DOI QR코드

DOI QR Code

Difference in Characteristics in the Formation of Anti-E and Anti-E/-c in Patients with the CDe Phenotype

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

  • An, Gyu-Dae (Department of Laboratory Medicine, Dong-A University College of Medicine) ;
  • Kim, Kyeong-Hee (Department of Laboratory Medicine, Dong-A University College of Medicine) ;
  • Lim, Hyeon-Ho (Department of Laboratory Medicine, Dong-A University College of Medicine) ;
  • Jeong, In-Hwa (Department of Laboratory Medicine, Dong-A University College of Medicine)
  • 안규대 (동아대학교 의과대학 진단검사의학교실) ;
  • 김경희 (동아대학교 의과대학 진단검사의학교실) ;
  • 임현호 (동아대학교 의과대학 진단검사의학교실) ;
  • 정인화 (동아대학교 의과대학 진단검사의학교실)
  • Received : 2018.07.06
  • Accepted : 2018.09.10
  • Published : 2018.12.31

Abstract

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.

References

  1. Kim KH, Han JY, Kim JM, Park KH, Han KS. Fatal acute hemolytic transfusion reaction due to Anti-E+Fy(a). Korean J Lab Med 2003;23:57-9
  2. An GD, Kim KH, Jeong IH, Lim HH, Woo KS, Han JY, et al. Revisiting the pre-transfusion test: a case of acute hemolytic transfusion reaction due to multiple alloantibodies of Anti-E, Anti-c, Anti-Jk(b). Korean J Blood Transfus 2017;28:170-6 https://doi.org/10.17945/kjbt.2017.28.2.170
  3. Shin JW. Unexpected red cell antibody detection by conditional combination of LISS/Coombs and NaCl/Enzyme gel tests at a tertiary care hospital in Korea: a 5-year study. Blood Res 2013;48:217-21 https://doi.org/10.5045/br.2013.48.3.217
  4. Shin DW, Kim H, Chung Y, Kim JN, Hong YJ, Park KU, et al. Establishment and utilization of a transfusion recipient registry in Korea: estimating the frequencies of specific antigennegative blood units. Am J Clin Pathol 2018;150:154-61 https://doi.org/10.1093/ajcp/aqy044
  5. Kim KH, Kim BR, Choi JL, Woo KS, Kim JM, Han JY. Difference of Rh phenotype between irregular antibody positive patients and RhD positive population in Korea. Korean J Blood Transfus 2014;25:60-8
  6. Kim HO, Ahn HJ, Eom YB, Lee JS, Choi MJ. The olloimrnunizotion rote of onti-c concurrent with onti-E in R1R1 potients. Korean J Blood Transfus 1996;7:181-6
  7. Evers D, Middelburg RA, de Haas M, Zalpuri S, de Vooght KM, van de Kerkhof D, et al. Red-blood-cell alloimmunisation in relation to antigens' exposure and their immunogenicity: a cohort study. Lancet Haematol 2016;3:e284-92 https://doi.org/10.1016/S2352-3026(16)30019-9
  8. Hong YJ, Chung Y, Hwang SM, Park JS, Kwon JR, Choi YS, et al. Genotyping of 22 blood group antigen polymorphisms and establishing a national recipient registry in the Korean population. Ann Hematol 2016;95:985-91 https://doi.org/10.1007/s00277-016-2645-7
  9. Han KS, Park MH, Kim SI, Cho HI. Transfusion medicine. 3rd ed. Seoul: Korea Medical Book Publisher, 2006:214-19
  10. Song SW, Kim SY, Kim HO. Frequency of Rh-Hr phenotypes according to RhD type in Korean. Korean J Blood Transfus 2013;24(S1):S139-40
  11. Schonewille H, Honohan A, van der Watering LM, Hudig F, Te Boekhorst PA, Koopman-van Gemert AW, et al. Incidence of alloantibody formation after ABO-D or extended matched red blood cell transfusions: a randomized trial (MATCH study). Transfusion 2016;56:311-20 https://doi.org/10.1111/trf.13347
  12. Moncharmont P, Barday G, Meyer F. Red blood cell alloimmunisation after platelet transfusion: a 5-year study. Blood Transfus 2014;12 Suppl 1:s147-8
  13. Kitazawa J, Nollet K, Morioka H, Tanaka K, Inomata M, Kubuki Y, et al. Non-D Rh antibodies appearing after apheresis platelet transfusion: stimulation by red cells or microparticles? Vox Sang 2011;100:395-400 https://doi.org/10.1111/j.1423-0410.2010.01435.x
  14. Reckhaus J, Jutzi M, Fontana S, Bacher VU, Vogt M, Daslakis M, et al. Platelet transfusion induces alloimmunization to D and Non-D rhesus antigens. Transfus Med Hemother 2018;45:167-72 https://doi.org/10.1159/000490122
  15. Enko D, Habres C, Wallner F, Mayr B, Halwachs-Baumann G. Frequencies and specificities of "enzyme-only" detected erythrocyte alloantibodies in patients hospitalized in Austria: is an enzyme test required for routine red blood cell antibody screening? J Blood Transfus 2014;2014:532919
  16. Lee JS, Cho D, Shin MG, Ryang DW. Usefulness of NaCl/Enzyme gel test for the identification of unexpected antibodies. Korean J Lab Med 2006;26:204-9 https://doi.org/10.3343/kjlm.2006.26.3.204
  17. Redman M, Regan F, Contreras M. A prospective study of the incidence of red cell alloimmunisation following transfusion. Vox Sang 1996;71:216-20 https://doi.org/10.1159/000462061
  18. Vichinsky EP, Earles A, Johnson RA, Hoag MS, Williams A, Lubin B. Alloimmunization in sickle cell anemia and transfusion of racially unmatched blood. N Engl J Med 1990;322:1617-21 https://doi.org/10.1056/NEJM199006073222301
  19. Compernolle V, Chou ST, Tanael S, Savage W, Howard J, Josephson CD, et al. Red blood cell specifications for patients with hemoglobinopathies: a systematic review and guideline. Transfusion 2018;58:1555-66 https://doi.org/10.1111/trf.14611
  20. Hendrickson JE, Tormey CA. Understanding red blood cell alloimmunization triggers. Hematology Am Soc Hematol Educ Program 2016;2016:446-51 https://doi.org/10.1182/asheducation-2016.1.446
  21. Sanz C, Nomdedeu M, Belkaid M, Martinez I, Nomdedeu B, Pereira A. Red blood cell alloimmunization in transfused patients with myelodysplastic syndrome or chronic myelomonocytic leukemia. Transfusion 2013;53:710-5 https://doi.org/10.1111/j.1537-2995.2012.03819.x
  22. Arora K, Kelley J, Sui D, Ning J, Martinez F, Lichtiger B, et al. Cancer type predicts alloimmunization following RhD-incompatible RBC transfusions. Transfusion 2017;57:952-8 https://doi.org/10.1111/trf.13999
  23. Killick SB, Carter C, Culligan D, Dalley C, Das-Gupta E, Drummond M, et al. Guidelines for the diagnosis and management of adult myelodysplastic syndromes. Br J Haematol 2014;164:503-25 https://doi.org/10.1111/bjh.12694