Distribution of ABO, Rhesus Factor Blood Phenotype and Haemoglobin Genotype among Antenatal Clinic Attendees in Anyigba, North Central Nigeria

Background: In the practice of obstetrics and gynecology, the ABO and Rhesus factor (Rh) blood type are important. Blood typing for blood transfusion of compatible blood is very common in emergency and routine care. There is a scanty literature on the distribution of ABO and Rhesus blood types in Anyigba, (North central) Nigeria. Objective: This study aims to determine the distribution of ABO blood and Rhesus blood group phenotypes and Hemoglobin genotypes among antenatal clinic attendees in a teaching hospital. Methods: Antenatal records of attendees (October 2017 to September 2020) at the Kogi State University Teaching Hospital were retrieved and results of antenatal hematological investigations were collected using a structured tool.Bio data, ABO blood group, Rhesus group phenotype and Hemoglobin genotype were collected, inputted and analyzed using SPSS version 20. Results: The mean age was 26 +/- 7years, blood group O is most prevalent,561 (53.6%) then A 276 (26.4%), B 189 (18.1%) and AB,21 (2%).1014 (96.4%) were Rhesus D positive, 33 (3.1%) were Rhesus D negative. For hemoglobin genotype, 786 (75.1%) were AA, 258 (24.6%) were AS, AC were 3 (0.3%). Conclusion: The distribution of the ABO, the Rhesus (D) blood groups and hemoglobin genotypes are in concurrence with the findings of previous studies; Blood group O is the most prevalent and AB the least prevalent, Rhesus (D) positive in the population is high and the hemoglobin genotype AA is the most prevalent. There is no association between blood group phenotypes studied and the hemoglobin genotypes.

A case study of a patient with anti-Yta alloantibodies against the high-prevalence antigen of red blood cells qualified for heart transplantation

The Yta antigen from the Cartwright blood group system is a high-prevalence antigen found in 99.8% of the population. The literature data shows that antibodies anti-Yta demonstrate the variable clinical significance and are rarely the cause of a hemolytic post-transfusion reaction. The study aims to present the difficulties related to the selection and sustainable supply of blood for transfusion for the patient of the Silesian Centre for Heart Diseases with anti-Yta alloantibodies, qualified for a heart transplant. If Yt(a-) blood is not available Institute of Hematology and Transfusion Medicine in Warsaw, referring to reports in the publications, allowed transfusion of the least incompatible red blood cells in indirect antiglobulin test. One hour after transfusion of leucocyte-depleted concentrate of red blood cells (RBCs), issued in accordance with the above recommendations by Regional Blood Donation Center in Katowice as the least incompatible, the patient was observed to experience symptoms of an adverse post-transfusion reaction. For subsequent transfusions, RBCs from Yt(a-) donors were selected, of which only eight were registered in Poland at that time. Medical decisions on RBCs transfusion in patients for whom no compatible blood can be selected is very difficult, and the benefits of incompatible transfusion should be weighed against the risk of possible complications. To avoid this, it should be remembered that the early identification of antibodies increases the chance of finding serologically compatible blood and in many cases allows to supply blood for a patient with autologous donations.

Towards manufactured red blood cells for the treatment of inherited anemia

Patients with inherited anemia and hemoglobinopathies (such as sickle cell disease and β-thalassemia) are treated with red blood cell (RBC) transfusions to alleviate their symptoms. Some of these patients may have rare blood group types or go on to develop alloimmune reactions, which can make it difficult to source compatible blood in the donor population. Laboratory-grown RBC represent a particularly attractive alternative which could satisfy an unmet clinical need. The challenge, however, is to produce - from a limited number of stem cells - the 2x1012 RBC required for a standard adult therapeutic dose. Encouraging progress has been made in RBC production from adult stem cells under good manufacturing practice. In 2011, the Douay group conducted a successful proof-of-principle mini-transfusion of autologous manufactured RBC in a single volunteer. In the UK, a trial is planned to assess whether manufactured RBC are equivalent to RBC produced naturally in donors, by testing an allogeneic mini-dose of laboratory-grown manufactured RBC in multiple volunteers. This review discusses recent progress in the erythroid culture field as well as opportunities for further scaling up of manufactured RBC production for transfusion practice.

Para-Bombay B phenotype: a rare ABH blood group variant at tertiary care hospital, Gwalior India

Background: The H antigen is the precursor substance for A and B antigens formation on red blood cells of an individual and absence of it is termed as H deficient phenotype. If H antigen is absent on both RBCs and secretions, and then the resulting blood group is a Classical Bombay phenotype with anti-H antibodies in their serum. If H antigen are absent on RBCs and present in secretions and plasma, the resulting blood group is Para-Bombay phenotype. Genetically Para-Bombay’s lack an active H gene (genotype is hh) but carry at least one Se gene (Secretor gene). Para-Bombay or red blood cell (RBC) H negative secretor individuals may or may not have anti-H in their serum. In both cases routine blood grouping is O. Case Report: Blood sample of 24-year-old female is submitting in blood bank, resulting her routine grouping O RhD positive. Complete blood grouping by Gel technology revels her forward grouping is Oh and reverse grouping B. Patient is secretor for B and H antigens. Absorption and elusion test is negative. Family grouping was also done to find out compatible blood and her family genesis. Conclusion: Patient blood group is Para-Bombay B. Complete blood grouping (Forward and reverse) as well as saliva grouping and absorption /elusion test is advisable when there is a discrepancy in ABH grouping.

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

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.

Genotyping of Eight Human Platelet Antigen Systems in Serbian Blood Donors: Foundation for Platelet Apheresis Registry

Introduction: The aim of this study was to investigate the allele and genotype frequencies of 8 human platelet antigen (HPA) systems among blood donors from the Blood Transfusion Institute of Serbia and to compare them with published studies. These data would be useful to establish the basis for a platelet apheresis donor registry. Material and Methods: Seventy-two unrelated male platelet apheresis/blood donors from Serbia were typed for 8 HPA systems (HPA-1 to HPA-6, HPA-9, and HPA-15) via the FluoGene method, based on polymerase chain reaction-sequence-specific amplification (PCR-SSP; PCR using sequence-specific primers) with fluorometric signal detection. Allele and genotype frequencies were estimated by direct counting and compared to the expected genotype frequencies according to the Hardy-Weinberg principle. The transfusion mismatch probability was calculated for every HPA specificity. Results: The allele frequencies were: HPA-1a, 0.868; HPA-1b, 0.132; HPA-2a, 0.917; HPA-2b, 0.083; HPA-3a, 0.611; HPA-3b, 0.389; HPA-5a, 0.903; HPA-5b, 0.097; HPA-9a, 0.993; HPA-9b, 0.007; HPA-15a, 0.472; and HPA-15b, 0.528. For HPA-4 and HPA-6 only allele a was detected. Discussion: The HPA allele frequencies of European populations showed no significant differences in comparison with our results. Statistically significant differences were revealed in comparison with some populations of non-European origin. In the tested donors no HPA-2 bb genotype was detected, but we found 1 donor with the rare HPA-9b allele. The biggest transfusion mismatch probability in the Serbian population is for systems HPA-15 (37.4%) and HPA-3 (36.2%), which means that more than a third of random transfusions could cause mismatch in these systems. This study was enabled by the introduction of molecular HPA typing, and it provides initial results of the HPA allele and genotype frequencies in the population of blood donors in Serbia. They will be used to provide a compatible blood supply on demand for treating patients with alloimmune thrombocytopenic disorders. The successful implementation of PCR-SSP with fluorometric signal detection could be further complemented in the future by the introduction of high-throughput methods, which will largely depend on the available financial resources.

PREVALENCE OF IRREGULAR RED CELLANTIBODIES IN HEALTHY BLOOD DONORS ATTENDING A TERTIARY CARE HOSPITAL IN SOUTH INDIA

Introduction: Red cell antibodies that are found normally in human serum are considered naturally occurring and those are anti A and anti B. All other antibodies directed against RBC antigens are considered “unexpected or irregular". Aim: This study is aimed to evaluate the prevalence of the anti-red blood cell antibodies among healthy blood donors. Material and Methods: Antibody screening and identification was done using commercially available 3 cell and 11 cell reagent cells (0.8% Surgiscreen, Ortho Clinical Diagnostics Limited, USA and Low ionic Strength Saline Ortho Bliss with AHG Cassettes) in antihuman globulin phase. Results: A total of 36,684 donors were screened for the presence of irregular erythrocyte antibodies. Among these donors, twenty donors showed presence of alloantibodies in their serum (0.054%). Most frequent alloantibodies identified were from Lewis blood group system. The results showed statistically a higher prevalence of RBC alloantibodies in males than in females. Conclusion: Screening for presence of alloantibodies in donor blood is important to provide compatible blood products and to avoid transfusion reactions.

A day in the life of a biomedical scientist

Andrew Paluszkiewicz is a biomedical scientist at Nottingham University Hospital Trust (NUH) working in the haematology and blood transfusion departments, which provides a 24/7 service to patients. The two departments perform a vast array of routine and specialized tests to aid the monitoring and diagnosis of conditions such as anaemia, leukaemia, sickle cell disease, haemophilia and other bleeding and clotting conditions, while also providing compatible blood components and products. This is achieved by identifying patients’ blood groups and detecting and identifying clinically significant antibodies that could cause a transfusion reaction, and potentially death, if incompatible units are transfused.

Erythrocyte Phenotyping in ABO, RH and Kell Blood Group Systems in the Donor and Recipient of Blood Products at the Yaounde University and Hospital Center

In order to prevent post transfusion alloimmunization, it is essential to give recipients compatible blood products. However in countries with limited income, blood grouping is limited to the ABO system and to the D antigen of the Rhesus system; however, there are other immunogenic antigens such as C, c, E, e and K to name a few. This should be the reason why a retrospective study by Tayou et al. at the blood bank of the University Hospital Center (CHU) of Yaoundé in 2009 on the erythrocyte phenotype in the donor and recipient of blood product only reported to us that data relate to the erythrocyte blood group system ABO and the Rh 1 antigen. We therefore found it expedient to carry out erythrocyte phenotyping in the ABO, RH and KELL blood group systems in the donor and recipient of blood products at the CHU of Yaoundé. A descriptive, transversal and prospective study was carried out at the blood bank of the CHU of Yaoundé over 6 months, from June 1, 2017 to December 31, 2017. It was interested in the donor-recipient couples of blood within which the recipient was a patient hospitalized at the CHU. Laboratory analyses of donor and recipient blood samples have allowed us to have the phenotypes in the ABO, RH, and KELL blood group systems. In the ABO system, the phenotypes obtained were 4: A1, A1B, B and O at 27.27%, 2.27%, 13.64% and 56.82% respectively among donors and 31.82%, 2.27%, 13.64% and 52.27% among recipients. In addition, from the Rhesus system, there were 5 phenotypes in donors: D + C + E + c + e +, D + C + E-c + e +, D + C-E + c + e +, D + CE-c + e +, DCE-c + e + respectively at 2.27%, 11.36%, 9.09%, 75.00% and 2.27% and in recipients 4 phenotypes, namely: D + C + E + c + e +, D + C-E + c + e +, D + CE-c + e +, DCE-c + e + at 15.91%, 27.27%, 54.55% and 2.27% respectively. In the KELL system, the K antigen was present in 4.55% of donors and 2.27% of recipients. An antigen supply from the donor to the recipient was evaluated at 6.82% for C, 4.54% for E, 2.27% for K and 2.27% for K, C, E at the same time. This gave us an estimate of the average risk of alloimmunization at 15.9%. Erythrocyte phenotyping would therefore be of major benefit during blood transfusion and would considerably prevent the risks of alloimmunization.