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Subramaniyan R. Phenotyping of clinically significant blood group antigens among the South Indian donor population. Hematol Transfus Cell Ther 2023; 45 Suppl 2:S30-S35. [PMID: 34998784 PMCID: PMC10433306 DOI: 10.1016/j.htct.2021.11.012] [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: 03/30/2021] [Revised: 07/17/2021] [Accepted: 11/02/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Data on the prevalence of clinically significant antigens (Rh, Kell, Kidd, Duffy, MNSs, Lewis, P and Lutheran) among the Indian donor population is sparse. OBJECTIVE This prospective study was aimed at determining the prevalence of 21 clinically significant antigens for the first time in the South Indian donor population. METHOD A total of 672 regular O group blood donors were enrolled for Rh (C,c, E, e) and Kell (K) antigens typing. Of these, 188 donors were typed for other clinically significant antigens (k, Kpa, Kpb, Jka, Jkb, Fya, Fyb, M, N, S, s, P1, Lea, Leb, Lua and Lub). RESULTS Antigen frequencies were expressed in percentages. In our study, R1R1 and rr were the most common phenotypes among D+ and D- donors, respectively. Among the Rh antigens, the e antigen was expressed by 97.5% and 100% of D+ and D- donors, respectively. The K antigen was found in only 0.15% of donors. In the Duffy and Kidd blood group system, Fy (a+b+) and Jk (a+b+) were the most frequent phenotypes, respectively. In the MNSs blood group system, M+N+ and S-s+ were the most common phenotypes reported. The Le (a-b+) was found to be the phenotype with the highest prevalence in the Lewis blood group system. The Lu (a-b+) was the only phenotype found in the Lutheran blood group system. CONCLUSION Knowledge regarding the prevalence of antigens in a given population is essential in developing cost-effective in-house panels and a rare donor registry comprising donors typed negative for a high-frequency antigen or a combination of common multiple antigens.
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Pathak A, Tejwani N, Panda D, Mehta A. Determination of the Rh/Kell phenotypes in donor as well as patients might be significant to provide phenotype-matched blood to cancer patients: A retrospective analysis from a tertiary care oncology center in North India. Asian J Transfus Sci 2023; 17:234-238. [PMID: 38274955 PMCID: PMC10807539 DOI: 10.4103/ajts.ajts_44_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/19/2023] [Accepted: 05/15/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Multiple reports are available from different parts of the globe indicating the incidences of alloimmunization and blood transfusion-related reactions, which emphasizes the need for phenotyping and providing antigen-matched safe blood. AIMS AND OBJECTIVES This study aims to determine the frequency of Rh and Kell antigens and phenotype for both donors and patients to propose the importance of providing Rh Kell phenotype cross-matched packed red blood cell (RBC) units to minimize the alloimmunization and transfusion reactions. MATERIALS AND METHODS Ten thousand blood donors and four thousand patients were investigated between October 2017 and July 2019. Each donor unit was tested for blood grouping, antibody screening, and Rh Kell antigen Phenotyping, and the blood unit was issued after the patient's blood grouping, antibody screening by 3 cell panels, and Rh Kell antigen phenotyping followed by cross-matching with an Rh Kell-matched phenotype RBC unit. RESULTS Nine thousand four hundred and fifty-two donors were D positive (94.5%) while 548 tested D negative (5.5%). Overall Rh and K antigens frequencies in donors were: "e" (98%) >"D" (94.5%) >"C" (86.6%) > "c" (57.5%) >"E" (18.8%) >K (0.98%). Among patients, 3762 tested D positive (94.05%), and 238 tested D negative (5.95%). Overall Rh and K antigens frequencies in patients were: "e" (98.5%) >"D" (94.05%) >"C" (90.2%) >"c" (51%) >"E" (18.2%) >K (1.8%). CONCLUSION Our study has given us more clarity on the prevalence of major Rh and K antigens in our donor as well as patient populations, highlighting the similarities as well as differences. This variance holds a great significance, since such donor units when transfused into patients may lead to alloimmunization and adverse transfusion reactions. Hence, the determination of Rh and Kell phenotypes and providing phenotype-matched blood will help prevent such events.
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Affiliation(s)
- Amardeep Pathak
- Department of Transfusion Medicine, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Narender Tejwani
- Department of Laboratory Medicine, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Devasis Panda
- Department of Laboratory Medicine, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Anurag Mehta
- Department of Laboratory Medicine, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
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Mbalibulha Y, Natukunda B, Livex OA, Ononge S, Kalyango JN, Kajja I. ABO and Rh Antigen Distribution Among Pregnant Women in South Western Uganda. J Blood Med 2022; 13:351-355. [PMID: 35769868 PMCID: PMC9234189 DOI: 10.2147/jbm.s360769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction ABO and Rh are the major blood group systems in Transfusion Medicine, the ABO system based on two red cell antigens (A, B) while the Rh has about 50 antigens of which five are highly clinically significant (D, C, c, E, e). These vary among races and ethnic groups. Blood type phenotype incompatibility between mother and fetus may result in antigen mismatch, triggering alloimmunization, and thus causing hemolytic transfusion reaction (HTR), which results in hemolytic disease of fetus and newborn (HDFN). This study aimed to determine the frequencies of ABO and rhesus blood group antigen in the pregnant women in South Western Uganda. Methods A cross-sectional study was carried out on 1369 pregnant women who were recruited and provided consent to participate during their regular antenatal visits between August 2020 and July 2021. Four milliliters (4mL) of EDTA-anti-coagulated blood samples were collected and ABO and Rh-blood grouping including Rh antigen screening was done using the agglutination technology comprised of glass beads and reagent contained in a column of the Ortho Biovue ID Micro Typing System (Ortho Clinical Diagnostics, New Jersey, USA). The Rh antigen phenotypes and frequencies were then determined. Results There was percentage distribution of 99.8%, c 99.3%, D 94.3%, C 19.2% and E 15.9%, with Rh cDe/cDe (65.1%) being the most common phenotype followed by cDe/CDe (15%), cDe/cDE (10.8%) and cDE/cDE 0.1% least common. The ABO grouping frequency was obtained as O 49.4%, A 29.5%, B 17.0% and AB 4.1%, with D positivity at 94.3%. Discussion Population genetic variations result in varied expressions of red cell antigens that may have clinical complications. Knowledge of the presence of these Rh antigen distributions and phenotype frequencies during pregnancy help in rational management of the pregnancy, alloimmunization and better approach to safe blood transfusion.
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Affiliation(s)
- Yona Mbalibulha
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bernard Natukunda
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Okwi Andrew Livex
- Department of Pathology, College of Health Science, Makerere University, Kampala, Uganda
| | - Sam Ononge
- Department of Obstetrics & Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joan N Kalyango
- Director Clinical and Epidemiology Unit, School of Medicine, College of Health Science, Makerere University, Kampala, Uganda
| | - Isaac Kajja
- Deputy Principal College of Health Sciences, Makerere University, Kampala, Uganda
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Devi AS, Soumee B, Sitalakshmi S. Prevalence of ABO, Rh (D, C, c, E, and e), and Kell (K) antigens in blood donors: A single-center study from South India. Asian J Transfus Sci 2022. [DOI: 10.4103/ajts.ajts_159_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Datta SS, Basu S, Reddy M, Gupta K, Sinha S. Comparative evaluation of the conventional tube test and column agglutination technology for ABO antibody titration in healthy individuals: a report from India. Immunohematology 2021; 37:25-32. [PMID: 33962486 DOI: 10.21307/immunohematology-2021-006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Determination of accurate anti-A/-B titers is important for treatment selection in ABO-incompatible stem cell and solid-organ transplants. The standard method for ABO antibody titration is the conventional tube test (CTT). Dithiothreitol (DTT) is commonly used to inactivate the IgM antibody component. The aim of this study was to compare six different methods for ABO antibody titration and to observe the effectiveness of DTT on antibody estimation. A total of 90 healthy voluntary blood donors were enrolled in this study, including 30 each for blood groups A, B, and O. Antibody titrations were performed and tested using the CTT-immediate spin (IS), CTT-antihuman globulin (AHG) with and without DTT, column agglutination technology (CAT)-IS, and CAT-AHG with and without DTT methods. Bead-CAT was used, and the positive cutoff value was set to 1+ for each method to determine the endpoint of the titer. The median values of anti-A/-B titers by IS were found to be higher than those values by AHG in CTT and CAT among group B and A individuals, whereas no statistically significant differences were observed in values from group O individuals for IS and AHG anti-A/-B titers, estimated by each method. Although there was positive correlation between the anti-A/-B titer results obtained using the CTT and CAT in all blood groups, testing using AHG showed poor agreement with and without DTT pretreatment (kappa value of 0.11 and 0.20, respectively). Moderate agreement was observed between CTT-IS and CAT-IS (kappa value of 0.46). Median anti-A/-B AHG titers were reduced by the use of DTT in all blood group samples. Significant differences in the interpretability of anti-A/-B titers were observed among different methods. A uniform approach for selecting the method for ABO antibody titration is highly recommended, and DTT pretreatment of plasma to neutralize IgM activity should be considered to obtain precise values of IgG anti-A/-B titers. Immunohematology 2021;37:25-32 . Determination of accurate anti-A/-B titers is important for treatment selection in ABO-incompatible stem cell and solid-organ transplants. The standard method for ABO antibody titration is the conventional tube test (CTT). Dithiothreitol (DTT) is commonly used to inactivate the IgM antibody component. The aim of this study was to compare six different methods for ABO antibody titration and to observe the effectiveness of DTT on antibody estimation. A total of 90 healthy voluntary blood donors were enrolled in this study, including 30 each for blood groups A, B, and O. Antibody titrations were performed and tested using the CTT-immediate spin (IS), CTT-antihuman globulin (AHG) with and without DTT, column agglutination technology (CAT)-IS, and CAT-AHG with and without DTT methods. Bead-CAT was used, and the positive cutoff value was set to 1+ for each method to determine the endpoint of the titer. The median values of anti-A/-B titers by IS were found to be higher than those values by AHG in CTT and CAT among group B and A individuals, whereas no statistically significant differences were observed in values from group O individuals for IS and AHG anti-A/-B titers, estimated by each method. Although there was positive correlation between the anti-A/-B titer results obtained using the CTT and CAT in all blood groups, testing using AHG showed poor agreement with and without DTT pretreatment (kappa value of 0.11 and 0.20, respectively). Moderate agreement was observed between CTT-IS and CAT-IS (kappa value of 0.46). Median anti-A/-B AHG titers were reduced by the use of DTT in all blood group samples. Significant differences in the interpretability of anti-A/-B titers were observed among different methods. A uniform approach for selecting the method for ABO antibody titration is highly recommended, and DTT pretreatment of plasma to neutralize IgM activity should be considered to obtain precise values of IgG anti-A/-B titers. Immunohematology 2021;37:25–32 .
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Affiliation(s)
- S S Datta
- Transfusion Medicine, Tata Medical Center , 14 Middle Arterial Road (EW), Rajarhat, New Town, Kolkata 700160 , India
| | - S Basu
- Transfusion Medicine, Tata Medical Center , Kolkata , India
| | - M Reddy
- Transfusion Medicine, Tata Medical Center , Kolkata , India
| | - K Gupta
- Transfusion Medicine, Tata Medical Center , Kolkata , India
| | - S Sinha
- Tata Medical Center , Kolkata , India
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Sachan D, Tiwari AK, Dara R, Jothimani D, Kaliamoorthy I, Reddy SM, Rela M. Patient blood management in a patient with multiple red cell antibodies (anti-C, anti-e, and anti-K) undergoing liver transplant in South India: A team approach. Asian J Transfus Sci 2020; 14:74-78. [PMID: 33162713 PMCID: PMC7607982 DOI: 10.4103/ajts.ajts_54_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 03/03/2019] [Indexed: 11/17/2022] Open
Abstract
End-stage liver disease (ESLD) patients undergoing liver transplant (LT) surgery are often multiply alloimmunized and pose significant challenges to the transfusion services in terms of red cell cross-match incompatibility, unpredictable blood requirements, and often lead to significant delays in availing compatible red cell units. We report a case of a 64-year-old female from Bahrain, a known case of hepatitis C-related ESLD referred for LT surgery. She had a history of multiple uneventful transfusions in the preceding year. Her blood group was A-positive, direct antiglobulin test, and cold antibodies were negative. Indirect antiglobulin test was positive, and antibody identification confirmed the presence of anti-C, anti-e, and anti-K. Her red cell phenotype was R2R2 and Kell negative (C-c+E+e-K-). The patient was started on erythropoietin. Requests for R2R2 and Kell negative units were sent to various blood banks across the country. After >800 A/O group units phenotyping and a waiting period of 6 weeks, two compatible R2R2 phenotypes and Kell negative could be arranged in-house and three units were received from Gurgaon, North India. Intraoperative management included blood preservation techniques including cell salvage, antifibrinolytic drug, and monitoring using thromboelastography. The estimated blood loss was 350 ml with pre- and postoperative Hb 10.4 gm% and 9.2 gm%, respectively. She received intraoperatively two units of single-donor platelet and four units of fresh frozen plasma and postoperatively one unit of leukocyte-depleted-packed red cells and doing well at 12-month follow-up. This case highlights the importance of advance immunohematology for timely detection of alloimmunization and providing antigen-negative compatible units, proper communication between the transfusion specialists, and the clinical team for proper patient blood management as well as the need for central rare donor registry program to avoid delays in providing compatible blood in such inevitable cases.
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Affiliation(s)
- Deepti Sachan
- Department of Transfusion Medicine, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Aseem K Tiwari
- Department of Transfusion Medicine, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Ravi Dara
- Department of Transfusion Medicine, Manipal Hospitals, Jaipur, Rajasthan, India
| | - Dinesh Jothimani
- Institute of Liver Disease and Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Ilankumaran Kaliamoorthy
- Institute of Liver Disease and Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Srinivas Mettu Reddy
- Institute of Liver Disease and Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Mohamed Rela
- Institute of Liver Disease and Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India
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Shah R, Harimoorthy V, Shah R, Barot T, Kumar K. Role of extended red cell phenotyping in management of patient with multiple antibodies and their utility in development of indigenous cell panels for antibody screening. GLOBAL JOURNAL OF TRANSFUSION MEDICINE 2020. [DOI: 10.4103/gjtm.gjtm_8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shah A, Ghosh K, Sharma P, Mishra K. Phenotyping of Rh, Kell, Duffy and Kidd Blood Group Antigens among Non-Tribal and Tribal Population of South Gujarat and its Implication in Preventing Alloimmunization in Multitransfused Patients. Mediterr J Hematol Infect Dis 2018; 10:e2018070. [PMID: 30416702 PMCID: PMC6223596 DOI: 10.4084/mjhid.2018.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/22/2018] [Indexed: 11/15/2022] Open
Abstract
Background:Sickle cell anaemia is common amongst Tribal population of south Gujrat. Alloimmunisation in multitransfused sickle cell anaemia patient is 10 times commoner in these patients than beta Thalassemia major patients from regular blood donor communities.
Study design & methodology: Red cell antigen typing of Rh (D,C,E,c,e ), Kell (K, k), Duffy (Fya, Fyb) and Kidd (Jka, Jkb) were carried out in 222 regular voluntary blood donors who belonged to non-tribal population and in 113 samples of tribal population using conventional antisera.
Results: Rh D antigen frequency was 96.6% in non-tribal and 96.5% in tribal population. 2.4% of K antigen was found in non-tribal population whereas the antigen was absent in tribal population .Amongst Rh antigens, e was the most common (100%) followed by D, C (91.0%, 85.8%), c (50.5%, 44.2%) and E (16.5%, 17.0%) with DCe/DCe (R1R1, 48.0%, 55.8%) being the most common phenotype in both the groups. In Kell antigens k antigen was 100% ,Kidd and Duffy antigens Jk (a+b-) (39.2%, 46.9%) and Fy (a+b-) (64.2%, 52.2%) were the most common phenotypes in non-tribal and tribal population respectively.
Conclusion: There is significant difference in Duffy , Kidd and Kell (k) antigen distribution between non tribal and tribal population . Total absence of Kell antigen in tribalsalong with. E antigen in a significant portion of blood donors and its absence in large number of tribals also increase the risk of alloimmunisation.
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Affiliation(s)
- Avani Shah
- Surat Raktadan Kendra & Research Centre, Udhna Magdalla Road (Nr. Chosath Joganio Mata Mandir), Surat 395002, Gujrat India
| | - Kanjaksha Ghosh
- Surat Raktadan Kendra & Research Centre, Udhna Magdalla Road (Nr. Chosath Joganio Mata Mandir), Surat 395002, Gujrat India
| | - Preeti Sharma
- Department of Biotechnology, Veer Narmad South Gujarat University, Surat 395002
| | - Kanchan Mishra
- Surat Raktadan Kendra & Research Centre, Udhna Magdalla Road (Nr. Chosath Joganio Mata Mandir), Surat 395002, Gujrat India
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