ABSTRACT
BACKGROUND: Until recently, SARAH (SARA) was a low-frequency antigen within the 700 series (700.052). SARA was discovered in Australia and subsequently described in Canada where anti-SARA was implicated in severe hemolytic disease of the fetus and newborn (HDFN). This study investigated whether SARA could be recategorized into an existing, or novel, blood group system. STUDY DESIGN AND METHODS: Serologically typed Australian SARA family members (n = 9) were exome sequenced followed by bioinformatics analysis. Sanger sequencing of Exon 3 of GYPA of Australian (n = 9) and Canadian (n = 9) family members was then performed, as were peptide inhibition studies. RESULTS: Exome sequencing identified 499,329 single-nucleotide variants (SNVs) within the nine individuals. Filtering excluded SNVs with an NCBI dbSNP ID (n = 482,177) and non-protein coding SNVs (n = 14,008); for the remaining 3144 SNVs, only one, c.240G>T of GYPA encoding p.Arg80Ser, was present in all six SARA-positive individuals. Sanger sequencing confirmed the presence of c.240G>T in the Australian SARA-positive individuals and demonstrated the same genetic basis in the Canadian SARA family. For a peptide representing the SARA sequence, inhibition of anti-SARA against SARA-positive cells was 84.6% at a concentration of 1.0 mg/mL. CONCLUSION: We provide evidence that the SARA antigen is encoded by a SNV on GYPA and SARA has been reassigned to the MNS blood group system, now MNS47. This discovery provides a basis for application of genetic approaches in SARA typing when clinically indicated, for example, in HDFN.
Subject(s)
Genetic Variation , Isoantigens/genetics , MNSs Blood-Group System/genetics , Australia , Canada , Erythroblastosis, Fetal/genetics , Family , Female , Gene Frequency , Humans , Infant, Newborn , Male , Pedigree , Polymorphism, Single Nucleotide , Pregnancy , Sequence Analysis, DNAABSTRACT
BACKGROUND: The first case describing the SARAH (SARA) antigen occurred in 1990, in an Australian blood donor. Hemolytic disease of the fetus and newborn (HDFN) due to anti-SARA has not been previously described. CASE REPORT: We report a case of HDFN in a multiparous female. The pregnancy was unremarkable except that she was involved in a seemingly minor motor vehicle accident at 25 weeks' gestation. Routine prenatal antibody screening was negative throughout the pregnancy. She presented at 37 weeks' gestation because of decreased fetal movements. Labor was induced and a 2702-g infant male was delivered. The infant's hemoglobin was 49 g/L and the bilirubin was 153 µmol/L. RESULTS: Blood samples from the parents and infant were referred to Canadian Blood Services National Immunohematology Reference Laboratory and subsequently to the Australian Red Cross Red Cell Reference Service. The father's and infant's red blood cells were confirmed to be SARA positive, and the mother's plasma contained anti-SARA. CONCLUSION: The infant was successfully treated with a double-volume exchange transfusion. This is the first example of HDFN associated with this antibody.
