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RESUMEN La enfermedad hemolítica perinatal es infrecuente hoy por la prevención que de ella se hace. Sin embargo, existen casos de madres altamente sensibilizadas que desean tener un hijo, lo que obliga a que ese embarazo deseado sea controlado de manera especial y sometido a procedimientos invasivos no exentos de morbimortalidad fetal. El uso prenatal de inmunoglobulina humana en la madre puede representar una alternativa terapéutica. Se presenta un caso en que su uso impidió el desarrollo de enfermedad intrauterina y favoreció la buena evolución neonatal a pesar de que el pronóstico inicial era muy adverso.
ABSTRACT Perinatal Hemolytic Disease is uncommon today due to its prevention. However, there are cases of highly sensitized mothers who wish to have a child, that forces this desired pregnancy to be controlled in a special way and be subjected to invasive procedures not exempt from fetal morbidity and mortality. Prenatal use of human inmunoglobulin in the mother may represent a therapeutic alternative. We present a case in which its use prevented the development of intrauterine disease and favored a good neonatal evolution despite the fact that the initial prognosis was very adverse.
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Humans , Female , Pregnancy , Infant, Newborn , Adult , Immunoglobulins, Intravenous/administration & dosage , Erythroblastosis, Fetal/prevention & control , Anemia, Hemolytic/prevention & control , Prenatal Care , Rh Isoimmunization/prevention & control , Blood Transfusion, IntrauterineABSTRACT
ABO, Rhesus D and subgroups of ABO are highly immunogenic and are the common cause of antibody production in mismatched blood transfusions, haemolytic transfusion reaction and maternal alloimmunization. The aim of this study was to determine the occurrence of ABO, Rh D and subgroups of ABO among blood donors attending Specialist Hospital Sokoto, Nigeria. ABO, Rhesus D and subgroups of ABO antigen status of 176 blood donors with mean age of 30.44 � 8.210 years attending Specialist Hospital Sokoto were determined using tile method for ABO and Rh D and conventional tube method for anti- A1, anti- H reagents for ABO subgroups respectively. Among the 176 subjects tested, blood group O+ was the most frequent group with 93 (52.8%), 39 (22.2%) were blood group B+, 37(21.0%) were blood group A+, 5 (2.8%) were blood group AB+, 2 (1.1%) were blood group O-. No data was obtained for A-, B- and AB- blood groups. Out of 37 A blood groups obtained, 31 (83.8%) had A1 antigens and 6 (16.2%) had A2 antigens. Out of the 5 AB blood groups, all had A1B antigens. The study also shows that there was statistically significant difference between blood group A and ethnic groups (Hausa, Fulani and Yoruba) (p<0.05). Blood group O was found to be the most frequent followed by B, A and AB except among Hausa which revealed a pattern of O> A> B> AB. ABO, subgroups shows majority had A1 followed by A2 and A1B respectively.
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Background: The haemoglobin content and red blood cells counts in four different ABO blood groups in healthy adults remain conflicting with different results. The present study was undertaken to analyse the possible differences in the haemoglobin content and red blood cell counts in health adults in four ABO blood groups.Methods: This prospective study was undertaken in a tertiary health care facility. A total of 227 healthy students were finally included in this study for analysis. The study subjects were belonging to 18-22 years old of both genders. The haemoglobin content was measured by Sahli’s method and ABO blood group typing along with Rh D typing was carried out in all the students. The statistical analyses were carried out by using Graph-Pad Instat.Results: The mean age of the students was 19.91 years with 59.9% being males. Both haemoglobin level and red blood cells counts were significantly high in males compared to females. Blood groups A, B, AB and O was reported in 41(18.06%), 63(27.75%), 15(6.60%) and 108(47.58%) healthy students respectively.conclusion: There was no significant difference was observed in the mean haemoglobin level and red blood cells counts among the four ABO blood groups.
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Rh system in today’s world is probably the most complex red cell antigen system in humans. The presence ofD antigen confers Rh positivity and vice versa. Two allelic antigen pairs, E/e and C/c are also found on the Rhprotein. The D antigen is the most immunogenic red cell antigen after A and B. As there is paucity of datadistribution of Rh antigen subgroup from the Indian literature, the study was conducted to know the prevalenceof Rh antigen subgroups in this part of the region and to determine the phenotype and most common genotypeof Rh antigen among the blood donors. The observational 1 year prospective study was conducted on blooddonors attending the blood bank in the Department of Pathology, MMIMSR, MMDU, Mullana.The studycomprised of blood donors of various age groups which included 90%(450) males and 10%(50) females. Anoverall Rh D positivity was seen in 88.4% of blood donors while 11.6% lacked the D antigen. The mostcommon Rh phenotype was ccDEE 26.6%. In conclusion, sensitization to clinically important blood groupantigens can be prevented through complete blood typing. All patients should be genotyped before the firstblood transfusion
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Background: Rh D is the most important Blood Group antigen after ABO Blood group antigen for transfusion purpose. All negative blood units by routine methods must be tested to detect weak D using IAT method. When the test for D and Du is positive, the label should read Rh(D) Positive . When the test for D and Du is negative, the label should read Rh(D) Negative. Objective: To know the prevalence of weak D in the donor population. No study has been done in this part of the country earlier. It will help in the knowledge of weak D, which is very important for better patient care and prevent allo-immunzation in blood recipients. Materials and Methods: Blood samples were tested by ID Gel technique or by tube method with two anti D reagents - anti-D IgM monoclonal and blend of anti-D IgM&IgG. All negative samples were further tested for weak D in IAT phase by LISS/Coombs' gel card. Results: A total of 13043 samples were tested from January 2011 to December 2013. 12196 were Rh positive and 847 were Rh D negative. Weak D was positive in 8 samples. Conclusion: The study shows the prevalence of weak D as 0.07% in blood donors who were primarily from in and around Jalandhar in Punjab. These donors may have posed problem to the recipients of blood and blood product and their detection prevented them from alloimunisation.
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Background and Objectives: Incidence and outcome of Hemolytic disease of Fetus and New-born due to RhD alloimmunisation has changed in last few decades after the advent of RhIG and other diagnostic and therapeutic tools. But reports from different centres vary. In this study Rh D sensitised antenatal women were followed up at Medical college, Trivandrum and clinical &laboratory profile analysed. Objectives of the study are to describe the clinical &laboratory profile of Rh D alloimmunised pregnant ladies and to describe severity and treatment of Hemolytic Disease in their off springs. Materials and Methods: Cross sectional study done on 64 antenatal cases, positive for anti Rh D antibodies by ICT and followed up with serial titres and ultrasound. Cord blood values and Direct Coombs test were used to diagnose HDFN at birth. Data was analyzed in SPSS ver.17.catagorical data was expressed in percentages and continuous data was expressed with mean and standard deviation. Results: Out of 2,496 Rh D negative women tested with ICT, 78 (3.12%) were positive.54 RhD positive new-borns were DCT positive (93.1%).50.9% cases were unaffected or mild. Severe cases accounted for 10% only. Majority (50%) received no treatment and phototherapy was the major modality of treatment. Overall survival rate of affected new-borns was 92.18%. Out of 6 hydropic babies, 4 died in utero. Interpretations and Conclusions: Rh alloimmunisation is still prevalent among antenatal women, but majority of cases produces only mild disease in new-born. Survival rate in newborns is >90%. Hydropic babies have a higher death rate. Better strategies to prevent Rh D alloimmunization and introduction of interventions like IUT are warranted.
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Objective To understand the neonatal ABO type positive and reverse typing consistent rate and to improve the accu-racy of the methods of neonatal blood.Methods The traditional tube method was used to detect the local neonatal ABO blood.The method of micro gel cards,improved tube method,enhancer and traditional tube method,paper,micro-plate,polybrene method to de-tect anti A,anti B,anti D titer,and neonatal blood detection comparator.Results Neonatal ABO positive and negative stereo types compliance rate was 83% (913/1 100);Detecting 15 copies of anti A,B,D titer,the highest sensitivity was improved intensifier tube method and the worst is the method of paper.The method of neonatal specimens was with the similar results.Conclusion ABO positive and negative stereo types should be increased by plasma (serum)levels and extending the incubation time,or using theen-hancerof this study,thereby improving the accuracy of the newborn blood testing.
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Background & Objectives: Out of total 328 antigens recognized by the International Society of Blood Transfusion (ISBT), ABO and RhD antigens are the most important from the transfusion medicine perspective. The present study was conducted with larger sample size than prior studies to determine frequencies of ABO and Rh alleles and obtain distribution of ABO and RhD blood group pattern among blood donors. Methods: A retrospective study was conducted in the Department of IHBT, Civil Hospital, Ahmedabad from October 2007 to September 2012. ABO grouping and RhD typing was done using conventional tube technique on a total of 109771 donors. Commercial anti-sera and in-house prepared cells were used for cell and serum grouping respectively in those tests. Departmental Standard Operating Procedures (SOPs) were followed for each aspect of testing. Observed ABO and RhD antigen frequencies were noted. Bernstein and Hardy-Weinberg equations were applied to determine the allele frequencies of ABO and RhD respectively. Results: Blood group B has the highest prevalence (35.81%) in the population under study followed by O (32.74%), A (22.68%) and AB (8.77%). Female donors comprised only 1.75% of the sample size. Rh D positivity was noted in 94.48% donors. Conclusion: Results obtained were quite similar to prior studies from Ahmedabad with smaller sample size. Remarkable differences were noted as compared with western population. The data generated in the present study combined with several other studies of different geographical region of India has significant implications in inventory management of blood transfusion services.
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Red cell alloimmunization among antenatal women attending a tertiary care hospital in south India Jophy Varghese, Mary P. Chacko, Molly Rajaiah & Dolly Daniel Department of Transfusion Medicine & Immunohaematology, Christian Medical College & Hospital, Vellore, India Received December 13, 2011 Background & objectives: Detection of maternal alloimmunization against red cell antigens is vital in the management of haemolytic disease of the foetus and newborn (HDFN). This study was conducted to measure the presence of allosensitization to blood group antibodies in the antenatal women attending a tertiary care hospital and to observe the proportion of minor blood group antibodies to assess the benefit of screening for the same. Methods: All antenatal women registered in the hospital between January 2008 and January 2009, were screened for irregular antibodies using a commercial 3-cell antibody screening panel. Antibody identification was performed on samples found positive using a commercial 11 cell-panel. Results: Screening was performed on 5347 women, 339 (6.34%) of whom were Rh negative. Allosensitization was found in 79 women (1.48%; confidence interval 1.17 -1.84). In 29 of these 79 (37%) women the allo-antibodies could not be identified. In the remaining 50 women, 54 antibodies were characterized. A total of 40 clinically significant antibody specificities were identified among 36 women, of whom four were Rh(D) positive. Allosensitization with clinically significant antibodies was found in 9.43 per cent (confidence interval 6.55-13.06) Rh(D) negative and in 0.08 per cent (confidence interval .02-0.2) Rh(D) positive women. Anti D was the most frequent antibody found in 8.85 per cent Rh(D) negative women. The remaining clinically significant antibodies identified included anti-C, c, E, Jka, Jkb, M and S. In Rh(D) negative women, anti-D and antibodies of the Rh system contributed 83.3 and 94.4 per cent of clinically significant antibodies. However, in Rh(D) positive women, non-Rh antibodies comprised three out of four clinically significant antibodies. Interpretation & conclusions: The presence of alloimmunization in our study corroborated with data reported from India. The most frequent antibody was anti-D. However, a significant fraction was non-D. Alloimmunization among Rh(D) positive women though low as compared to Rh(D) negative women, included clinically significant antibodies, and most of these were non Rh.
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Background: The quality of blood transfusion services (BTS) is essential for the treatment of patients who need blood or blood products. BTS involve several steps, including the acquisition of the donor’s blood, blood grouping, unexpected antibody screening, blood storage, transfusion, etc. There is a need to check the effectiveness of all elements in the BTS can be assessed and monitored by an external quality assessment. Aim: To assess and evaluate the performance of ABO and Rh(D) blood grouping and unexpected antibody screening of the selected World Health Organization (WHO) South-East Asia Region Member country laboratories. Methods: WHO Collaborating Centre on Strengthening Quality of Health Laboratories (Thailand) organized a regional external quality assessment scheme for blood group serology (REQAS-BGS) between 2002 and 2008 for laboratories in countries of the WHO South-East Asia Region. Test items for ABO and Rh(D) blood groupings and unexpected antibody screening and identification were distributed three cycles per year to BTS laboratories in Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand. By the end of the project, a total of 20 BTS laboratories had participated for differing lengths of time. Results: It was found that 87.5%, 93.3%, 81.3%, 92.3%, 100% and 87.5% of laboratories returned the test results in 2002, 2003, 2004, 2006, 2007 and 2008, respectively. Laboratories with excellent quality or a trend of quality improvement for ABO and Rh(D) blood grouping, unexpected antibody screening and identification during the six years were 60% (12/20), 50% (10/20), 52.9% (9/17) and 81.8% (9/11), respectively. At the initiation of the scheme, most laboratories were using substandard methods for ABO and Rh blood groupings, i.e. performing only direct blood grouping alone but subsequently adopted the standard methods, i.e. performing both direct and reverse blood groupings. Conclusion: REQAS-BGS in South-East Asia countries has been useful for assessing, monitoring and improving the quality of testing. Challenges such as high costs and regulatory requirements for international shipment of blood samples could be solved by amending the regulation(s) for shipment, or establishing a national EQAS.
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Objective: To construct a phage display library of human single-chain Fv antibodies against blood group Rh(D) substance. Methods: Combining phage display library techniques, isolated total RNA from B lymphoblastoid cell lines secreting anti-Rh(D) antibodies was used for the synthesis of the first strand of cDNA, V_ H and V_ L genes were amplified by 2nd PCR and linked together by splicing overlap extension (SOE) with the use of a (Gly_ 4Ser)_ 3 linker. The resulted scFv genes were then cloned into pCANTAB5E vectors and displayed on the phage. Phage clones were selected using intact red cells as a source of antigen. After 4 rounds of "binding-elution-enrichment", each clone was assayed for specificity by Dot ELISA. Results: A phage antibody library, with the sink size being 1.2?107, was obtained. The percentage of full-length scFv gene inserted into phage DNA was 0.80. Rescued by helper phage, a phage scFv library with titer of 3?108 pfu/ml was established. Specific phages with scFv were acquired after 4 rounds of panning, one clone exhibiting specific binding to Rh+ cell was identified by Dot ELISA. Conclusion: A strategy for construction phage antibody library by means of phage display technique was practicable, which would be useful in screening engineered antibodies against human Rh (D) blood group substances.
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Objective To develop a new method of preparing anti-Rh(D) reagent serum in order to help overcome the shortage of Rh(D) negative red blood cells(RBCs). Methods Anti-Rh(D) containing type A and B sera were mixed. Through dilution and neutralization, the titer of complete antibodies decreased to 2. Anti-Rh(D) saturated Rh(D)positive RBCs were prepared by adding anti-Rh(D) containing serum to Rh(D) positive RBCs so that all the Rh factors on the cells were saturated. The anti-Rh(D) saturated type A and type B RBCs were added to the mixed plasma to absorb the remaining anti-A and anti-B. Results The acquired regent sera had a high anti-Rh(D) titer with a high specificity. Conclusion Anti-Rh(D) saturated Rh(D) positive RBCs absorption after neutralization can help with the production of human origin anti-Rh(D) reagent serum and save a large amount of Rh(D) negative evythvocytes.
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Objective To establish the FCM method of non invasive detection of fetal ABO and Rh(D) blood groups in maternal blood.Methods Using absorption and elution method, we obtained the IgG anti A and anti B from human sera. The IgG anti A, B, D were used as the first antibody to react with RBCs in maternal peripheral blood.The goat anti human IgG F(ab')2 FITC was used as the second antibody to conjugate anti A, B, D antibodies, Meanwhile anti i PE was used to mark fetal RBCs in maternal peripheral blood.The fluorescence dot plot diagrams of maternal and fetal cells acquired by FCM were used to detect fetal ABO and Rh(D) blood groups.Results Peripheral blood from 69 pregnant women between 8 and 39 weeks of gestation were studied.Fetal cells could not be found in 13 samples.Of the remaining 56 samples,fetal red cells were identified successfully with ABO/Rh(D) blood types identical to those tested after the birth of the baby.Conclusion In women with fetomaternal hemorrhage(FMH) during pregnancy,the FCM method established by the author can accurately and non invasively detect the blood groups of fetuses.This method can possibly be used for diagnosis of hemolytic disease of the newborn.
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The patient, a 65-year-old woman, was admitted for chronic subdural hematoma. ABO and Rh blood typing were performed as a pre-operation test. Her red blood cells were not agglutinated with anti-D reagent (Ortho Diagnostic System, USA). But they were positive in subsequently performed weak-D test and also agglutinated with three other anti-D reagents (Baxter Dade, USA; Biotest Diagnostics, Korea; Bioscot Ltd., UK). The patient s Rh phenotype was CcDe. Antibody screening test, direct and indirect antiglobulin tests showed negative results. Different reactivity to various anti-D reagents as shown in this case suggested that her cells have partial-D antigen which lack one or more components of the Rh D antigen. We considered that this case was category Va according to the reactivity patterns of monoclonal anti-D antibodies with various partial- D cells.
Subject(s)
Aged , Female , Humans , Antibodies , Blood Grouping and Crossmatching , Coombs Test , Erythrocytes , Hematoma, Subdural, Chronic , Indicators and Reagents , Korea , Mass Screening , Phenotype , Somatostatin-Secreting CellsABSTRACT
BACKGROUND: Today, blood group antigens are a strong barrier of safe transfusion. We evaluated the change of agglutinability of antibody to RBC surface antigen before and after activated methoxy polyethylene glycol (mPEG) modification. METHODS: We collected blood from healthy volunteers and the blood were treated by activated mPEG (MW 5,000, Sigma, USA). Agglutinability of RBC was measured using anti-sera (Green Cross, Korea) in ABO and Rh(D) groups, and compared the agglutinability changes before and after mPEG treatment. RESULTS: The agglutinability of Rh(D) surface antigen (n=20) was disappeared after mPEG treatment. However, ABO antigens showed variable agglutinability against antisera, some of which showed no change at all. CONCLUSIONS: In the case of Rh(D) antigen, it would be useful to apply mPEG treated RBCs for clinical use, if the safety problem were solved. But in the case of ABO antigen, the more evaluation of the condition of reaction and the concentration of mPEG should be needed.
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Antigens, Surface , Blood Group Antigens , Blood Substitutes , Healthy Volunteers , Immune Sera , Polyethylene Glycols , PolyethyleneABSTRACT
BACKGROUND: It is important to know one's own exact blood type. While the primary purpose of blood donation is an adequate blood supply, it is also an excellent opportunity for donors to confirm their blood type. Over 5% of the total population in Korea donated bloods in 1997. This study was carried out to investigate the relationship between increased participation in blood drives and an increase in members of the public's knowledge of their own blood type. METHODS: 271,346 blood donors at Dung-Bu Red Cross Blood Center answered to a questionnaire. The discrepancy ratio between perceived and actual ABO blood type was obtained through answerey questionnaire. Another 3,058 answered a more detailed questionnaire to probe their general knowledge of ABO and Rh(D) blood types were analyzed. RESLUTS: The discrepancy ratio between real and perceived ABO blood types was 1% but only 90.7% were confident of their ABO blood type. Only 58.3% were correctly answered to their Rh(D) blood type, and 98.7% of the donors who knew his or her Rh(D) blood type as negative were proved to be Rh(D) positive. The ABO discrepancy ratio was lower in females and it has decreased as blood donations increased (p<0.01). The discrepancy ratio increases with the age of the donor, and respondents over 30 had a higher discrepancy than those under 30 (p<0.01). Knowledge of Rh(D) blood type in transfusion was not well known to the general public. CONCLUSION: The study shows that the discrepancy ratio between real and perceived ABO blood type has decreased as a national blood donation rate has increased. Nevertheless, to increase the public's knowledge of blood type in relation to transfusion, especially to increase awareness of Rh(D) blood type, it is needed to conduct test exactly and to educate the result and general knowledge of blood type and tranfusion to the public.
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Female , Humans , Blood Donors , Surveys and Questionnaires , Korea , Surveys and Questionnaires , Red Cross , Tissue Donors , VolunteersABSTRACT
Objective Study on fetomaternal immuno state and RHD type of a pregnant woman of weak D phenotype.MethodsThrough polymerase chain reaction (PCR)、direct genomic DNA sequencing and flow cytometry.ResultsIn both sequence specific promer (SSP) PCR and the sequencing PCR tests, the sample was detected negative in exons 3 6 of the RHD gene, whereas all other exons (exons 1 2,7 10) were tested positive. And the sequence of detected exons (exons 1 2,7 10) are the same with normal RHD in GenBank (accession no. AJ299020 1 and AJ299026 9). Serologically and genetically, the sample can be designated as D category VI type Ⅲ. Through a duce tube PCR method, the RhD zygosity of this individual was typed CD VI e/cde。In flow cytometry, a few fetal erythrocytes were detected in peripheral blood of the mother. However there were no anti D detected in sera and hemolytic disease of the newborn(HDN) observed at all.ConclusionSevere cases of HDN have occurred in D positive babies born to partial D mother with anti D, although HDN don't take place in this case. We may still consider D VI phenotype individuals as D positive donors and D negative receiptions in our transfusion practice and in clinical anti D allo immune prophylaxis and monitoring.