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Prevalence of ABO, Rhd and Other Clinically Significant Blood Group Antigens Among Blood Donors at Tertiary Care Center, Gwalior

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Prevalence of ABO, Rhd and Other Clinically Significant Blood Group Antigens Among Blood Donors at Tertiary Care Center, Gwalior ORIGINAL ARTICLE Bali Medical Journal (Bali Med J) 2020, Volume 9, Number 2: 437-443 P-ISSN.2089-1180, E-ISSN.2302-2914 Prevalence of ABO, RhD and other clinically ORIGINAL ARTICLE significant Blood Group Antigens among blood donors at tertiary care center, Gwalior Published by DiscoverSys CrossMark Doi: http://dx.doi.org/10.15562/bmj.v9i2.1779 Shelendra Sharma, Dharmesh Chandra Sharma,* Sunita Rai, Anita Arya, Reena Jain, Dilpreet Kaur, Bharat Jain Volume No.: 9 ABSTRACT Issue: 2 Background: Among all blood group systems and antigens, ABO and of them 1000 randomly selected donor samples were processed for D antigens of the Rh blood group system are of primary importance, complete Rh, Kell, Duffy and Kidd blood grouping. hence included in routine blood grouping and transfusion. Other blood Result: ABO group pattern was; A - 22.56%, B - 36.52%, AB - 9.8% group systems and antigens that are important in multiparous women, and O -31.12 %, while RhD status was RhD+ 90.99% and RhD- 9.01%. First page No.: 437 multi-transfused patients and hemolytic disease of newborn are Kell, Prevalence of Rh phenotypes was DCCee 43%, DCcee 33%, DCcEe 10%, Rh, Duffy, and Kidd. dccee 6.5%, DccEe 4.5%, Dccee 1%, DCCEe 0.3% and dccEe 0.2%. Aims and Objectives: To know the pattern of ABO, RhD and other Kell phenotype was K-k+ 95.5%, K+k+ 4.5%, while K+ k- and K- clinically significant major antigens of Rh, Kell, Duffy and Kidd blood k- phenotypes were not encountered in this study. Duffy phenotypes P-ISSN.2089-1180 group systems as well as evaluation of phenotypes, genotypes and were Fya+ Fyb+ 47.5%, Fya+ Fyb- 35%, Fya- Fyb+17% and Fya- Fyb- gene frequency of related antigens among blood donors in Gwalior 0.5%. Kidd phenotype was Jka+ Jkb- 44.5 %, Jka- Jkb- 26.5%, Jka+ Jkb+ region. 18% and Jka- Jkb+ 11%. E-ISSN.2302-2914 Materials and methods: A prospective study was carried out at Conclusion: Present study is helpful in the transfusion management the Blood Bank from July 2017 to June 2019. During the study period of multiparous women and multi-transfused patients. Extended blood 48500 blood donors were included for ABO and RhD grouping, Out grouping is the need of future to ensure safe blood transfusion practices. Key words: Blood Groups, Rare Blood group, Multiparous women, Multi-transfused Patients. Cite This Article: Sharma, DS., Sharma, D.D.C., Rai, D.S., Arya, D.A., Jain, D.R., Kaur, D.D., Jain D.B. 2020. Prevalence of ABO, RhD and other clinically significant Blood Group Antigens among blood donors at tertiary care center, Gwalior. Bali Medical Journal 9(2): 437-443. DOI:10.15562/bmj. v9i2.1779 Blood Bank, Department of INTRODUCTION Pathology, G. R. Medical College and J A Hospital Gwalior India Till date, 36 blood group systems and more than active in body temperature, therefore, these three 420 blood group antigens have been discovered.1 As blood group systems are important in clinical far as blood transfusion is concerned; the ABO blood transfusion practices.6 group system has prime importance because of the India is a developing country with limited presence of reciprocal antibody which is of IgM nature resources and heavy patient load, thus making it in the serum of patients. Apart from ABO grouping, impossible to do extensive blood grouping for every antigen D of Rh blood group system has also been donation, so we rely upon ABO and RhD blood included in routine blood grouping and transfusion grouping in routine. In specific groups of popu- services because of its highly immunogenic nature. lation like females of childbearing age, newborn, Other blood group systems and antigens that are pregnant women and patients requiring multi- important in cases with prior multiple blood trans- ple blood transfusions (hemolytic diseases), it is fusion and hemolytic disease of the newborn are Kell mandatory to determine the phenotype of clinically (K), Other Rh blood group antigens (C, c, E, e), Duffy significant blood group antigens on the donor red * Correspondence to: (Fya, Fyb) and Kidd (Jka, Jkb). blood cell (RBC) since alloimmunization is partic- Dharmesh Chandra Sharma, Blood Bank, Department of Pathology, G. International Society of Blood Transfusion ularly undesirable in such cases. To prevent allo- R. Medical College and J A Hospital (ISBT) recognized 9 blood group systems known as immunization we have to select a particular blood Gwalior India ABO, Rhesus, Kell, Duffy, Kidd, MNS, P, Lewis, and group system which is phenotypically similar to [email protected] Lutheran, that are clinically significant and related to that of the recipient for transfusion.7 Moreover, it is hemolytic transfusion reactions (HTR) and hemo- preferred to transfuse such patients with clinically 2-5 Received: 2020-03-23 lytic disease of the fetus and newborn (HDFN). significant alloantibodies to a particular antigen by Accepted: 2020-06-30 Out of these, antigens of the ABO, Rh and Kell blood and blood products lacking corresponding Published: 2020-08-01 blood group systems are highly immunogenic and antigens, in case of emergency.7 Open access: www.balimedicaljournal.org and ojs.unud.ac.id/index.php/bmj 437 ORIGINAL ARTICLE ABO was the first human blood group system The inclusion criterion for selection of blood discovered and it plays a significant role in transfu- donors was: donor fitness, according to the donor’s sion medicine, hematopoietic stem cell transplan- questionnaire, their physical examination, hemoglo- tation, and solid organ transplantation. ABO blood bin (Hb %) above 12.5 GMs/dl and aged between groups are not fully developed at birth until the age 18-60 years. of 2-4 years, and after that it remains unchanged The exclusion criterion for selection of blood throughout the life.8 The ABO blood group system donors was: unfit donor, according to the donor’s is classified on the basis of the presence of one, both, questionnaire, their physical examination, hemoglo- or neither of the A and B antigens on the surface of bin (Hb %) less than 12.5 GMs/dl and age <18 year red blood cells. Anti-A and Anti-B antibodies or and >60 year. agglutinins are usually of IgM type and naturally occur in the human body, these are produced in the Aseptically 5 ml blood was collected from the first year of life by sensitization to environmental donor/ blood unit and 3ml was transferred into factors such as food, bacteria and viruses.9 plain disposable vials and 2ml in EDTA/ CPD Unlike ABO blood groups, the formation of anti anti-coagulant. After centrifugation of the plain vial D antibodies is not natural; it is due to immuni- sample, serum was obtained and labeled appropri- zation by fetal RhD positive RBCs in Rh negative ately and immediately stored at 20-80C if tests were mothers or transfusion of RhD positive RBCs in not performed simultaneously. It was then used RhD negative person. These antibodies persist for ABO reverse grouping and agglutinin reaction for many years. Antibodies against the D antigen study to know the irregular antibody. With whole are responsible for clinically significant HDN and blood sample in EDTA/ CPD, three washings with transfusion reaction.10 ABO and RhD blood group normal saline was done and button was used to pre- systems carry the hereditary character which is pare 5% saline suspension of RBCs by adding 95% useful in blood transfusion practice, in genetic of saline to the 5% of RBCs. This cell suspension study of specific population and medico-legal was used for forward blood grouping in the study. cases.11 Blood group systems are genetically deter- ABO and RhD grouping was done by ABD Gel mined and most of them are inherited in simple Card Make Tulip. Test for the rest major Rh anti- Mendelian fashion and have stable characteristics, gens i.e. C, c, E, e was done by the Complete Rh Gel which also have importance in paternity testing.12 Card. For Kell, Duffy and Kidd blood group anti- Antibodies against antigens related to Kell, Duffy gens AHG (Coombs) test card and the neutral gel and Kidd blood group systems are responsible for card was used. For antigens K, Jka and Jkb neutral HTR and HDFN, and are regarded as clinically gel card was used in the study because Antisera significant if they react with indirect Antiglobulin anti-K, anti-Jka, and anti-Jkb used was saline agglu- at 37ºC temperature. In antenatal patients and tinating while for antigen k, Fya and Fyb coomb’s patients who require repeated blood transfusion, Gel card was used because anti-k, anti-Fya, anti-Fyb testing of these antigens is of clinical significance used in the study was AHG (Anti Human Globulin) and should be done. agglutinating. Ethnic differences of various blood group anti- Rare Antisera used in the study were from gens are common and it shows various striking Immucor India Pvt. Ltd. Figure 2(A). All aggluti- and interesting findings. There are very few studies nation tests were done as per standard operating that were conducted on minor blood system in our procedures for the test and in accordance with the country.13 manufacturer’s instructions. Grading of agglutina- Blood group systems and antigens were included tion is shown in Figure 2(B). in the present study, are summarized in table 1. In the present study gene frequency was calcu- lated by the Hardy-Weinberg equation. The data MATERIALS AND METHODS has been collected, tabulated. Summarized and compared statistically by distribution and percent- The present prospective study was done at Blood age proportion. Chi square (X2) test was applied to Bank in the Department of Pathology at Gajra understand the many (p value) ratio of difference Raja Medical College and J.A.
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