Blood Units For Patients Research Articles

Clinically significant minor blood group antigens amongst South Indian donor population

Background and objectives: Distribution of blood group antigen varies among different races. It is important to know the distribution of these antigens so as to provide a donor database that aid in providing compatible blood units for patients with multiple alloantibodies. The present study was conducted to determine the distribution of clinically significant minor blood group antigens amongst the South Indian blood donors. Materials and methods: Blood samples were collected from healthy regular repeat voluntary blood donors of same ethnicity attending a tertiary care hospital in South Kerala. Clinically significant blood antigens of the ABO, Rh (D, C, c, E, and e), Kell, Duffy and Kidd blood group systems were determined. The ABO and Rh(D) grouping were performed by tube technique using monoclonal antisera. Column agglutination technique was used to phenotype Rh, Kell, Duffy and Kidd antigens. Results: Total 200 healthy repeat voluntary blood donors were enrolled in the study. Out of 200 donors, 92% were RhD positive. Among the Rh antigens, the e antigen was positive in 97.8 % and 100% among the Rh(D) positive and Rh(D) negative donors respectively. No E antigen was detected in RhD negative donors. Total 6 and 2 Rh phenotypes were observed among the Rh(D) positive and negative donors respectively. R1R1 and Rr were the most frequent phenotypes among the RhD positive and negative donors (47.28% and 93.75%) respectively. Among the Kell blood group antigens, K and Kpb antigens were present in 100% of our donors while in Duffy and Kidd system Fya and Jka were most predominant (89% and 87%) respectively. Conclusions: The findings of the present study would be helpful in developing in-house panel cells. Moreover, a rare donor registry of donors typed negative for a high-frequency antigen can be formulated. IMC J Med Sci. 2024; 18(1):004. DOI: https://doi.org/10.55010/imcjms.18.004 *Correspondence: Soonam John, Department of Transfusion Medicine, Government Medical College, Parippally, Kollam, Kerala,India. Email: johnsoonam@gmail.com

ABO, Rh, and Kell Blood Group Antigen Frequencies in Blood Donors of Taif City, Saudi Arabia.

The ABO, Rh, and Kell blood group antigens are clinically significant. Knowledge of antigen frequencies is important to assess the risk of alloimmunization and to guide the probability of finding antigen-negative donor blood. Patients that lack such antigens may produce antibodies that may cause transfusion reaction. The frequencies of ABO, Rh, and Kell antigens in Taif city, Saudi Arabia have not yet been determined. This study aims to assess the frequencies of ABO, Rh, and Kell blood group antigens among Saudi donors in Taif city, Saudi Arabia. A retrospective study was conducted on 2,073 Saudi blood donors of both genders from May 2016 to May 2019. The data were collected, and calculations were done to determine the frequencies of ABO, Rh, and Kell blood group antigens. Of the 2,073 donors, the ABO blood groups of the donors were O (53.8%), A (24.9%), B (16.4%), and AB (4.6%). Rh-positive samples were (87.8%) and (12.1%) were Rh-negative. The most common Rh antigen was e (95.8%), followed by the c and C antigens (81.7% and 62.3%, respectively). The lowest Rh antigen frequency was E (31.3%). DCce was the most prevalent phenotype (29.5%). The KEL1 (K) antigen was determined in (22.1%) of the donors. This is the first study conducted in Taif city to assess the frequency of ABO, Rh, and Kell antigens among Saudi blood donors. This study provides the first step to create a regional donor database to obtain negative antigen blood units for patients with unexpected antibodies and to offer compatible bloods for multi-transfused cases by designing red cell panels.

Molecular red cell genotyping of rare blood donors in South Africa to enhance rare donor-patient blood matching.

BackgroundMolecular red cell genotyping is devoid of serology limitations such as the scarcity of rare antisera and the possibility of inconclusive results due to biological interferences. Blood incompatibility can result in immune transfusion reactions such as haemolytic transfusion reactions or haemolytic disease of the foetus and newborn.ObjectiveThe study aimed to use molecular red cell genotyping to identify rare blood group donors among South African blood donors.MethodsRed cell genotyping data were extracted retrospectively from the BIDS XT genotyping software in the Immunohaematology Reference Laboratory from January 2015 to August 2016. The ID CORE XT genotyping assay was used to identify the single nucleotide polymorphisms of 10 blood groups system alleles in 150 donors. Associations between the resultant genotypes and predicted phenotypes, ABO group, RhD type, race group and gender were studied.ResultsSignificant red cell genetic variability was noted among the numerous South African donor genotypes identified in this study. Genotyping further confirmed the presence of at least one of the 16 rare genotypes in 50 donors. Group O Black donors were associated with two rare blood types, while several other rare blood types were found only in White donors, supporting an association between ABO/Rh subtype, race group and rare blood types.ConclusionTargeted screening of donors for antigen-negative rare blood units for patients should be done to reduce the risk of haemolytic transfusion reactions and haemolytic disease of the foetus and newborn.

Red cell genotyping in Thailand: trends for blood transfusion in Asian populations

Numerous molecular techniques have been employed to determine well‐matched blood units for patients in need, particularly those requiring blood transfusions within 3 months and presenting positive DAT results. Only specialized reference laboratories use commercially available kits for red cell (RC) genotyping due to their expense and requiring extremely sophisticated instruments. Moreover, regarding complicated cases, particular typing reagents may be unavailable or insufficient. Therefore, identifying and confirming the compatibility of the blood units donated would require more time. This article aims to review the present uses of RC genotyping in Thailand and their significant contributions to transfusion practices in Asian populations. RC genotyping using PCR‐sequence‐specific primer (PCR‐SSP) and multiplex PCR (M‐PCR) has been established and used in patient and donor populations. The results of genotyping acquired by PCR‐SSP and M‐PCR were precise and in agreement with serological techniques. Predicted phenotypes of clinically significant blood group systems have been used to determine the compatibility of RC units among Thai patients having multiple antibodies. As a result, one additional advantage is the expanded storing of donated, frozen rare blood types. RC genotyping for high‐ and low‐prevalence antigens among differing Asian ethnicities requires consideration. RC genotyping employing these advanced PCR techniques could provide testing results that are both reliable and appropriate to screen suitable donor blood units in complex cases or patients presenting rare blood types. In addition, comparable strategies could be employed in other Asian populations using limited resources.

First report of a KELnull phenotype in Peru and a lesson of invisible genetic disparity

Blood banks in developing countries have limited capability to typify common blood groups creating disparities in the access to blood units for patients with rare blood genotypes. We report the case of a Peruvian woman with metastatic breast cancer with KELnull phenotype (K0), a rare blood group characterized by the lack of expression of all Kell antigens on the red blood cells (RBCs). The molecular studies identified that the patient's RBCs were homozygous for the nonsense c.1546C > T mutation predicted to encode p.Arg516Ter (KEL*02 N.17 allele), which confirmed the K0 phenotype. We conducted a local and international search of compatible blood units. Finally, the Japanese Red Cross donated the blood units for the patient. We present here the first report for a K0 phenotype in Peru and the challenging genetic disparities that many patients have to face to access to blood units in our country.

Managing a rare donor programme: the immunohaematology laboratory perspective

Alloimmunization is a major complication of blood transfusion which occurs more frequently in patients who are chronically transfused. It causes serologic investigations and makes the selection of compatible blood difficult, expensive and time‐consuming. Prompt availability of compatible units for patients with complex alloimmunization requires access to an inventory of extensively typed blood and to a database of rare donors. There are two key factors for rare donor provision. First, the routine programmes of red cell antigen typing in large cohorts of donors. Second, the ability to enrol healthy donors and patients negative for high‐prevalence antigens as well as family members. The immunohaematology laboratory is a highly specialized unit in charge of identifying challenging antibodies. It uses multiple methods of analysis and a broad inventory of reagents and cells not easily available. The laboratory also finds compatible blood units for patients with complex alloimmunization and designs appropriate transfusion strategies for these patients often in cooperation with international programmes.

A simple approach to screen rare donors in Brazil

Abstract Providing blood units for patients with an antibody to a high-prevalence antigen or with multiple common antibodies is a constant challenge to the blood banks. Finding a compatible donor requires extensive screening, which incurs a large amount of investment. In this article, we share our experience of organizing a rare donor inventory with limited resources, we include the strategy used for finding rare donors, and we share the difficulties found during the implementation of the approach and the results obtained. Immunohematology 2015;31:20–23.

Transfusion management of patients with red blood cell antibodies

Red blood cell antibodies may cause a positive result of pre-transfusion blood compatibility testing (crossmatch test). It can be a problem to provide suitable blood units for patients with clinically significant antibodies to high-frequency antigens as well as for those with multiple alloantibody specificities. This study was aimed at identifying transfused patients in the population of South-Backa who had developed clinically significant red blood cell alloantibodies. We analyzed the records of crossmatch results and antibody screening performed at the Blood Transfusion Institute of Vojvodina during 2012. Antibodies were found in 103 patients: A) 63 patients with single antibodies: 1) 16 with antibodies of unknown specificity (3 autoantibodies, 13 alloantibodies); 2) 39 with clinically significant antibodies (23 from Rh system (2 anti-C, 2 anti-D, 12 anti-E, 7 anti-c), 4 anti-K, 3 anti-Fya, 7 anti-Jka, 2 anti-S); 3) 8 with usually not significant antibodies (6 anti-M, 1 anti-Al, 1 antiC); B) 40 patients developed multiple antibodies: 1) all patients had at least one clinically significant antibody from various blood group system (44 Rh, 13 Kell, 7 Kidd, 7 MNSs (S, s)); 2) 3 patients had usually not significant antibodies (1 Lewis, 2 Lutheran); 3) 3 patients occasionally had clinically significant antibody (3 anti-Ytd4) 3 patients had antibodies of unknown specificity (2 autoantibodies, lalloantibody). Antibodies detected in the majority of patients (65-63.1%) had a specificity of Rh and/or the Kell system. The main goal of pre-transfusion blood compatibility testing is to detect clinically significant antibodies. The provision of antigen negative blood units for those patients is a special challenge for blood establishments. Database with a sufficient number of typed blood donors can help to resolve this problem.

Issuing of blood components dispensed in syringes and bar code–based pretransfusion check at the bedside for pediatric patients

The pretransfusion check at the bedside is the most critical step for the prevention of mistransfusion in pediatric patients, as well as in adults. The objective of this study was to assess whether a bar code-based patient-blood unit identification system could be applied to the pretransfusion check at the bedside for the issuing of blood dispensed in syringes. The issuing of blood components dispensed in syringes and the bar code-based pretransfusion check at the bedside were initiated for pediatric patients in May 2003. The number of blood components transfused to pediatric patients and rate of compliance with electronic bedside verification for blood dispensed in syringes were determined. Several variables in blood samples that were freshly collected, irradiated, split into 20-mL aliquots, and stored in syringes at 4 degrees C were measured. Between May 2003 and April 2007, a total of 3957 blood components (10% of all transfusions) were administered to pediatric patients without a single mistransfusion, of which 871 (22%) were issued by dispensing in syringes. The compliance rate with electronic bedside verification for blood dispensed in syringes was 99%. The supernatant potassium concentrations and extracellular free hemoglobin in blood samples stored in syringes at 4 degrees C for 24 hours were 14 +/- 1.3 mmol/L and less than 0.3 g/L, respectively, and these were considered to be acceptable for transfusion to pediatric patients. The bar code-based identification system that we used was fully applicable to the pretransfusion check at the bedside for blood dispensed in syringes.

Molecular Bases and Genotyping for Rare Blood Types

The provision of suitable blood units for patients carrying clinically significant antibodies to high-frequency antigens (HFAs) is a special challenge for blood establishments. Typing of donors and screening for HFA-negative individuals is increasingly performed by genotyping. In this context the selection of the HFAs of interest, the molecular background of some model antigens, and the different requirements for donor screening versus resolving serological problems are addressed. In addition, several published approaches for mass-scale donor genotyping are reviewed. Furthermore, the results of a DNA-based donor screening for 12 HFAs in 11,400 Austrian donors that resulted in finding 94 newly identified HFA-negative donors are referred to.

Causes of failure of a barcode‐based pretransfusion check at the bedside: experience in a university hospital

The objective of this study was to assess the cause of failure of bedside barcode identification before blood administration. The bedside check is the most critical step for prevention of mistransfusion. A barcode patient-blood unit identification system was implemented in all inpatient wards, operating rooms and an outpatient haematology unit in July 2002. The transfusion service monitored compliance with bedside barcode identification and checked it at 24 h or 1 h after issuing of blood. If electronic checking was not completed at that time, the transfusion service clarified the cause of failure and indicated the immediate use of the issued blood when it was not yet transfused. From April 2004 to December 2007, a total of 43 068 blood components were transfused without a single mistransfusion and 958 transfusions (2.2%) were performed without electronic checking. The overall compliance rate with bedside barcode identification was 97.8%, and it was 99.5% in the past 6 months. The cause of failure of bedside barcode identification was human error in 811 cases (84.7%), handheld device error in 74 (7.7%), system error in 50 (5.2%) and wristband error in 23 (2.4%). The number of errors leading to failure of bedside barcode identification was decreased for human errors, especially manipulation errors, after initiation of notification at 1 h after issuing of blood. The transfusion service may have an important role in increasing transfusion safety by monitoring compliance with bedside verification and bedside use of issued blood.

A computer‐assisted transfusion management system and changed transfusion practices contribute to appropriate management of blood components

ABO-incompatible blood transfusions attributable to inadequate identification (ID) of the patient or the blood unit are among the most serious of transfusion hazards. It has been unclear whether a computer-assisted transfusion management system connected to a bar code ID system could contribute to the appropriate management of blood components, as well as to the prevention of mistransfusions. A transfusion management system has been developed that links the hospital information system, a bar code patient-blood unit ID system, and an automated device for pretransfusion testing. The guidelines for issuing blood components from the transfusion service were also changed. The appropriateness of blood management was evaluated by monitoring the time to initiate transfusion after issuing a blood unit from the transfusion service (time after issuing [TAI]) and by calculating the number of units issued and subsequently returned, as well as the rate of date-expired red cell (RBC) components. From July 2002 to December 2006, a total of 49,974 blood components were transfused without a single mistransfusion. The monitoring of TAI and the notice to use the issued blood immediately had the effect of shortening TAI in the inpatient ward. The number of issued and subsequently returned RBC components, as well as the rate of date-expired RBC components, decreased significantly after the introduction of the system. A computer-assisted transfusion management system and changing transfusion practices appear useful in preventing mistransfusions and in contributing to the appropriate management of blood components.

Transplantation of Multiple Cord Blood Units for Patients with Hematologic Malignancy.

Limited number of umbilical cord blood (UCB) cells indeed compromises the result of adult UCB transplantation. Therefore, to augment graft cell dose, we evaluated the safety and effectiveness of the combined transplantation of multiple partially HLA-match UCB units which was scarcely performed in china. After myeloablative conditioning, six patients with high-risk hematologic malignancy (median age, 29 years; range, 10–37 years) received two or three UCB units with at least one 5/6 HLA-match unit (median infused dose, 3.77×107 nucleated cell [NC]/kg; range, 3.40–7.49×107 NC/kg). Patients' characteristics and transplantation data are detailed in Table 1. Five patients were engrafted successfully at a median of 22 days (range, 16–29 days) except one patient developed early graft failure (GF). In one patient, engraftment was derived from both donors for six months until her death. The both units' were 6/6 HLA-A-, HLA-B-, and HLA-DRB1- matched the recipient's, and they had similar number of nucleated cells, CD34 positive cells and CD3 positive cells. In the remaining four patients, Sustained hamatopoiesis was derived from a single donor which predominated as early as the day of engraftment after hematopoietic stem cell transplantation (HSCT). Units with a higher number of total nucleated cells and CD34+ cells predominated in two and one of four patients, respectively, and units with higher numbers of CD3+ cells predominated in three of four patients. The degree of HLA mismatch is also important (Table 2). Acute GVHD grades I-II was observed in the five patients. Two of them died of invasive fungus infection, one died of serious hepatitis, the remaining two patients were both alive and one survived in continuous complete remission 6 months after HSCT. Therefore, transplantation of multiple partly HLA-matched UCB units is a promising procedure to overcome the cell-dose barrier that limits the use of UCB in many adults and adolescents.Patient characteristics and transplantation dataPatientsNo. 1No. 2No. 3No. 4No. 5No. 6Age(years)/sex37/F30/M32/M27/M10/M10/FBody weight64kg84kg69.5kg56kg32kgDiagnosisALLALL(Ph+)ANLL(M0)ALLALL(Ph+)ANLL(M2)Pre-CBT statusCR2CR2CR1CR1CR1CR1ConditioningTBI12GY/Ara-c/CYTBI12GY/Ara-c/CYTBI12GY/Ara-c/CYTBI12GY/Ara-c/CYBU/CYBU/CY/ATGNucleated cells3.51×107/kg3.40×107/kg3.43×107/kg4.03×107/kg6.28×107/kg7.49×107/kgCD34+ cells2.37×107/kg2.75×105/kg4.28×105/kg2.22×105/kg3.40×105/kg5.51×105/kgANC>0.5×109/L21d27d16d29dNo22dPlt>20×109/L30dNoNo46dNo30dOver survive6M60d94d4M+2M+1M+OutcomesDeath(hepatitis)Death(IFI)Death(IFI)LiveGFLiveCharacteristics of dominant and non-dominant cord blood unitsPatientsNo. 2No. 3No. 4No. 6Nucleated cells(×107/kg)Dominant unit1.141.881.333.79Non-dominant unit10.941.551.453.7Non-dominant unit21.32CD34+ cells(×105/kg)Dominant unit0.811.561.451.86Non-dominant unit10.762.720.773.29Non-dominant unit21.18CD3+ cells(×107/kg)Dominant unit0.270.530.420.68Non-dominant unit10.140.40.340.63Non-dominant unit20.34Seratype (HLA-A,-B) and low-resolusion genotype (HLA-DR) mismatchDominant unit1/6.1/6.1/6.0/6.Non-dominant unit11/6.1/6.1/6.1/6.Non-dominant unit21/6.

Bar Code and Radio-Frequency Technologies Can Increase Safety and Efficiency of Blood Transfusions

Bar-coded labels on wristbands, blood sample tubes, and blood components can facilitate matching the “right” blood unit and the “right” patient. Nurses preferred to verify their patientblood unit identification matches by scanning bar code labels rather than seeking out a second nurse for a conventional visual “double check” verification. Occasional scans of barcoded wristbands failed because of crinkles, food spills, and blurring due to bathing. Also, inadvertently scanning the wrong bar code on a blood component signaled the program that a mismatch was occurring and “shut down” the system, according to the requirements of our software program. Radio-frequency identification (RFID) labels on wristbands and blood components were easier to scan, but bar coded labels may be adequate for personal identification cards and labels on blood sample tubes for budget-conscious transfusion safety systems. We envision significant advantages to combining transfusion safety and medication dispensing systems, using common hardware and complementary software programs.

輸血管理ネットワークシステムの構築を契機とした輸血運用変更の有効性

ABO-incompatible blood transfusion attributable to inadequate identification of the patient or blood unit remains the most common serious hazard of transfusion. A final bedside check to insure that the blood unit is intended for the patient is a prerequisite to the prevention of incorrect blood transfusions. We have developed a network computer-assisted blood transfusion management system, which connects with a novel barcoded patient-blood unit identification system and automated device for pretransfusion testing. This system permits a decrease in the number of manual procedures in the multiple steps of the transfusion process, and the monitoring of the bedside verification process in real-time at the transfusion laboratory. Since the initial implementation of this blood transfusion management system (July 2002), more than 17, 000 blood components (approximately 70, 000 units) have been transfused without mistransfusion. Further changes to transfusion practices, especially in the guidelines for blood component issuance for surgical operations, have resulted in a decrease in the date-expired rate and use of red cell components. This network computer-assisted blood transfusion management system may be useful for the prevention of incorrect blood transfusion attributable to human error and for the appropriate use of blood components, when used in conjunction with the patient-blood unit identification system.

バーコード照合システムと連携した輸血マネジメントシステムの構築

To prevent incorrect blood transfusion attributable to misidentification of the patient or blood unit, we developed a novel computer-assisted blood transfusion management system which connects with the barcode patient-blood unit identification system. The system is composed of 1) a hand-held computer that reads the barcodes of the patient's wristband, the blood unit, the compatibility report form and the compatibility label attached to the blood pack, 2) a computer-assisted blood transfusion management system capable of receiving the patient's transfusion data from a bedside hand-held computer, and 3) an automated blood testing instrument (GelStation). This system permits a decrease in the number of manual procedures in multiple steps of the blood transfusion process and the monitoring of bedside verification procedures in real-time at the transfusion laboratory, together resulting in the minimization of human errors and the improvement of transfusion safety. Further evaluation is needed to establish whether this barcode patient-blood unit identification system may play a role in increasing transfusion safety.

国際さい帯血バンクネットワーク組織ＮＥＴＣＯＲＤウェブサイト登録のための東京さい帯血バンクコンピューターシステムの構築

Cord blood transplantation has become an important method of achieving the hematopoietic reconstitution of marrow-ablated unrelated patients. It has been reported that improved patient survival results from higher cell doses and better histocompatibility matches. The prompt availability of these preferred cord blood units for patients in need can only arise from increased collection and improved access of transplant physicians to the available inventory. Consequently, the Tokyo Cord Blood Bank (TCB) has created a computer program using Kanri and Exporter software which allows the secure transfer and integration of the TCB database of cord blood inventory with the “virtual office” NETCORD web site, allowing transplant physicians to search the combined inventory of the two networks.

Blood Units for Patients with Irregular Blood Group Antibodies: Frequency and Supply

Blood banks face significant problems supplying blood units compatible with erythrocyte antigens other than ABO and rhesus D. In this study the number of such units was evaluated between 1973 and 1982, and it was found that 1.5% of the total number of blood units were compatible with other antigens than ABO and rhesus D. Based on data of the number of units requested for each such antigen and the frequency of the antigen in the European population, a logistical system providing sufficient numbers of 'antibody-compatible' blood units is proposed.

Blood Units for Patients with Irregular Blood Group Antibodies: Frequency and Supply

Blood Units for Patients with Irregular Blood Group Antibodies: Frequency and Supply