Red cell alloimmunization in pregnancy: a study from a premier tertiary care centre of Western India

Meenakshi Gothwal,Pratibha Singh,Archana Bajpayee,Neha Agrawal,Garima Yadav,Charu Sharma 대한산부인과학회 2023 Obstetrics & Gynecology Science Vol.66 No.2

ObjectiveThe study was conducted to determine the frequency of alloimmunization to various blood group antibodies in pregnant women, and the risk of hemolytic disease in the fetus and newborn. MethodsAll antenatal women, irrespective of the period of gestation or obstetric history, were included, whereas those taking anti-D immune-prophylaxis or with a history of blood transfusion were excluded. Antibody screening and identification were performed using a Bio-Rad ID microtyping system. ResultsOf 2,084 antenatal females, 1,765 were D?antigen positive and 319 D?antigen negative. Sixty-five (3.119%) women alloimmunized. Out of 54 (2.591%) who had sensitized to D-antigen, 11 (0.527%) also sensitized to other antibodies. These 11 alloantibodies identified included: anti-M (n=6; 9.23%), anti-C (n=1; 3.076%), anti-E (n=1; 1.538%), anti-e (n=1; 1.538%), anti-Lewis (a) (n=1; 1.538%), and unspecified antibodies (n=1; 1.538%). Multiple antibodies were seen in four patients that combined: anti-D and anti-C (n=2; 3.076%), anti-e and anti-c (n=1; 1.538%), and anti-D and anti-G (n=1; 1.538%). ConclusionThe rate of alloimmunization in D-antigen-negative women was high. Apart from this, the alloimmunization rate in women with bad obstetric history was very high, at 8.1%. In developing countries such as India, universal antenatal antibody screening, though desirable, may not be justified at present, as the cost and infrastructure required would be immense because of the lower alloimmunization rates in RhD antigen-positive women. However, it is necessary to impose properly formulated protocols to screen pregnant women with bad obstetric history.

Characteristics of Red Blood Cell Alloimmunization in Patients with Hematologic Diseases

안규대,김경희 대한수혈학회 2022 大韓輸血學會誌 Vol.33 No.1

Background: Patients with hematologic diseases receive frequent transfusions of red blood cells (RBCs), platelets (PLTs), and fresh frozen plasma (FFP). These patients are more likely to develop alloimmunization due to repeated exposure to RBC antigens. The purpose of this study was to investigate the need for extended RBC matching in patients with hematologic diseases and a history of repeated transfusions. Methods: We assessed patients who had undergone bone marrow examination at the Dong-A University hospital, Busan, South Korea from January 2008 to December 2012. A total of 571 patients were examined. We retrospectively investigated the frequency and volume of the transfusions of RBCs, PLTs, and FFP, the diagnosis of each patient, and the generation of unexpected antibodies. Results: Alloimmunization occurred in 18 out of 571 patients (3.15%). Among the identified antibodies, Rhesus (Rh) group antibodies were the most frequently detected (58.6%). The number of RBC transfusion episodes was higher in the alloimmunized group than that in the non-alloimmunized group (P=0.0016). The RBC transfusion volume was also significantly higher in the alloimmunized group than that in the non-alloimmunized group (P=0.0020). Also, the number of PLT transfusion episodes and transfusion volume were higher in the alloimmunized group. There were no statistically significant differences in the sex, age, or FFP transfusions between the two groups. Conclusion: The number of RBC transfusion episodes and the RBC transfusion volume affected the possibility of generating unexpected antibodies. The number of PLT transfusion episodes and the PLT transfusion volume also affected alloimmunization. The Rh antigen should therefore be matched in elderly patients who are expected to receive repeated blood transfusions. (Korean J Blood Transfus 2022;33:14-23)

비예기 항체선별검사에 의해 검출된 복합항체의 특성

김지은,김보람,우광숙,한진영,김경희 대한수혈학회 2010 大韓輸血學會誌 Vol.21 No.2

Background: Multiple alloimmunization is the production of two or more alloantibodies by an individual. These antibodies are significant because they can present major problems in compatibility testing. The goal of this study was to determine the properties of concurrent blood group (BG) antibodies in Korea. Methods: The transfusion records of 540 patients from Dong-A University Hospital were reviewed to identify alloimmunized individuals. The records spanned a time period from September 2002 to March 2010. The data regarding transfusions and the clinical characteristics of those patients making concurrent antibodies were gathered. Results: Concurrent blood group antibodies were found in 23.9% (45/188) of alloimmunized patients, constituting 40.7% (100/246) of all antibodies. The most common alloantibody pair were anti-E/-c and anti-C/-e. The mean transfused RBC units, mean interval, and mean transfusion frequencies before detection of two or more antibodies were 2.4 units, 92 days, and 2.4 times, respectively. The majority of alloantibody pairs appeared and were undetectable at the same time. Among 45 patients (mean age 55.9 years, range 32 to 82 years), twenty-six (57.8%) were female and the remaining nineteen were male. Non-hematological malignancy accounted for a major share (26.7%) in the underlying disease. Conclusion: Antibody concurrence varied by BG antigenic specificity. Rh antibodies, in particular anti-E with anti-c appeared to be highly linked. Unlike in Western countries, anti-K was less common in Korea and so the pairs involving this antibody were scarce. More prospective investigations are needed to delineate the immunologic phenomenon of multiple alloimmunization. (Korean J Blood Transfus 2010;21:115-121) 배경: 복합면역반응은 한 개인에서 두 개 이상의 적혈구 동종 항체가 만들어지는 것이다. 이러한 항체는 수혈 적합성 검사에서 중요한 문제를일으킬 수 있어 의의가 있다. 우리는 한국인에서존재하는 복합 항체의 특성과 빈도를 알아보고자하였다. 방법: 2002년 9월부터 2010년 3월까지 동아대학교병원에서 항체동정검사를 실시한 540명의수혈기록과 병력을 후향적으로 검토하였다. 복합항체의 종류와 빈도, 지속성에 대해 조사하였고,복합항체 생성에 영향을 미치는 인자들 중에서수혈자의 성별, 나이, 질환군별로 분석하고 적혈구 수혈량, 수혈기간 및 수혈횟수 등을 분석하였다. 결과: 적혈구 복합항체는 전체 동종면역환자의23.9% (45/188)에서 발견되었고 전체 동정된 항체의 40.7% (100/246)를 차지했다. 가장 흔한 복합항체 조합은 anti-E+c 그리고 anti-C+e였다. 복합항체가 동정된 환자들의 평균 수혈량은 2.4단위,마지막 비예기항체 선별검사 음성에서 양성 사이의 기간은 평균 92일, 평균 수혈횟수는 2.4회였다. 대부분 같은 시기에 나타나고 수혈 후 함께지속되거나 역가가 감소하였다. 복합항체가 동정된 45명의 평균 나이는 55.9세, 범위는 32∼82세였고, 26명(57.8%)이 여성이었고 나머지 19명이남성이었다. 기저질환으로는 악성종양이 가장 높은 비율(26.7%)을 나타냈다. 결론: 복합항체는 적혈구 항체 특이성에 따라다양하게 나타났다. 복합면역은 Rh계열의 항체가 가장 많았으며, 서구와 달리 항-E+c의 빈도가가장 높았고 항-K와 조합을 이룬 복합항체의 빈도는 매우 낮았다. 복합면역반응을 이해하기 위해서는 보다 전향적인 연구가 필요할 것으로 생각된다.

Rh 항원 부적합 적혈구 수혈에 의한 동종면역 발생의 확인

송새암,오승환,유신애,전경란,이정녀 대한수혈학회 2020 大韓輸血學會誌 Vol.31 No.3

The rhesus (Rh) blood group system is one of the most important systems in transfusion medicine. Rh alloantibodies can cause hemolytic transfusion reactions and difficulties in finding compatible blood. On the other hand, the phenotypic test and pre-transfusion compatibilization for RhCE antigens have not been routinely performed in most clinical laboratories. This study examined the occurrence of Rh alloimmunization, including C, c, E, and e antigens, after Rh incompatible red cell transfusion during a specific period. From November 2016 to December 2017, clinical and laboratory information of transfused patients was collected; this included the transfusion history and Rh phenotypes of the patients and transfused red blood cell (RBC) products. Of 3,623 patients who received red cell transfusion, 99 (2.8%) revealed unexpected antibodies. Among them, 48 patients (48.5%) had alloantibodies to the Rh-system antigen, including the anti-D antibody. Based on the transfusion history and Rh phenotypes of patients and transfused packed RBCs, 11 patients (11.1%) were assumed to develop Rh alloantibodies after discrepant Rh phenotype red cell transfusion. A considerable proportion of unexpected antibodies was caused by the exposure of Rh mismatched red cells. Therefore, extended Rh antigen matching, including the C, c, E, and e, is needed to prevent alloimmunization. (Korean J Blood Transfus 2020;31:247-253)

한국 임산부에서 Human Neutrophil Alloantigen-3a 동종면역

한태희,한규섭 대한수혈학회 2015 大韓輸血學會誌 Vol.26 No.2

Background: Alloantibodies against human neutrophil alloantigen (HNA)-3a are associated with severe and fatal transfusion related acute lung injury (TRALI). HNA-3 genotyping and HNA-3a antibody (Ab) identification are essential to diagnosis and prevention of TRALI caused by HNA-3a Ab. However there had been no laboratory for HNA-3a Ab identification in Korea. The aims of this study were to establish the HNA-3a Ab test in Korea and to estimate the incidence of HNA-3a alloimmunization among pregnant Korean women. Methods: HNA-3a homozygotes and HNA-3b homozygotes were identified by HNA-3 genotyping. Three HNA-3a homozygotes and three HNA-3b homozygotes are included in the granulocytes panel, which consisted of 10 donors for granulocytes. Sera from 650 pregnant Korean women were tested for granulocyte Ab using a mixed passive hemagglutination assay (MPHA). When a HNA-3a Ab was detected, the woman’s HNA-3 was typed to support her HNA-3a alloimmunization. Results: MPHA showed positive reactions in the sera from 26 women (4.0%, 26/650). HLA Abs were detected in 18 women (2.8%, 18/650), among whom HNA Abs were identified simultaneously in 7 women. Granulocyte Abs were detected in sera from 15 women (2.3%, 15/650). The incidence of HNA-3a, HNA-1b, HNA-1a, HNA-2a, and unidentified HNA Abs among pregnant Korean women was 0.77% (5/650), 0.77% (5/650), 0.62% (4/650), 0.15 (1/650), and 0.31% (2/650), respectively. Conclusion: In this study, we established the HNA-3a Ab test using MPHA for diagnosis and prevention of TRALI caused by HNA-3a Ab. The incidence of HNA-3a Ab in pregnant Korean women was 0.77% (5/650). 배경: HNA-3a 항체는 심각하고 치명적인 수혈관련급성폐손상의 원인이다. HNA-3 유전자검사와 HNA-3a 항체 동정검사는 HNA-3a 항체에 의해 발생하는 수혈관련급성폐손상을 진단하고 예방하는데 필수적인 검사이다. 하지만 한국에는아직 HNA-3a 항체를 동정하는 검사실이 없었다. 저자들은 이번 연구에서 HNA-3a 항체검사를 한국에서도 시행할 수 있게 하고 한국 임산부의HNA-3a 동종면역 발생률을 확인하고자 하였다. 방법: HNA-3a 동형접합자와 HNA-3b 동형접합자를 HNA-3 유전자검사로 확인하였다. 각각 3명의 HNA-3a 동형접합자와 HNA-3b 동형접합자를포함한 10인의 공혈자의 과립구로 제작한 과립구패널이 제조되었다. 혼합수동적혈구응집법(MPHA) 으로 650명의 임산부의 혈청을 이용하여 과립구항체 검사를 실시하였다. HNA-3a 항체가 검출되면 HNA-3a 동종면역을 확인하기 위해 HNA-3 유전자검사를 시행하였다. 결과: 혼합수동적혈구응집법을 이용하여 총26명(4.0%, 26/650)의 임산부의 혈청에서 양성반응을 확인하였다. HLA 항체를 18명(2.8%, 18/650) 의 혈청에서 검출하였다. 이 중 과립구항체와 HLA 항체가 동시에 검출된 경우가 7명이었다. 과립구항체는 15명(2.3%, 15/650)의 임산부의 혈청에서검출되었다. HNA-3a 항체, HNA-1b 항체, HNA-1a 항체, HNA-2a 항체, 특이성이 동정되지 않은 과립구항체가 각각 0.77% (5/650), 0.77% (5/650), 0.62% (4/650), 0.15 (1/650), 0.31% (2/650)로 확인되었다. 결론: 이번 연구에서 저자들은 HNA-3a 항체에의해 발생하는 수혈관련급성폐손상의 진단과 예방에 사용할 수 있는 혼합수동적혈구응집법을 이용한 HNA-3a 항체 검사를 확립하였다. 한국인 임산부에서 HNA-3a 항체발생률은 0.77% (5/650)이었다.

농축혈소판제제 다회 수혈환자에서의 혈소판수혈불응증 발생빈도와 동종면역 양상

용동은,김현옥,김현숙,민유홍,송경순,양윤선 大韓血液學會 1999 大韓血液學會誌 Vol.34 No.2

CDe 표현형의 환자에서 항-E와 항-E/-c 항체 생성 특이성의 차이

안규대,김경희,임현호,정인화 대한수혈학회 2018 大韓輸血學會誌 Vol.29 No.3

Background: Anti-E or paired anti-E/-c antibodies can develop in patients with the Rh CDe phenotype. This study examined the differences in transfusion in patients with the CDe phenotype according to formation of anti-E or anti-E/-c antibodies. Methods: Retrospective reviews were carried out on the results of antibody identification tests performed in 2014. The Rh phenotype and antibody specificity were investigated. The transfusion and medical records of patients with the CDe phenotype were examined. Results: In total, 76 patients were included in the review. Of these 76 patients, 38 (50.0%) were of the CDe phenotype. Anti-E antibodies were the most frequent (60.5%), followed by anti-E/-c antibodies (23.7%). The total transfusion units and platelet transfusion units were significantly higher in patients with anti-E/-c antibodies (P=0.028 and P=0.01, respectively). The distribution of categorized diseases was similar in the patients with the anti-E and anti-E/-c antibodies. A frequency of transfusion episodes greater than or equal to four was higher in patients with hepatobiliary diseases (85.7%). Conclusion: In CDe phenotype patients, platelet transfusion was significantly higher in the anti-E/-c positive group than the anti-E positive group, indicating that platelets play a role in red blood cell alloimmunization. Because E is the most immunogenic antigen in Korea, it is important to define the disease group, in which patients with CDe phenotype require a transfusion of E and c-negative blood.

A case of Severe Hydrops Fetalis due to Anti-E Alloimmu- nization

박미선,최민선,이재희,박상기 대한신생아학회 2016 Neonatal medicine Vol.23 No.4

Hydrops fetalis is a condition characterized by an accumulation of fluid, or edema, in at least two fetal compartments. Only a small percentage (less than 10%) of hydrops fetalis cases are related to immune hydrops caused by variant antigens present the surface of the red blood cells (RBCs), depending on blood groups, such as ABO, Rh (C, D, E, c, e), I, P, Kell, etc. The Rh (E) antigen generally does not cause fetal anemia; however, in rare cases, it can be lethal, leading to stillbirth. We report a case of a preterm infant born at 28 weeks gestational age with severe hydrops fetalis caused by anti-E alloimmunization.

Studies on the RBC Alloimmunization after Blood Transfusions

Kim Jae-Woo,Kim We-Jong 대한의생명과학회 2006 Biomedical Science Letters Vol.12 No.1

Alloimmunization to red blood cell (RBC) antigens may cause a delayed hemolytic transfusion reactions (DHTR) and a delayed serologic transfusion reactions (DSTR). In the present study, the frequency of alloimmunization and its clinical significance were evaluated. Also, transfusions were correlated with antibody formation. Alloimmunization rate was 0.63%. Alloimmunization rate in multiple transfused patients was 24.5%. The most common clinically significant alloantibodies of alloimmunized patients were found to be Rh antibodies (52.6%). Nine patients out of 38 (23.7%) became undetectable after the first detection. To be positive at antibody screening test after RBC transfusion was mean transfused numbers: 3.7 units, mean transfused periods: 56 days, mean transfused frequencies: 1.7 times. The results from antibody specificity and RBC transfusions were comparatively analyzed and it shows that Rh system antibodies were longer than other antibodies (P<0.05). In case of disease group, malignant diseases was longer than other diseases (P<0.05). In order to prevent the formation of RBC alloimmunization, irregular antibody screening tests were performed at propriety intervals in multiple transfused patients.

Red Blood Cell Alloimmunization in Korean Patients With Myelodysplastic Syndrome and Liver Cirrhosis

김현영,조은정,천세종,김경희,조덕 대한진단검사의학회 2019 Annals of Laboratory Medicine Vol.39 No.2

Red blood cell (RBC) alloimmunization varies across human populations and ethnic groups. We evaluated the characteristics of RBC alloimmunization and compared the risk of alloimmunization in Korean patients with myelodysplastic syndrome (MDS) and liver cirrhosis (LC), two representative diseases in which chronic transfusion is required. In total, 115 MDS patients and 202 LC patients transfused with RBCs between 2013 and 2015 were retrospectively included. Twenty patients (6.3%) were newly alloimmunized (five MDS patients, 4.3%; 15 LC patients, 7.4%). The median number of RBC units transfused in alloimmunized patients was nine (interquartile range, 4–15 units). As the number of transfused RBC units increased, the cumulative risk of alloimmunization was higher in LC than in MDS patients (P=0.001). The most common alloantibody detected in patients was anti-E (45%), followed by anti-c (17%), anti-e (10%), anti-C (7%), anti-Fyb (7%), and anti-Jka (7%). The present data indicate the need for matching of extended RBC antigens (Rh, Duffy, and Kidd systems) for chronically transfused patients with MDS and LC in Korea.