High throughput genomic testing for blood groups allows large scale antigen typing and assessment of donor pool compatibility with chronic transfusion dependent populations, particularly thalassemia or sickle cell disease (SCD) patients, in order to decrease RBC alloimmunization. Thus, it is crucial to determine if the quantity and antigen diversity of the donor pool meets the demands to sustain these patients on phenotype/genotype extended matched chronic transfusion protocols.
We calculated the most common extended RBC predicted phenotypes for the 12 major clinically significant blood group antigens, D, CcEe, K, Jka/b, Fya/b, and Ss, in patients undergoing chronic transfusion for sickle cell disease (n=203) or thalassemia (n=98). The most common phenotypes in each diagnostic group were used to determine the prevalence of these phenotypes in a single day donor inventory (n=5,000) and stratified by ethnic group (70% Caucasian, 10% African-American, 13% Hispanic, 5% Asian, and 2% Other). All patient samples were tested for the presence of the GATA mutation which disrupts erythroid expression of Fy(b), and if present deemed not at risk for Fy(b) alloimmunization.
The majority of patients with SCD and thalassemia are RhD positive (97% and 90% respectively), but differ in extended Rh phenotype, with Ro (Dce) prevalent in SCD pa tients (61%), and R1 (DCe) in thalassemia patients (79%). For patients with SCD, the most prevalent antigen-negative phenotypes were 17% C-E-K-,Fy(a-),Jk(b-), S-; 9% C-E-K-, Fy(a-),S-; 5% E-K-,Fy(a-),S-; and 4% C-K-,Fy(a-), Jk(b-), S-. In patients with thalassemia, no minor antigen profile exceeded 5% of individuals. The most prevalent antigen-negative profiles were 5% E-c-K-, Fy(b-),Jk(b-),S-, and 4% E-K-.
Comparison of the most prevalent antigen-negative phenotype in patients with SCD with the donors revealed only 0.06% Caucasian (n=2), but 20% of the African-American donors (n=90) were antigen-negative matches. For the second most prevalent phenotype, 0.08% Caucasian (n=3) and 33% of African-American (n=167), 2% of Hispanic (n=13), and 5% other (n=5) were antigen-negative matches. For the third and fourth prevalent phenotypes, 47% of African-American (n=233) and 23% (n=115) respectively, were antigen-negative matches, while only 0.14% (n=5) and 0.06% (n=2) of Caucasians, but 5% (n=31) and 2% (n=13) of Hispanic donors were appropriate matches, respectively.
For the thalassemia patients, antigen matches for the most common phenotype were found most often in Asian (13%) and donors identifying as “other” (6%). Matches were present in only 2% of the Caucasians, 2% of Hispanics, and 1.8% of African-American donors for thalassemia patients.
These results confirmed the importance and impact of African-American donors for extended antigen-matching for patients with SCD. Less than 1% of our Caucasian donors could serve as extended matching for SCD. Nearly 20% of patients with SCD are negative for a common group of antigens, which allows future donor recruitment efforts focused on extended antigen profiles of the donor. Patients with thalassemia do not have a common antigen-negative profile, but extended matching for these patients can be improved by increase recruitment of Asian donors. High throughput genotyping enables typing of large numbers of donors, and potentially the majority of the donor inventory. Analysis of antigen-negative phenotypes in the donor pool with analysis of patient groups is important for inventory management, focused donor recruitment, and improved transfusion practice by avoiding alloimmunization.
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Asterisk with author names denotes non-ASH members.