Sonker Atul, Dubey Anju, Mohan Yatendra
Department of Transfusion Medicine, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India.
Department of Transfusion Medicine, Kalyan Singh Super Speciality Cancer Institute, Lucknow, Uttar Pradesh, India.
Asian J Transfus Sci. 2024 Jan-Jun;18(1):56-61. doi: 10.4103/ajts.ajts_174_23. Epub 2024 Feb 6.
In autoimmune hemolytic anemia (AIHA) patients, conventional pretransfusion testing is difficult to interpret due to the presence of autoantibodies which may show panreactivity. Molecular phenotyping of red cell antigens could potentially be used to precisely match blood units, thereby reducing the need to perform intensive serologic laboratory testing, hence time delay in providing transfusion to such patients. The aim of this study is to perform the molecular typing for Kell, Kidd, and Duffy blood group antigens in direct antiglobulin test (DAT)-positive red blood cells of AIHA patients and provide corresponding antigen-matched blood for transfusion therapy.
Blood samples from 50 normal blood donors and 30 DAT-positive AIHA patients were tested using standard serological techniques and polymerase chain reaction-based methods for Kell (K/k), Kidd (Jk/Jk), and Duffy (Fy/Fy) blood group systems. Five patients requiring blood transfusion were given donor blood units identical for Kell, Kidd, and Duffy antigens and followed up.
Genotyping and phenotyping results were 100% concordant for normal blood donors. Serological phenotyping of minor red cell antigens showed varied degree of agglutination for AIHA patients. The molecular typing was able to detect the antigen frequency accurately in all samples. The results of genotyping were used to provide Kell-, Kidd-, and Duffy-matched blood for transfusion therapy to AIHA patients with no adverse reaction.
Molecular blood group typing has proved immensely useful in the determination of actual antigen profile and hence in providing appropriate transfusion support in patients with AIHA reduced risk of transfusion reactions and alloimmunization.
在自身免疫性溶血性贫血（AIHA）患者中，由于存在可能表现出泛反应性的自身抗体，传统的输血前检测难以解释。红细胞抗原的分子表型分析有可能用于精确匹配血液单位，从而减少进行密集血清学实验室检测的需求，进而减少为这类患者提供输血时的时间延迟。本研究的目的是对AIHA患者直接抗球蛋白试验（DAT）阳性红细胞中的凯尔、基德和达菲血型抗原进行分子分型，并提供相应的抗原匹配血液用于输血治疗。
使用标准血清学技术和基于聚合酶链反应的方法对50名正常献血者和30名DAT阳性AIHA患者的血样进行凯尔（K/k）、基德（Jk/Jk）和达菲（Fy/Fy）血型系统检测。对5名需要输血的患者给予凯尔、基德和达菲抗原相同的供血单位并进行随访。
正常献血者的基因分型和表型分析结果一致性为100%。AIHA患者小红细胞抗原的血清学表型分析显示凝集程度各不相同。分子分型能够准确检测所有样本中的抗原频率。基因分型结果用于为AIHA患者提供凯尔、基德和达菲匹配的血液进行输血治疗，未出现不良反应。
分子血型分型已被证明在确定实际抗原谱方面非常有用，因此在为AIHA患者提供适当的输血支持、降低输血反应和同种免疫风险方面具有重要作用。
