Rh Subgroups Research Articles

Pre-transfusion Testing Using Crossmatching Agglutination Reaction Grades Combined With Rh Subgroup Phenotyping in Patients With Autoantibodies: A Three-year Experience at a Tertiary Hospital.

The currently recommended pre-transfusion testing techniques for patients with autoantibodies are complex, time-consuming, and labor-intensive. Therefore, although the red blood cell (RBC) selection method using crossmatched RBC agglutination reaction grades (i.e., the "least incompatible" transfusion) is discouraged, many institutions still use it. We aimed to evaluate the effectiveness of this method combined with Rh subgroup phenotyping. We retrospectively investigated RBC transfusions from January 2019 to December 2021 in patients presenting as auto-control-positive via antibody identification (auto-control (+) group), where Rh subgroup phenotype-matched RBCs were selected based on the agglutination reaction grades of crossmatched units. For each study patient, an auto-control-negative patient was matched based on age, sex, department, and pre-transfusion Hb levels (auto-control (-) group). The mean Hb change per unit, transfusion-associated symptom/sign reports, and agglutination reaction grades upon crossmatching were analyzed. In the auto-control (+) group, the Hb change per unit among different agglutination reaction grades of transfused RBCs and among different relative grades of transfused RBCs and crossmatching auto-controls was not significantly different (P=0.392 and P= 0.132, respectively). No significant difference was observed in Hb changes and transfusion-associated symptom/sign occurrence between the auto-control (+) and auto-control (-) groups (P=0.121 and P=0.822, respectively). In addition, no definite evidence of hemolysis in the auto-control (+) group was observed in the medical record review. Together with Rh subgroup phenotyping, selecting the RBC unit with the lowest agglutination reaction grade upon crossmatching does not adversely affect transfusion efficiency.

Distribution of Rh Subgroups and Kell Antigens in Patients with Thalassemia

First-line therapy for thalassemia patients is blood transfusion. Patients who get repeated transfusions of red blood cells (RBCs) risk developing an immune response to the RBCs, resulting in a hemolytic transfusion reaction and even death. Patients who get phenotype blood transfusions are less likely to experience these side effects. Between 2014 and 2015, researchers at Baghdad’s Ibn Al-Baladi Thalassemia Hospital performed a prospective survey and collected samples.

Prediction of Covid-19 infection severity using ABO blood group types and Rh factor.

Background & Objective:Biological markers for the prediction of acquiring Covid-19 risk are deficient and there is a dire need of immediate research data. The objective of the study was to predict the link of ABO blood group types along with Rh factor distribution with the severity of Covid-19.Methods:This was an observational cross-sectional survey conducted in medicine department of Pakistan Ordnance Factory Hospital, Wah Cantt Pakistan, from August 2020 to December 2020 after approval of IRB. Participants tested positive for presence of Covid-19 infection by polymerase chain reaction (PCR) were included in the study. Covid-19 infection severity was measured through mild, moderate and severe disease categories and analyzed. ABO blood group and Rh subgroups data for all the Covid-19 infected patients were obtained from the laboratory section of the hospital and analyzed. Data was entered in SPSS v 26 and analyzed. Cox regression model was used to find out the severity of Covid-19.Results:Total 248 patients were included; 75% patients were male and 25% were females. The mean age of the patients was 52.77±15.58 years. A very significant association was found between ABO blood group types, Rh factor antigen and severity of Covid-19 (p=0.001). When stratified ABO, Rh antigen blood group with health status of all patients there was a very significant association between them (p=0.013). An insignificant association between male and female odds ratio of ABO blood group types but blood group B, Rh positive antigen was more susceptible in Covid-19 positive patients.Conclusion:There is a link between ABO blood group types along with Rh factor antigen (B+ and O+) with the severity of Covid-19 positive patients. ABO blood group types and Rh factor can be used as a potential marker/tool to predict the susceptibility of acquiring Covid-19 infection as well as for severity of the infection.

Blood group genotyping in multi-transfused patients

Aim. To assess the possibility of using blood group genotyping in recipients who received transfusions for 3 months.
 Methods. The study included blood samples from 95 patients who received 3 or more erythrocyte transfusions within 3 months. The patients had the following diagnoses: multiple myeloma (n=7), beta thalassemia (n=4), non-Hodgkin's lymphomas (n=11), chronic myeloid leukemia (n=16), primary myelofibrosis (n=9), myelodysplastic syndrome (n=22), acute leukemia (n=21), aplastic anemia (n=5). Red blood cells phenotyping was performed in Diaclon Rh Subgroups+K Gel Cards. The Rh and Kell genotyping was performed by using RBC SSP-PCR kits FluoGene vERYfy (Inno-train Diagnostics, Germany). The standard RHD/RHCE alleles, as well as polymorphisms associated with KEL1/KEL2 [T698C (Met198Thr)] of the KEL gene were genotyped.
 Results. The concordance rate between serological and molecular genetic typing of RhCE and Kell blood groups for donors was 100%, while the patients results were discordant in 45.3% of cases. Discrepancies in antigens of the Rh system were registered in 41 patients: one antigen of the Rh system in 30 patients, two in 9 patients. Ten patients who had been previously phenotyped as RhCc were genotyped as RHCE*CC. 2 patients who had been previously phenotyped as Rhee were genotyped as RHCE*EE. In 2 patients, antigens D and C were not detected in the phenotype but were identified in the genotype. Discrepancies in antigen K were recorded in 2 patients, and the antigen was absent in the phenotype but was present in the genotype. The genotyping results were confirmed by serological typing at subsequent hospitalizations.
 Сonclusion. Blood group genotyping is a useful adjunct to traditional methods when serological typing is limited.

Implementation of a regional rare donor registry in India

BackgroundIn an ethnically diverse country like India, establishing a national rare donor registry is a massive challenge. We aimed to establish a regional rare donor registry at our center by screening the local donor population for rare phenotypes. MethodsSerological testing of O blood group donors was done using monoclonal antisera from Bio-Rad for 23 different blood group antigens, which include Rh subgroups (C,cE,e), Kell (K,k, Kpa, Kpb), P1, Duffy (Fya, Fyb), Kidd (Jka, Jkb), Lewis (Lea, Leb), Lutheran (Lua, Lub), H, M, N, S and s. We categorized the donors with rare blood phenotypes into two categories. Category-I: High-frequency antigen-negative phenotypes with a prevalence of less than 1% in our study population. Category-II: Multiple common antigen-negative phenotypes with a prevalence of less than 1% in our study population. ResultsA total of 521 donors with blood group O, meeting the inclusion criteria among a total of 23567 were phenotyped for minor blood group antigens. Out of these, 85.6% (n = 446) were Rh D positive, and 14.4% (n = 75) were Rh D negative. The male-to-female ratio was 9:1. We had identified eight rare phenotypes in category-I and 18 rare phenotypes in Category-II according to the definition adopted in our study. We have noticed a significant decrease in turnaround time in providing rare blood to patients after implementing the registry. ConclusionThis is a first-of-its-kind rare donor registry established in South India. Establishing a national rare donor registry is the need of the hour in India.

Association of Blood Subgroups With PCR Test Positivity and Lung Involvement in Patients With COVID-19.

ObjectiveThe goal of this study was to investigate whether blood group type caused susceptibility to COVID-19 infection.MethodsTwo hundred and eleven consecutive patients admitted with various symptoms associated with COVID-19 were included. We compared the AB0 and Rh subgroup distributions between patients with a positive polymerase chain reaction (PCR) test result and the patients without. We compared the AB0 and Rh subgroup distributions between patients with lung involvement and patients without. Additionally, comparisons were performed between the patients both with positive PCR result and lung involvement, and the patients with a negative PCR result.ResultsNo significant difference of ABO and Rh subgroup distributions was evident between patients with and without a positive PCR test result (p=0.632 and p=0.962). No significant difference of ABO and Rh subgroup distributions was evident between the patients with and without lung involvement (p=0.097 and p=0.797). No significant difference of ABO and Rh subgroup distributions was evident among patients both with PCR positivity and lung involvement, patients with only PCR positivity, and the patients with negative PCR test results (p=0.3 and p=0.993).ConclusionAll blood group types seem to have an equal risk of COVID-19 infection. Everyone should follow the precautions to avoid the COVID-19 infection.

Prevalence of Red Blood Cell Alloimmunization Among Beta-Thalassemia and Sickle Cell Anemia Patients: a Study from Saudi Arabia.

The periodic transfusion of red blood cells (RBCs) is an essential supportive therapy for beta-thalassemia and sickle cell anemia (SCA) patients. Nevertheless, this therapy can cause some adverse effects, such as RBC alloimmunization. This study aimed to determine the prevalence of RBC's alloimmunization and frequency of Rhesus (Rh) and Kell (K) antigens among SCA and beta-thalassemia patients in Al-Madinah region of Saudi Arabia. A cross-sectional study was conducted on 137 multiple transfusion patients with SCA and beta-thalassemia, who attended two of the largest hospitals located in Al-Madinah, Saudi Arabia. Demographic and medical data were collected from medical files of patients. Blood samples were collected from patients and Rh and Kell typing were done. Also, antibody screening and identification tests were performed. There were 66 (48.18%) pediatric patients with mean age of 7.8 years, while adult patients were 71 (51.82%) with mean age of 24.5 years. RBC alloantibodies were found in 9 patients (6.57%), and the most frequent alloantibody was anti-K. Antigen e (99.05%) was the most common antigen, while the least common was the antigen K (3.81%). The association between age (pediatric and adult) and alloimmunization rates was insignificant. Although the RBC alloimmunization rate among SCD and beta-thalassemia patients in this study is low compared to other studies in Saudi Arabia and countries all over the world, it still warrants more attention. Phenotyping of donors/recipients' RBCs for K and Rh subgroups may reduce the risk of alloimmunization and increase the efficiency of blood transfusion.

ABO, RH, and KEL1 Antigens, Phenotypes and Haplotypes in Southwestern Saudi Arabia.

Over the past years, the vast majority of blood grouping research in Saudi Arabia has been noted to be mainly focusing on ABO and D antigens. Consequently, knowledge on other clinically significant antigens regarding the RH and KEL blood group systems is required. Therefore, an experimental study using serotyping of ABO antigens, five main antigens (D, C, c, E and e) of the RH blood group system and the KEL1 antigen of the KEL blood group system will be carried out. A total number of 3,563 blood samples obtained from Saudi volunteer blood donors in Jazan Province were investigated. The following antigens were included in this study: A, B, AB, O, and D type (D VI) and C, c, E, e, and KEL1 antigens. Moreover, RH phenotypes and haplotypes were also determined. Serological analysis was performed using ID System gel cards. DiaClon ABO/D + Reverse grouping and DiaClon Rh subgroups + K were used. Statistical analysis was used to determine the frequency of all antigens, phenotypes, and RH haplotypes. Regarding the ABO blood group system, observations were as follows: A, 29.44%; B, 10.44%; AB, 1.15%; and O, 58.97%. Antigens of RH blood group systems demonstrated as follows: D, 93.32%; C, 70.97%; E, 18.91%; c, 75.38% and e, 97.95%. The frequency of KEL1 antigen is 4.54%. The frequencies of RH haplotypes are as follows: Dce, 0.0078; DCe, 0.4723; DcE, 0.2736; DCE, 0.0051; dce, 0.2410; dCe, 0; dcE, 0.0001; and dCE, 0. We established the frequencies of ABO, RH, and KEL1 antigens in Jazan Province of Saudi Arabia. In addition, RH phenotypes and haplotypes were determined. This blood donor screening may help provide compatible blood units for transfusion and patient safety. Therefore, this might be recommended to other provinces of Saudi Arabia to investigate the prevalence of these antigens for better transfusion practice.

A study of red blood cell alloimmunization and autoimmunization among 200 multitransfused Egyptian \u03b2 thalassemia patients

The development of hemolytic erythrocyte alloantibodies and autoantibodies complicates transfusion therapy in thalassemia patients. These antibodies ultimately increase the need for blood and intensify transfusion complications. There is a scanty data on the frequency of RBC alloimmunization and autoimmunization in Egyptian β thalassemia patients as pretransfusion antibody screening is not routinely performed. We studied the frequency of alloimmunization and autoimmunization among 200 multiply transfused β thalassemia patients and investigated the factors that possibly affect antibody formation. Of the 200 patients in our study, 94 were males and 106 females, with the age range of 2–37 years. Alloantibodies were detected in 36 (18%) of the patients, while autoantibodies were detected in 33 (16.5%). The dominant alloantibodies were directed against Kell (33%) and Rh (24.4%) groups. Alloimmunization had a significant relationship with treatment duration and the frequency of transfusion (P = 0.007, 0.001, respectively). The presence of autoantibodies was significantly related to age (P = 0.001), total number of transfused units (P = 0.000) and splenectomy (P = 0.000). The high prevalence of alloimmunization in the study population disclosed the need for providing phenotypically matched cells for selective antigens especially for Kell and Rh subgroups to reduce risk of alloimmunization and increase the efficiency of blood transfusion.

The relationship between AB0 blood groups and COVID-19

Aim: Although COVID-19 infection spreads very quickly, not every individual is infected at the same rate. It should be investigated whether blood groups affect this difference in susceptibility to COVID-19. This study was conducted to investigate whether there was a relationship between AB0 and Rh blood groups and COVID-19 patients. Methods: A total of 535 patients suspected of COVID-19 who were admitted to the emergency departments and pandemic polyclinics of 3 different hospitals were included in this prospective cohort study. The patients were divided into two groups as those with positive and negative results according to the swab test. According to the ABO and Rh subgroups of the patients whose blood groups were known, each patient was evaluated for the presence of COVID-19. The data on patients' age, gender, complaints during the admission, blood groups, and swab test results were recorded in the study forms, and statistical analyses were performed. Results: The mean age of the patients was 45.5 (22.2) years. There were 291 (54.40%) males and 244 (45.60%) females. It was observed that most patients had A Rh + blood group (n=225, 42.1%). When age groups were compared in terms of gender, swab test results, and blood groups, no significant differences were found (P=0.307, P=0.316 and P=0.694, respectively). Conclusion: We found that no specific blood group increased the risk of getting infected with COVID-19. However, according to our results, those with A Rh – and A Rh +, 0 Rh - and AB Rh - blood groups had a higher risk of catching COVID-19, while those with 0 Rh + blood group had a lower risk.

Red cell alloantibodies in beta-thalassaemia major patients' blood referring to the regional blood transfusion center of Tehran, Iran.

Introduction: Thalassemia is associated with a genetic decline in the rate of synthesis of one or more types of natural hemoglobin polypeptide chains. One of the major complications in thalassemia patients is alloimmunization, which is antibody production by the patient against transfused red blood cells (RBCs). These RBCs are unknown by the recipient and the formed antibodies against them are called alloantibodies. This study aimed to evaluate the frequency of alloantibodies against RBCs in beta-thalassemia patients referred to Tehran Regional Blood Transfusion Center. Methods: In this study, antibody screening tests (Dia-cell I, II, and III) were performed on 184 thalassemia patients. An identification test by the Dia panel consisting of 11 different O RBCs groups to examine sera with Dia cells (I, II, or III) was performed. Results: In our study, males and females patients comprised 66 (35.87%) and 118 (64.13%), respectively, of whom 116 (63%) had alloimmunization. In addition, 68 thalassemia subjects (37%) lacked alloantibodies. Among 184 patients with beta-thalassemia major, anti-K (Kell system), anti-D, and anti-E (Rhesus system) had the most abundant alloantibody variants with an incidence of 24 (13%), 11 (5.98%), and 10 (5.4%), respectively. Conclusion: Before RBC transfusion, regular RBC antigen phenotypes, as well as problem-solving of alloantibody production by receiving compatible blood for Kell and RH subgroups, are suggested for all cases of transfusion-derived thalassemia.

Prevalence of ABO and RH Blood Group and Sub-Group A1 and A2 in Blood Donors of Odisha - Experience of One Tertiary Centre

The paucity of report from Odisha regarding prevalence of ABO and Rh blood group promoted us to undertake the present retrospective study. Total number of subjects studied are 45,564. Prevalence rate of A, B and O are 9679 (21.24%), 13881 (30.46%) and 16662 (36.56%) respectively. The subgroup analysis showed of A1 and A2 has also been carried out in the present study. One case of A2 has been described which had antibody to A1 where there was difficulty in arranging the blood transfusion insisting there by the importance of subgroup analysis in the blood bank.

Rh-Matched Transfusion through Molecular Typing for β-Thalassemia Patients Is Required and Feasible in Chinese

Background: Molecular typing for RHCE blood group alleles has been established in many countries for patients and blood donors. In the Chinese literature nearly 80% of transfused patients with alloimmunization have antibodies specific for antigens of the Rh blood group system. We investigated if it is feasible to match packed red blood cells (RBCs) for Chinese β-thalassemia patients by RHCE genotyping. Methods: In this study, 481 patients with β-thalassemia were enrolled. They were genotyped for RHCE alleles by a simple PCR method with sequence-specific primers (PCR-SSP). Among these patients, 203 continuously received RBCs of the identical Rh subgroups according to the genotyping results for at least 3 months. Subsequently, their phenotypes were tested through a micro-column gel card method. For validation purposes, 400 donors were serologically typed with the same technology, of which 164 were genotyped too. Finally, the C, c, E, and e frequencies and the feasibility of the simple genotyping method were analyzed. Results: All patients showed mixed-field agglutination in the Rh subgroup gel cards before the same Rh subgroups in blood donors were selected for blood transfusion. The results, however, lacked mixed-field agglutination in all 203 cases after transfusion with RBC concentrates selected for the patient's C, c, E, and e antigens for at least 3 months. The genotyping results of 164 donors were all consistent with the serological results. Whole coding regions of RHCE were sequenced in 7 individuals with weak c, E, or e antigens. In only one sample we observed a 1059G>A nucleotide mutation coding for a truncated RhCE polypeptide (GenBank KT957625), in the other 6 samples no sequence variant was found. Both patients and donors were predominantly CcEe and CCee, with a prevalence of 55.3% and 24.9% for patients or 49.3% and 31.3% for donors, respectively. It revealed that about 80% of Chinese could receive Rh-matched RBCs easily. Conclusion: A simple RHCE genotyping technique is safe enough for Rh-matched transfusion of β-thalassemia patients in Chinese Han.

Determination of the frequency of the most immunogenic Rhesus antigens among Saudi donors in King Abdulaziz Medical City - Riyadh.

Background:The Rhesus (Rh) blood group system is one of the most polymorphic and immunogenic systems known in humans, because of its immunogenicity along with ABO grouping, RhD antigen testing was made mandatory before issuing a compatible blood. At present, there are five major antigens, i.e., D, C, E, c, and e in Rh blood group system.Aims:The aim of this study is to provide essential data about the distribution of the major Rh antigens and the most common phenotype among the Saudi population.Materials and Methods:This is a retrospective study to evaluate the Rh grouping and Rh sub-groups performed among some donors who donated blood or blood products at the department of donation center at King Abdulaziz Medical City Riyadh, Saudi Arabia from January 1, 2014 to December 31, 2014. Sample size included 600 donors. Donors are males and females and their ages are above 18 years.Results:The incidence of RhD was 84.8% and only 15.2% of samples were negative for D antigen. The Incidence of other Rh antigens C, E, c, and e were 62.3%, 23.5%, 74.3%, and 95.0%, respectively. The most common phenotype among RhD positive donors was DCcee (28.7%) and among RhD negative donors was dccee (13.7%). However, three donors (0.5%) were negative for antithetical antigens C and c.Conclusion:This study shows that there is a wide racial and geographical variation in the distribution of Rh antigens and phenotypes among study participants. The Rh blood group system has a vital role in population genetic study and in resolving medical legal issues and more importantly in transfusion medicine practice.

Phenotype Prevalence of Blood Group Systems (ABO, Rh, Kell) in Voluntary, Healthy Donors-Experience of a Tertiary Care Hospital in Delhi, North India

Objective: To study phenotypic prevalence of ABO, Rh and Kell blood group system. Material and Method: Voluntary blood donors were tested for red cell antigen of ABO, Rh (D, C, c, E, e) and Kell (K) blood group systems. Each sample was tested using LISS/Coombs ABO-Rh gel card and DiaClon Rh subgroups +K gel card. Calculations of antigen and phenotypes frequencies were expressed as percentages and allele frequencies were expressed under the standard assumption of Hardy-Weinberg equilibrium. Results: Study included a total of 2769 voluntary blood donors in which blood group distribution was (A-22.3%, B-39.2%, AB-8.9%, O-29.6%). Rh antigen was found positive in 93.8% and negative in 6.2% donors. Amongst Rh positive antigens, e was the most common (98.7%) followed by C (91.8%), c (55.2%) and E(21.1%). DCe/DCe (44.7%) was the most common phenotype. Distributions of Rh minor antigens were also assessed in different blood group and were found similar. For the Kell System, only 1.6% was K positive which is less than previous study from India. Conclusion: The prevalence of red cell antigen and phenotype frequencies differs in different populations. The knowledge of the prevalence of blood group antigens will be helpful in rational use of blood and blood products. It will also prevent alloantibodies formation in multiple transfused patients against minor antigens. Gel-card test is a rapid, simple and practical method for population studies.

Role of Subgroup Incompatibility in Newborn Jaundice Requiring Exchange Transfusion

We aimed to determine the role of exchange transfusion related complications, treatment, and etiology as well as subgroup incompatibility in patients subject to ET (exchange transfusion) due to newborn jaundice. 82 patients hospitalized due to newborn jaundice and exposed to exchange transfusion between August 2007 and August 2011 were retrospectively studied. Before ET mean total serum bilirubin was 29,2±9,83. The most frequent cause of ET was ABO incompatibility (31%) followed by Rh incompatibility (19%) and subgroup incompatibility (17%), respectively. In 46% of all patients and in 71% of the patients presenting with subgroup incompatibility , direct combs test was detected to be (+). 49% of the patients were administrated with intravenous immunoglobulin. 5 of the patients who were exposed to ET presented with hydrops fetalis. Of these patients 3 had Rh, 1 had ABO while the other had subgroup incompatibility. Although ABO and Rh incompatibility are substantial underlying reasons of severe jaundice requiring exchange transfusion, particularly widespread use of RhoGAM thereby enabling the prior identification and precautions, ET need was reduced compared to previous cases. On the contrary, SGU related severe hemolytic jaundice relatively enhanced, however.

RHD gene polymorphisms in alloimmunized RhD-negative individuals with high rate of racial admixture

BackgroundThe D-negative phenotype is the result of the total RHD gene deletion in almost all Caucasians, but it accounts for only about 20% in Africans and 70% in Asians. In Africans the RHDΨ that is one of the most important causes of the D-negative phenotype. We investigated the RHD polymorphisms in D-negative phenotype mixed Brazilians who have anti-D alloantibody. Study design and methodsBlood samples from 130 individuals previously typed as D-negative were phenotyped again using: (a) two tube reagents (Anti-D blend reagent, Cellular line TH-28, MS-26; and Anti-D polyclonal); (b) one gel test ID-Card for Rh subgroups including Cw and K antigen; and (c) ABO/Rh (Anti-D blend reagent, Cellular line 175-2, LDM3). The method used for RHD screening detected the presence of RHD exon 10 and intron 4. Sequence analysis was performed on PCR products amplified from genomic DNA for all 10 exons RHD gene. ResultsWe found that 118/130 (90.8%) of D-negative tested individuals had total RHD gene deletion, while 12/130 (9.2%) showed RHD gene polymorphisms. The RHDΨ was found in 10 (7.7%) individuals, one sample (0.77%) hybrid RHD-CE-Ds /RHDΨ, and another (0.77%) weak D type 4.2. ConclusionsThe results showed that the RHD gene was present in 9.2% of racially mixed Brazilians who produced usually clinically significant anti-D alloantibodies. Therefore, the data showed that careful attention is necessary for clinicians in applying RhD genotyping to transfusion medicine in populations with high rate of racial admixture.

Blood Transfusion and Alloimmunization in Patients with Thalassemia: Multicenter Study

One of transfusion's side effects is alloimmunization against red blood cell (RBC) antigens. Early diagnosis by antibody screening is an important step in the detection of these alloantibodies. The authors studied the frequency of alloimmunization in thalassemic patients of 4 centers (2 adult and 2 pediatric centers) and compared the rates in children (up to 15 years) and adults. Antibody screening tests were performed by gel method according to its standard pattern and respective program. In positive cases, antibody identification test by gel method was performed. Eight hundred thirty-five patients were studied; 548 (65.6%) were adults (mean age = 24.5), and 287 (34.4%) cases were pediatrics (mean age = 10.05). Of these patients, 74.1% had no history of transfusion reaction, whereas 21 (2.5%) had hemolytic complications. Seventy-eight (9.3%) exhibited allergic symptoms, and 117 (14%) cases experienced febrile reactions during transfusion. Antibody screening showed positive results in 22 pediatric cases (7.7%) and 79 adults (14.4%); 72 (71.3%), 19 (18.8%), 3 (3%), and 1 (1%) cases exhibited single, double, triple, and autoantibodies, respectively. Anti-Kell antibody was seen in 34 (33.7%) cases, anti-D was seen in 11 (10.9%) cases, and anti-E in was seen in 10 (9.9%) cases. The authors observed 8 anti-D+C (7.9%) cases, 1 anti-D+E (1%), 3 anti-Kell+E, 3 anti-Kell+Kpa (3%), and 1 anti-Kell+D double antibodies. These antibodies were also a combination of Rh subgroups or Rh and Kell subgroups. The authors observed meaningful relations between history of transfusion reactions and age with antibody screening results (P = .005). Based on alloantibodies types, more than two thirds of them were Rh subgroups and Kell groups. Phenotype determination of RBCs before beginning chronic blood transfusion and careful cross-matching with Kell and Rh subgroups in addition to ABO may help reduce alloimmunization in chronic transfusion patients.

Multi‐centre evaluation of pre‐transfusional routine tests using 8‐column format gel cards (DG Gel®)

Advances in immunohaematology laboratory practice to improve performance, cost-effectiveness and patient safety are desirable. To perform a multi-centre evaluation of the 8-column Grifols DG Gel(®) cards and reagent system to assess its performance, suitability and adaptability to the daily blood transfusion laboratory routine in the United Kingdom. A total of 4281 immunohematological analyses {1825 ABO/D grouping, 1921 antibody screening, 75 Rh phenotyping and K antigen determination, 361 antibody identification and 99 neonates [ABO/D and DAT (direct anti-globulin test)]} were performed on 2255 specimens. All cases were run in parallel with the reference method of each laboratory (DiaMed-ID(®) cards or conventional tube technique in some cases). Concordant results between Grifols DG Gel(®) system and the reference method were obtained in 97·7% of tests. For ABO grouping by the Grifols DG Gel(®) system, sensitivity was 99·95%, specificity was 99·96%, predictive positive value (PPV) was 99·89% and predictive negative value (PNV) was 99·98%. For D grouping, sensitivity was 99·78%, specificity was 100%, PPV was 100% and PNV was 99·78%. For antibody screening, sensitivity was 90·63%, specificity was 99·94%, PPV was 99·32% and PNV was 99·15%. Of the Rh subgroups and K types, results were 100% concordant. For antibody specificity detection, accuracy was 96·95% for Grifols DG Gel(®) system and 95·29% for DiaMed-ID(®) system. For the newborn tests, concordant results were obtained in 100% of ABO/D grouping and in 89·9% of DAT. The Grifols DG Gel(®) 8-column system is reliable and safe for routine tests performed in the immunohaematology laboratory.

İndirekt Hiperbilirubinemisi Olan Yenidoğanlarda Manyetik Rezonans Görüntüleme Bulguları: Yüksek Bilirubin Düzeyleri ile T1-Ağırlıklı Görüntülerde Artmış Sinyal Yoğunluğu Arasında İlişki Var mı?

Objective: To examine the findings of magnetic resonance imaging (MRI) in newborns with indirect hyperbilirubinemia and disclose any relationship between high levels of bilirubin and increased in signal intensity on T1-weighted images. Material and Methods: The study included 35 newborns with indirect hyperbilirubinemia. Clinical findings, bilirubin levels and MRI images were evaluated. Results: Of the study population, 20 (57.1%) were females and 15 (42.9%) were males. According to the gestational age, 30 cases were defined as term and five as preterm. An abnormal and bilaterally symmetrical increase in signal intensity was observed in the globus pallidus of 26 (74.3%) newborns on T1-weighted images. A statistically significant relation was determined between the peak value of bilirubin and increased signal intensity on the T1-weighted images (p= 0.004). Jaundice, lethargy, hypertonia, hypotonia and poor feeding were among the clinical findings. The mean serum bilurubin level was found as 38.6 ± 8.9 mg/dl (Range between 25 to 58 mg/dl). Major group incompatibility was detected in seven (20%) and Rh subgroup incompatibility in four (11.4%) of the cases. Glucose 6 phosphate dehydrogenase enzyme activity was reduced in eight (22.8%) cases. The MRI studies were performed between the days 5 and 30, following parturition. Conclusion: There seem to be a relationship between the peak levels of indirect bilirubin and higher T1-weighted signal intensity on MRI of the central nervous system. No relationship was determined between the levels of indirect bilirubin and the area of the central nervous system with increased signal intensity.