1
|
Rodrigues MMDO, Mattos D, Almeida S, Fiegenbaum M. Hemolytic disease of the fetus and newborn-a perspective of immunohematology. Hematol Transfus Cell Ther 2024; 46 Suppl 5:S246-S257. [PMID: 39242288 PMCID: PMC11670614 DOI: 10.1016/j.htct.2024.04.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/29/2024] [Accepted: 04/01/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Hemolytic disease of the fetus and newborn is a public health problem caused by maternal-fetal incompatibility; no prophylaxis is available for most alloantibodies that induce this disease. This study reviews the literature regarding which antibodies are the most common in maternal plasma and which were involved in hemolytic disease of the fetus and newborn. METHOD Seventy-five studies were included in this review using a systematic search. Two independent authors identified studies of interest from the PubMed and SciELO databases. MAIN RESULTS Forty-four case reports were identified, of which 11 babies evolved to death. From 17 prevalence studies, the alloimmunization rate was 0.17 % with 161 babies receiving intrauterine transfusions and 23 receiving transfusions after birth. From 28 studies with alloimmunized pregnant women (7616 women), 455 babies received intrauterine transfusions and 21 received transfusions after birth. CONCLUSION Rh, Kell, and MNS were the commonest blood systems involved. The geographical distribution of studies shows that as these figures vary between continents, more studies should be performed in different countries. Investing in early diagnosis is important to manage the risks and complications of hemolytic disease of the fetus and newborn.
Collapse
Affiliation(s)
- Mirelen Moura de Oliveira Rodrigues
- Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Grupo Hospitalar Conceição (GHC), Serviço de Hemoterapia, Porto Alegre, RS, Brazil
| | - Denise Mattos
- Grupo Hospitalar Conceição (GHC), Serviço de Hemoterapia, Porto Alegre, RS, Brazil
| | - Silvana Almeida
- Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Marilu Fiegenbaum
- Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
| |
Collapse
|
2
|
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: 1] [Impact Index Per Article: 0.5] [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.
Collapse
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.
| |
Collapse
|
3
|
Ohto H, Ito S, Srivastava K, Ogiyama Y, Uchikawa M, Nollet KE, Flegel WA. Asian-type DEL (RHD*DEL1) with an allo-anti-D: A paradoxical observation in a healthy multiparous woman. Transfusion 2023; 63:1601-1611. [PMID: 37465939 PMCID: PMC10528739 DOI: 10.1111/trf.17465] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The DEL phenotype is the D variant expressing the least amounts of D antigen per red cell. Asian-type DEL (RHD:c:1227G > A) is the most prevalent DEL in East Asia without any anti-D alloimmunization reported before. We investigated the first observation of an anti-D in any DEL phenotype, reported in the Japanese language at a 1987 conference, only 3 years after the discovery of DEL. METHODS We contacted the proband 35 years after the initial report. Standard hemagglutination, adsorption/elution, and flow cytometry tests were performed, as was nucleotide sequencing for the RHD, RHCE, and HLA class I and class II genes. RESULTS The healthy multiparous Japanese woman, a regular blood donor, still had the anti-D of titer 8 representing an alloantibody by standard serologic methods. Unexpectedly, she carried an Asian-type DEL without any additional RHD gene variation. All 12 HLA alleles identified were known in the Japanese population. Interestingly, one of her HLA-DRB1 and a variant of her HLA-DQB1 alleles had previously been associated with anti-D immunization. CONCLUSION We described an allo-anti-D, maintained for more than three decades, in an Asian-type DEL. The combination of two implicated HLA alleles were rare and could have contributed to the anti-D immunization. Continued monitoring of anti-D immunization events in patients with DEL is warranted, and we discuss possible mechanisms for further study. As only this single observation has been recognized in the last 35 years, the current recommendation is affirmed: Individuals with Asian-type DEL should be treated as Rh D-positive for transfusion and Rh immune prophylaxis purposes.
Collapse
Affiliation(s)
- Hitoshi Ohto
- Department of Mesenchymal Stem Cell Research, Fukushima Medical University, Fukushima, Japan
| | - Shoichi Ito
- Tohoku Block Blood Center, Japanese Red Cross Society, Sendai, Japan
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Yoshiko Ogiyama
- Tohoku Block Blood Center, Japanese Red Cross Society, Sendai, Japan
| | - Makoto Uchikawa
- Kanto-Koshinetsu Block Blood Center, Japanese Red Cross Society, Tokyo, Japan
| | - Kenneth Eric Nollet
- 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, Maryland, USA
| |
Collapse
|
4
|
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: 1] [Impact Index Per Article: 0.3] [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
| |
Collapse
|
5
|
Flegel WA. Proceed with care: the "uncommon" serologic weak D phenotypes. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2021; 19:272-276. [PMID: 34704554 PMCID: PMC8297679 DOI: 10.2450/2021.0147-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, United States of America
- Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
6
|
Floch A. Maternal red blood cell alloimmunisation Working Party, literature review. RH blood group system: Rare specificities. Transfus Clin Biol 2021; 28:314-320. [PMID: 33895380 DOI: 10.1016/j.tracli.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
This report is part of a series reporting the GRADE review performed by the 2018-2020 French Working Party on maternal red blood cell alloimmunisation. This report focusses on the clinical significance in obstetrics, as published in the scientific literature, of the rare RH antibodies, variants and antigens (i.e. excluding conventional RH1 trough RH8 antigens, RH12, RH22 and RH27, which are discussed in other reports of this series). Extremely severe or severe haemolytic disease of the fetus and the newborn (HDFN), leading to death or requiring transfusions, have been reported for: anti-RH1 (-D) associated with DVI, DBT and DIVb phenotypes, RHD*12.04 (DOL4), RHD*03.03 (DIIIc), RHD*D-CE(2-5)-D, RHD*01EL.31 (RHD*148+1T), anti-RH9 (-CX), anti-RH11 (-EW), anti-RH17 (-Hr0), anti-RH18 (-Hr), anti-RH19 (-hrS), anti-RH23 (-DW), anti-RH29 ("total" Rh), anti-RH30 (-Goa), anti-RH32, anti-RH34 (-HrB), anti-RH36 (-Bea), anti-RH40 (-Tar), anti-RH46 (-Sec), anti-RH48 (-JAL), anti-RH54 (DAK), and antibodies to high prevalence antigens such as those associated with RHCE*02.08.02 (RHCE*CW-RHD(6-10)), RHCE*03N.01 (RHCE*cEMI). HDFN of moderate, mild or undetailed severity have been reported for: anti-RH1 associated with DHar, DIIIa and DIVa phenotypes, RHD*01EL.08 (RHD*486+1A),RHD*01EL.44 (RHD*D-CE(4-9)-D),RHD*25 (DNB), anti-RH20 (-VS), anti-RH31 (-hrB), anti-RH37 (-Evans), ani-RH42, anti-RH49 (-STEM), anti-RH51 (-MAR), anti-RH55 (-LOCR), anti-RH58 (-CELO). Positive direct antiglobulin test in the newborn but no clinically significant HDFN has been reported for anti-RH1 (-D) associated with RHD*10.05 (DAU5), RHD*12.02 (DOL2). Because so many specificities are associated with severe HDFN in the RH system, all RH antibodies should be considered as potentially able to cause HDFN, even if none has been reported yet.
Collapse
Affiliation(s)
- A Floch
- Université Paris Est Creteil, Inserm, IMRB, 8, rue du Général-Sarrail, 94010 Créteil, France; Établissement français du sang Île-de-France, IMRB, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Laboratory of Excellence GR-Ex, IMRB, 8, rue du Général-Sarrail, 94010 Créteil, France.
| |
Collapse
|
7
|
Zonneveld R, Kanhai HHH, Javadi A, Veldhuisen B, Brand A, Zijlmans WCWR, van der Schoot CE, Schonewille H. Frequency and characterization of RHD variants in serologically D- Surinamese pregnant women and D- newborns. Transfusion 2019; 59:2672-2677. [PMID: 31183885 DOI: 10.1111/trf.15394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/25/2019] [Accepted: 05/12/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Numerous RHD variant genes affect the expression of D on the red blood cell surface. In Suriname, 4.3% of pregnant women were D-, ranging from virtually zero to 7% among ethnic groups. Characterization of RHD variants, which are associated with a variable potential to induce anti-D, is of practical clinical importance especially in case of limited access to preventive measures. Here we report on the occurrence of RHD variant genes in Surinamese serologically D- pregnant women and their D- newborns from different ethnic groups. STUDY DESIGN AND METHODS The RheSuN study is a cross-sectional cohort study in D- pregnant women and their newborns, who visited hospitals in Paramaribo, Suriname, during routine pregnancy care. The presence of RHD variants was investigated using quantitative polymerase chain reaction targeting RHD Exons 5 and 7 and RH-multiplex ligation-dependent probe amplification. RESULTS Seven RHD variant genes were detected in 35 of 84 women and four RHD variant genes in 15 of 36 newborns. The RHD*03 N.01 and RHD*08 N.01 variants represented 87% of a total of 62 variant genes. Variants were comparably frequent among ethnicities. In four cases genotyping would have changed anti-D prophylaxis policy: one woman with a RHD*01EL.01 variant, not associated with anti-D formation and three D- newborns with RHD*09.01 and RHD*09.03.01 variants, potentially capable of inducing anti-D. CONCLUSION RHD variants at risk for anti-D are common among serologic D- individuals from African descent in Suriname. While genotyping D- women has limited added value, it may be considered in newborns from D- women.
Collapse
Affiliation(s)
- Rens Zonneveld
- Scientific Research Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname.,Department of Pediatrics, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Humphrey H H Kanhai
- Faculty of Medical Sciences, Anton the Kom University of Suriname, Paramaribo, Suriname.,Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ahmad Javadi
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
| | - Barbera Veldhuisen
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
| | - Anneke Brand
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco C W R Zijlmans
- Scientific Research Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname.,Faculty of Medical Sciences, Anton the Kom University of Suriname, Paramaribo, Suriname.,Department of Pediatrics, Diakonessen Hospital, Paramaribo, Suriname
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
| | - Henk Schonewille
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
| | | |
Collapse
|
8
|
Raud L, Ka C, Gourlaouen I, Callebaut I, Férec C, Le Gac G, Fichou Y. Functional analysis of novelRHDvariants: splicing disruption is likely to be a common mechanism of variant D phenotype. Transfusion 2019; 59:1367-1375. [DOI: 10.1111/trf.15210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/22/2018] [Accepted: 12/06/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Loann Raud
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies"; INSERM, EFS, Université de Brest, IBSAM, CHU de Brest; Brest France
- Laboratory of Excellence GR-Ex; Paris France
| | - Chandran Ka
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies"; INSERM, EFS, Université de Brest, IBSAM, CHU de Brest; Brest France
- Laboratory of Excellence GR-Ex; Paris France
| | - Isabelle Gourlaouen
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies"; INSERM, EFS, Université de Brest, IBSAM, CHU de Brest; Brest France
- Laboratory of Excellence GR-Ex; Paris France
| | - Isabelle Callebaut
- IMPMC, Sorbonne Universités - UMR CNRS 7590, UPMC Univ Paris 06, Muséum d'Histoire Naturelle, IRD UMR 206; Paris France
| | - Claude Férec
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies"; INSERM, EFS, Université de Brest, IBSAM, CHU de Brest; Brest France
- Laboratory of Excellence GR-Ex; Paris France
| | - Gérald Le Gac
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies"; INSERM, EFS, Université de Brest, IBSAM, CHU de Brest; Brest France
- Laboratory of Excellence GR-Ex; Paris France
| | - Yann Fichou
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies"; INSERM, EFS, Université de Brest, IBSAM, CHU de Brest; Brest France
- Laboratory of Excellence GR-Ex; Paris France
| |
Collapse
|