D. In U.S. samples, 48% could safely be treated as D+, 18% may require consideration if pregnancy possible, and 34% could potentially benefit from being treated as D-. Black and multiracial ethnicities were overrepresented relative to population.
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Affiliation(s)
- Sunitha Vege
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
| | - Ulrik Sprogøe
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Christine Lomas-Francis
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
| | - Marianne A Jakobsen
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Berit Antonsen
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Judith Aeschlimann
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
| | - Mark Yazer
- South Danish Transfusion Service at Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.,Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Connie M Westhoff
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprise, New York, New York, USA
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5
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Yaşa B, Şahin O, Öcüt E, Seven M, Sözer S. Assessment of Fetal Rhesus D and Gender with Cell-Free DNA and Exosomes from Maternal Blood. Reprod Sci 2020; 28:562-569. [PMID: 32968935 DOI: 10.1007/s43032-020-00321-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 09/16/2020] [Indexed: 12/30/2022]
Abstract
The detection of fetal cell-free DNA (cfDNA) from maternal plasma has enabled the development of essential techniques in prenatal diagnosis during recent years. Extracellular vesicles including exosomes were determined to carry fetal DNA fragments. Considering the known difficulties during isolation and stability of cfDNA, exosomes might provide a new opportunity for prenatal diagnosis and screening. In this study, comparison of cfDNA and exosome DNA (exoDNA) for predicting the fetal sex and Rhesus D (RHD) genotype was performed by using real-time polymerase chain reaction with simultaneous amplification of sequences of SRY and RHD genes. Fetal sex and RHD were determined in 100 and 81 RHD-negative pregnant women with cfDNA and exoDNA, respectively. The gestation ages of pregnant women were between 9 and 40 weeks. The results were compared with the neonatal phenotype for gender and a serological test for RHD. The cfDNA revealed 95.75% sensitivity and 100% specificity in RHD positivity and 100% sensitivity and 95.45% specificity in SRY positivity. Cohen's agreement coefficient in the Kappa test ranged from 0.8 to 1.0 (P < 0.00001). Although the exoDNA failed to amplify 16 cases, the remaining 65 cases revealed a true estimate for both fetal RHD and SRY genes with 100% sensitivity and specificity. Successful application of exoDNA and cfDNA with real-time PCR for fetal genotyping enables this technique to be applied in the assessment of fetal RHD and gender during pregnancy, allowing initiation of early treatment methods and avoiding unnecessary interventions and cost.
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Affiliation(s)
- Büşra Yaşa
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
| | - Orhan Şahin
- Clinic of Obstetrics and Gynecology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Elif Öcüt
- Department of Statistics, Yıldız Technical University, Istanbul, Turkey
| | - Mehmet Seven
- Department of Medical Genetics, Cerrahpasa Medical School Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Selçuk Sözer
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
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6
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Flegel WA, Denomme GA, Queenan JT, Johnson ST, Keller MA, Westhoff CM, Katz LM, Delaney M, Vassallo RR, Simon CD, Sandler SG. It's time to phase out "serologic weak D phenotype" and resolve D types with RHD genotyping including weak D type 4. Transfusion 2020; 60:855-859. [PMID: 32163599 DOI: 10.1111/trf.15741] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 01/21/2020] [Accepted: 02/15/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Willy A Flegel
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | - John T Queenan
- Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Margaret A Keller
- National Molecular Laboratory, American Red Cross Biomedical Services, Philadelphia, Pennsylvania, USA
| | - Connie M Westhoff
- Laboratory of Immunohematology and Genomics, New York Blood Center Enterprises, New York, New York, USA
| | - Louis M Katz
- Mississippi Valley Regional Blood Center, Davenport, Iowa, USA
| | | | | | - Clayton D Simon
- Defense Health Agency, Armed Services Blood Program Office, Falls Church, Virginia, USA
| | - S Gerald Sandler
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
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