scholarly journals Transfusion management of patients with alloanti-Gerbich antibodies: Case report

2011 ◽  
Vol 139 (7-8) ◽  
pp. 518-522
Author(s):  
Radmila Jovanovic ◽  
Nevenka Bujandric ◽  
Slobodanka Lisulov ◽  
Sanja Bogdanovic
Keyword(s):  
Blood Transfusion ◽  
Blood Group ◽  
High Frequency ◽  
Time Frame ◽  
Medical Intervention ◽  
Blood Group Antigens ◽  
Specific Patient ◽  
Clinically Significant ◽  
Compatible Blood ◽  
Cross Match

Introduction. Transfusion management of patients who are alloimmunized against high-prevalence erythrocyte antigens is often problematic. Strategy management depends, not only on the specific clinical circumstances of the patient, but also on the acceptable time frame. In patients without clinically significant antibody incompatible transfusion it may be less harmful than delaying medical intervention. Case Outline. We report a 57-year-old female from Libya, blood group O, RhD-positive, who was treated at the Institute of Cardiovascular Diseases of Vojvodina. At the Blood Transfusion Institute of Vojvodina, during pretransfusion testing an IgG alloantibody of unknown specificity was determined. A total of 200 blood units (O, RhD-positive) were crossmatched, but positive reactions indicating that the donor units were incompatible for that specific patient. By testing the patient?s family members in Tripoli, six compatible blood units were found and applied during and after surgery. Due to the deterioration of the patient?s condition a rapid transfusion was required; however cross-match compatible blood was not available. After a biological crossmatch to predict the clinical significance of this antibody, 12 units of erythrocytes with the lowest positive cross-match reactions, were transfused to the patient without any adverse effects. Good tolerance of the units suggested that the present antibodies were not clinically significant. Later on, a rare alloantibody directed to the high frequency Gerbich blood group antigens was identified by the Foundation Central Laboratory, Blood Transfusion Service in Bern, Switzerland. Conclusion. In cases of emergency patients with alloantibodies against high frequency Gerbich, when autologous or compatible alogenous transfusion is unavailable, blood with the lowest positive cross-match reaction could be transfused if the biological cross-match is negative. Formation of a national register of donors with rare blood groups and their connection with international registers is of crucial significance in the management of patients requiring antigen negative blood otherwise unavailable from routine blood banks.

scholarly journals Ways to develop the prophylaxis of post-transfusion hemolytic complications

2015 ◽  
Vol 22 (4) ◽  
pp. 90-95
Author(s):  
B. B. Bahovadinov ◽  
M. A. Kucher ◽  
A. Yu. Tretyakova ◽  
G. S. Ashurova ◽  
N. K. Ashuraliev
Keyword(s):  
Blood Transfusion ◽  
Blood Group ◽  
Health Care Facilities ◽  
Health Facilities ◽  
Blood Group System ◽  
Blood Group Antigens ◽  
Childbearing Age ◽  
Group System ◽  
Rhesus Factor ◽  
Compatible Blood

Post-transfusion hemolytic complications (РНС) remain аn urgent рrоblem in medical practice despite the improvement of selecting methods of compatible blood transfusion for patients. The numbеr of РНС remains still high (1 in 6 000 - 29 000 transfusions). Aim: to analyze cases of РНС registered in health care facilities (HCF) in the Republic of Tajikistan. Method of investigation. Retrospective analysis of materials of national аnd regional committees оп investigation of РНС cases, histories fro hospital archives. During the period 1989-2014 in health facilities were registered 86 cases of РНС approximately 850 000 doses of red bооd cell transfusions containing blооd components, or 1 in 9418 doses of red blood cell-containing blood components. РНС reasons were: incompatibility of АВО blооd group system - 32 (37,3 %), antigen D of blооd group Rhesus factor system - 34 (39,53 %), according to minor blood group antigens of Rhesus factor and Kell blood group system (С, с, Е, е, К) - 16 (18,6 %). In 4 cases (4,6 %) the cases of РНС were hemolytic transfusions of erythrocyte-containing bags as а result of improper storage in domestic refrigeration without control of temperature storage. Causes of development 78 out of 86 РНС (90,69 %) were HCF doctors' mistakes, 8 (9,31 %) - mistakes of health personnel of health facilities departments of blood transfusion аnd regional blооd centers. Reducing the frequency of PHC is impossible without training physicians оn transfusion medicine, introduction of modern methods of phenotyping erythrocyte antigens of recipients and donors оn major transfusion significant blood group antigens the АВО system by direct and cross-over methods, Rhesus (С, с, Е, е), Kell (К) of patients requiring multiple transfusions, as well as to girls and women of childbearing age.

Non-Hemolytic Antibody Induced Loss of RBC Antigen during Transfusion of Crossmatch Incompatible Blood.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 557-557 ◽  
Author(s):  
James C. Zimring ◽  
Gregory A. Hair ◽  
Traci E. Chadwick ◽  
Seema S. Deshpande ◽  
Kimberly M. Anderson ◽  
...  
Keyword(s):  
Blood Group ◽  
High Titer ◽  
Surface Protein ◽  
Biological Properties ◽  
Target Antigen ◽  
Blood Group Antigens ◽  
A Cell ◽  
Clinically Significant ◽  
Antigen Loss ◽  
A Minor

Abstract Background: Transfusion of red blood cells (RBC) into patients with anti-donor RBC antibodies (crossmatch incompatible transfusion) can result in antibody mediated hemolysis. Less well appreciated is the ability of anti-RBC antibodies to specifically remove their target antigen from donor RBCs without compromising cell survival. This phenomenon has now been reported for the major clinically significant blood group antigens, including Rh, Kell, Kidd and Duffy. Although this has been described multiple times in humans, no mechanistic elucidation has been accomplished. In an effort to investigate the mechanism of this process, we describe the first animal model of non-hemolytic antibody induced RBC antigen loss. Methods: mHEL mice express the model antigen Hen Egg Lysozyme (HEL) as a cell surface protein on RBC. Since mHEL mice are on a C57BL/6 background, the mHEL antigen represents a single antigenic difference between donor RBC and recipient mice. Immunizing C57BL/6 mice with HEL/CFA results in the generation of high titer IgG anti-HEL responses rendering the mice crossmatch incompatible with mHEL RBC. This system was utilized to study the effects of transfusing mHEL RBC into crossmatch incompatible recipients. Results: Similar to the antibody induced antigen loss observed in humans, transfusion of donor mHEL RBC into crossmatch incompatible mice results in selective loss of HEL antigen from donor RBC without affecting other blood group antigens or reducing the circulatory lifespan of the donor RBC. In addition, recovered RBC that have lost their antigen have normal morphology. This process is antigen specific and occurs in mice that have received passive injections of anti-HEL antisera. A spleen is not required for antigen loss to occur. However, antigen loss does not occur in animals with a targeted deletion of the FcγIII receptor. Although polyclonal anti-HEL antisera consistently causes antigen loss, and IgG1 and IgG2b are the predominant subclasses of anti-HEL IgG in the antisera, no antigen loss is observed in response to purified monoclonal anti-HEL antibodies of the IgG1 and IgG2b subclass. Conclusion: These studies demonstrate that antibody induced antigen loss is a process that involves interaction of RBC, anti-RBC IgG and FcγIII receptors, thus providing mechanistic insight into the phenomenon of antigen loss during incompatible transfusion. The lack of antigen loss in response to monoclonal anti-HEL IgG1 or IgG2b suggests that antigen loss occurs in response to a minor IgG subtype in antisera, depends upon biological properties of the antibody (such as affinity), or that additional serum cofactors are involved.

High Frequency Antigens of Human Erythrocyte Membrane Sialoglycoproteins, V.Characterization of the Gerbich Blood Group Antigens: Ge2 and Ge3

1987 ◽  
Vol 368 (2) ◽  
pp. 1375-1384 ◽  
Author(s):  
Wolfgang DAHR ◽  
Siegrid KIEDROWSKI ◽  
Dominique BLANCHARD ◽  
Patricia HERMAND ◽  
John J. MOULDS ◽  
...  
Keyword(s):  
Blood Group ◽  
Erythrocyte Membrane ◽  
Human Erythrocyte ◽  
High Frequency ◽  
Blood Group Antigens ◽  
Human Erythrocyte Membrane

scholarly journals Prevalence of ABO, Rh and KELL Blood Group Types and Transfusion- Transmissible Infections (TTI) among Blood Donors in Najran City, Saudi Arabia

2021 ◽  
Vol 14 (02) ◽  
pp. 1065-1076
Author(s):  
Osama M Alshehri ◽  
Mohammed H Nahari ◽  
Elhashimi E Hassan ◽  
Musab F Alqahtani ◽  
Turki H Awaji
Keyword(s):  
Saudi Arabia ◽  
Blood Transfusion ◽  
Hepatitis B ◽  
Blood Group ◽  
Blood Donation ◽  
Complete Blood Count ◽  
Blood Groups ◽  
Type I ◽  
Blood Group Antigens ◽  
Safe Blood

The knowledge of Red blood cells polymorphism and blood group antigens prevalence at the local and regional levels is necessary for safe blood transfusion services. This study was aimed to estimate the prevalence of significant blood group phenotypes like ABO, Rh, and Kell among the Najran people of Saudi Arabia. The transfusion transmittable infection (TTI) rate and blood abnormalities among various blood types were assessed to ensure safe blood transfusion. ABO and Rh blood prevalence (n=970) and Rh phenotype polymorphism were estimated in over 531 unrelated donors. The blood samples were screened for certain TTIs like AHBC- Anti-hepatitis B core, HTLV-1- human T-lymphotropic virus type I, HCV- hepatitis C virus, HBsAg- Hepatitis B antigen, HIV- Human immunodeficiency virus, SIC- Sickle cell, MP- Malaria parasite, and SYP- Syphilis. The selected samples were also observed for blood abnormalities by performing a complete blood count (CBC). Out of 970 subjects, 966 were males, and only 4 were females. The O>A>B>AB blood groups were identified with 46.89, 29.3, 9.1, and 2.38% prevalence among Rh-positive phenotype. While in the Rh system, 87.6% and 12.3% of Rh positive and Rh negative was observed. Among 953 samples, the prevalence of seropositive donors was approximately 5.66%. The screening showed about 5.036, 0.104, 0.314, 0.209, 2.18, 0.104, and 0.209% positivity for AHBC, HCV, HBsAg, HIV, SIC, MP, and SYP respectively. Results found that the frequency of D, C, E, c, and e were 99.9%, 67.98, 25.8, 77.9, 98.49%, respectively, in over 531 subjects. The e allele was more prevalent in Najran city. After observing the variations in the CBC parameters among the donors, it was perceived that about 28.78, 99.9, 29.41, and 31.6% of blood abnormalities were noticed for O, AB, B, and A blood groups, respectively. For blood banks and transfusion services, which play a significant role in the medical care of the patient, awareness of the distribution of the blood group is essential. Increasing consistency of blood donation programs would improve both donor satisfaction and motivation for potential donations of blood in near future.

scholarly journals Evidence that several high-frequency human blood group antigens reside on phosphatidylinositol-linked erythrocyte membrane proteins

Blood ◽  
1990 ◽  
Vol 75 (7) ◽  
pp. 1404-1407 ◽  
Author(s):  
MJ Telen ◽  
WF Rosse ◽  
CJ Parker ◽  
MK Moulds ◽  
JJ Moulds
Keyword(s):  
Membrane Proteins ◽  
Blood Group ◽  
John Milton ◽  
Human Blood ◽  
High Frequency ◽  
Paroxysmal Nocturnal Hemoglobinuria ◽  
Blood Group Antigens ◽  
Normal Complement ◽  
High Incidence ◽  
Erythrocyte Membrane Proteins

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired disorder associated with absence of expression of phosphatidylinositol (PI)- linked membrane proteins from circulating hematopoietic cells of multiple lineages. Recent work demonstrated that decay accelerating factor, one such PI-linked protein, bears the Cromer-related blood group antigens. This study demonstrated that other high incidence antigens, including Cartwright (Yta/Ytb), Holley-Gregory (Hy/Gya), John Milton Hagen (JMH), and Dombrock (Doa/Dob), are absent from the complement-sensitive (PNH III) erythrocytes of patients with PNH. The relatively normal, complement-insensitive erythrocytes from the same patients express these antigens normally. Therefore, these antigens most likely reside on PI-linked proteins absent from PNH III, but not PNH I, erythrocytes.

scholarly journals Prevalence of ABO, RhD and other clinically significant Blood Group Antigens among blood donors at tertiary care center, Gwalior

2020 ◽  
Vol 9 (2) ◽  
pp. 437
Author(s):  
Shelendra Sharma ◽  
Dharmesh Chandra Sharma ◽  
Sunita Rai ◽  
Anita Arya ◽  
Reena Jain ◽  
...  
Keyword(s):  
Blood Group ◽  
Blood Donors ◽  
Care Center ◽  
Tertiary Care ◽  
Blood Group Antigens ◽  
Tertiary Care Center ◽  
Clinically Significant

Synthetic Peptide Mimotopes of blood Group Antigens for Red Cell Antibody Screening

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 291-291
Author(s):  
Evelyn J A Tait ◽  
Robin Fraser ◽  
Michael Moss ◽  
Stanislaw J Urbaniak
Keyword(s):  
Blood Group ◽  
Test System ◽  
Blood Group Antigens ◽  
Optimal Test ◽  
Screening Assay ◽  
Antibody Screening ◽  
Random Peptide ◽  
Antibody Recognition ◽  
Genes Encoding ◽  
Clinically Significant

Abstract Background: Antibody screening is performed both routinely in the blood group typing procedures for donors and patients and in more detail as part of special investigations for transfusion-dependent patients such as those suffering from Sickle Cell Disease and Thalassaemia. However, despite the care taken, intrinsic limitations of traditional serological diagnostic tests mean that alloimmunisation of pregnant women and multiply transfused patient may still go undetected, resulting in Hemolytic Disease of the Newborn or Hemolytic Transfusion Reactions, respectively. Furthermore, although the genes encoding the majority of blood group antigens have been characterised, the expression of recombinant gene products and the subsequent determination of protein structure that might lead to novel diagnostic reagents have proved more difficult to achieve. Methods: Phage Display libraries that express random peptide sequences (~1015) on the virion surface were screened using a series of monoclonal antibodies and an anti-RhD polyclonal preparation to identify peptides that mimic epitopes of clinically important blood group antigens. The peptides thus identified, were then synthesised in macroarrays and evaluated using SPOTs (Simple Precise Optimal Test system) in a step towards development of a novel diagnostic antibody-screening assay. Results: The combined approach of phagepeptide display and SPOTs proved powerful. From 490 phage-peptides selected by biopanning, 86 mimotopes bound their cognate antibody in SPOTs assays and represented the clinically important blood group antigens RhD (including epitopes 1.1, 3.1 and 6.3), RhE, Rhe, Fya and Fyb. These peptides ranged in size from 7 to 15 residues and included 7-mers that were constrained at their termini by a di-sulphide bridge. Further SPOTs analyses showed 26 of these phage-peptides (12 RhD, 3 RhE, 1 Rhe, 2 Fya and 8 Fyb) have the appropriate strength of signal and binding specificity for inclusion in any future diagnostic antibody-screening assay. A subset of these peptides has been further tested. These peptides were immobilised on polystyrene microspheres and shown to specifically bind their cognate antibodies in both (1) monoplex gel agglutination immunoassays and (2) microsphere-based, multiplex suspension arrays. Conclusions: We have shown that, regardless of whether or not the mimotopes resemble the original antigen sequence, they bind their cognate antibodies specifically and are therefore genuine mimics of the natural antigenic epitopes. It has also been demonstrated that the context in which a peptide is presented is fundamentally important for antibody recognition. The value of the phage-peptide approach in identifying mimotopes to clinically significant blood group antigens has also been established. Moreover, these peptides could be used in a single, comprehensive screening assay and eliminate many of the problems associated with agglutination assays and may herald the possibility of a synthetic, diagnostic array for routine antibody screening for all patients and donors and patients in the near future.

Blood Group Genotyping to Prevent Alloimmunization in Children with Sickle Cell Disease

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2486-2486
Author(s):  
Nancy Robitaille ◽  
Yves D. Pastore ◽  
Anne-Julie Landry ◽  
Catherine Latour ◽  
Josée Lavoie ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Group ◽  
Blood Donors ◽  
Conflicts Of Interest ◽  
African Descent ◽  
African Ancestry ◽  
Adult Life ◽  
Blood Groups ◽  
Cell Disease ◽  
Compatible Blood

Abstract Introduction:Sickle cell disease (SCD) patients can suffer from devastating complications of their disease as a result of chronic hemolysis and vasculopathy. Chronic blood transfusion can effectively prevent some of the most severe organ damage such as cerebral vasculopathy. However, alloimmunization remains a major concern for chronically transfused patients, even if prophylactic antigen matching is performed for C, E and Kell antigens. Variants in the Rh blood group have been well described in people of African descent and must be considered when transfusing patients with SCD. The main objectives of this study were to determine the frequency of variants in the Rh and Duffy blood groups and to identify compatible blood donors presenting similar Rh variants Methods: Extended erythrocyte phenotypes were routinely done at diagnosis for every SCD patient followed at the SCD clinic of CHU Sainte-Justine. Serologic testing was performed by standard methods. Upon informed consent, genotyping for Rh and Fy blood groups was also proposed to all SCD patients. DNA analyses were used to predict D phenotype (including RHD pseudogene), C, c, E, e antigen profile, FY phenotype with GATA-1 status, and to confirm critical position in the RHD (DAU cluster, zygosity) and RHCEgenes (position 48, 254, 733, 1006). The study was approved by the local Research Ethics Board (REB). Results: 203 SCD patients were evaluated: HbSS 64.3%, HbSC 29.6%, HbSb0 3.1%, HbSb+ 2.5% and HbSDIran 0.5%. ABO blood groups followed published prevalence: Group O 48.7%, A 26.2%, B 20.4%and AB 4.7%. 90.2% of patients had either a normal RHD*01 or RHD*10.00 gene which would predict a normal D+ phenotype. Twenty patients would require D− units (9.8%) to reduce their alloimmunization risk (D−, weak partial D and partial D). The RHCE genotyping results were as followed: normal c allele 61.2%, normal e allele 39.3%, partial e allele 34.1% and weak e allele 17.6%. Most RHCE alleles present in the cohort reflected variants previously reported in individuals of African descent. Most patients were compound heterozygotes. 45.8% of RHCE alleles were considered normal: RHCE*ce, RHCE*Ce and RHCE*cE. Fy(a-b-) phenotype was found in 91.6% of patients (186/203). The list of RHCE variant alleles observed in the cohort was compared to Héma-Québec's (blood supplier for the province of Quebec) African descent blood donor database. For partial e, weak partial e and rare hrB− phenotypes, only D+ donors are available whereas some of the patients are D−. The same is true for one Sec− (RH46, high-prevalence antigen) patient for which no donor is available. As for CEAG− recipients (partial ce-phenotype), two compatible blood donors were identified by screening O− units from donors of African descent. Overall, five patients (2.4%) may not have suitable donors in our blood bank based upon genotype compatibility. Twenty other patients could be added to this calculation because of a variant e allele in trans to a normal E allele. Conclusions: The RH and FY results indicate that very few patients require rare blood units. More than 90% present a normal D antigen and are Fy(a−b−), similar to most blood donors of African ancestry. However, RHCE variants could be more problematic in terms of finding compatible units. This study showed a large array of RH variants, although most are present in heterozygous form accompanied by a normal allele. This could explain the low alloimmunization rate of 3% for Rh antigens observed in this cohort (overall alloimmunization rate of 18.9%). However, as all patients were younger than 18 years old, they will probably be exposed to more blood transfusion during their adult life. Having their RH and FY genotype readily available should make the blood donors' selection easier. Further prospective studies are needed to evaluate if such an approach will lower the alloimmunization rate. Disclosures No relevant conflicts of interest to declare.

scholarly journals P-Null Phenotype Due to a Rare Frame-Shift Mutation and with Allo-Anti-PP1Pk Causing a Severe Hemolytic Transfusion Reaction: A Case Report with Clinical Management

2021 ◽  
pp. 1-4
Author(s):  
Ashish N. Kanani ◽  
Snehal B. Senjaliya ◽  
Manisha M. Rajapara ◽  
Judith Aeschlimann ◽  
Connie M. Westhoff ◽  
...  
Keyword(s):  
High Frequency ◽  
Surgical Intervention ◽  
Medical Intervention ◽  
Transfusion Reaction ◽  
Genomic Study ◽  
Blood Clots ◽  
Null Phenotype ◽  
The Face ◽  
Hemolytic Transfusion Reaction ◽  
Compatible Blood

Introduction:The identification of alloantibodies to high-frequency antigens (HFA) and subsequent transfusion management can be challenging and often poses a problem in finding the compatible blood for transfusion. The aim of this study was to investigate the specificity of the antibody to the HFA causing a hemolytic transfusion reaction (HTR) and procure the compatible blood unit for future transfusion. Case presentation:A 4-year-old female met with a head injury that led to intracranial bleeding and surgical intervention was required to remove blood clots. In the face of anemia, blood transfusion was planned. The pretransfusion tests on her blood sample revealed the presence of a pan-reactive alloantibody with hemolytic properties. She was transfused with 10 mL of the least incompatible red blood cells (RBCs) to which she reacted with signs of clinical hemolysis, i.e., chill, rigor, fever, and hemoglobinuria, on 3 different occasions. Despite her anemia, she was managed by medical intervention only. Her antibody reacted with all RBCs tested, except autologous and P-null (p phenotype) cells. Her RBCs did not react with anti-PP1Pk, which corroborated her phenotype as P-null. The genomic study revealed she was hemi- or homozygous or for a deletion of 26-bp in A4GALTexon 3, previously reported as causing the P-null phenotype and designated A4GALT*01N.019.Conclusion:This report documents a rare case of the P-null phenotype with an alloanti-PP1Pk causing a severe HTR to transfusion of the trial dose of the least incompatible blood. The case is the first example of this specific A4GALTmutation found in India.

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