Ann Lab Med.  2018 Jan;38(1):32-38. 10.3343/alm.2018.38.1.32.

Application of Multiplex Ligation-Dependent Probe Amplification Assay for Genotyping Major Blood Group Systems Including DEL Variants in the D-Negative Korean Population

Affiliations
  • 1Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
  • 2Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea. sykim@yuhs.ac

Abstract

BACKGROUND
The DEL blood type, a very weak D variant, is a major concern in the field of transfusion medicine because of its potential to cause anti-D alloimmunization. We investigated the molecular basis of serologically D-negative phenotypes, including the DEL type, and the distribution of other blood group systems in the Korean population using the recently developed multiplex ligation-dependent probe amplification (MLPA) assay.
METHODS
Blood group genotyping using the MLPA assay and RhCE phenotyping were performed on randomly selected 95 D-negative red blood cell products. The MLPA results were verified by multiplex PCR for the RHD promoter, exons 4, 7, and 10 and by direct sequencing of RHD exon 9.
RESULTS
Out of 95 cases, total deletion of the RHD was observed in 74 cases (77.9%) and four cases (4.2%) had an RHD-CE-D hybrid allele. The other 17 cases (17.9%) had an RHD(1227G>A) allele, which was further confirmed by sequencing analysis. The RhCE phenotypes of RHD(1227G>A) alleles were composed of 14 Cce and 3 CcEe, and all 60 cases of the ce phenotype were revealed to have a total deletion of the RHD. Genotyping results and allele distribution of the other 17 blood group systems were consistent with previous reports on the East Asian population.
CONCLUSIONS
MLPA assay correctly determined RHD genotype, including RHD-CE-D hybrid alleles or RHD(1227G>A) allele, and other clinically relevant blood group genotypes in D-negative Koreans. The use of MLPA assay on serologically D-negative individuals may help improve transfusion safety by preventing anti-D alloimmunization.

Keyword

Rh-Hr blood-group system; Genotype; Multiplex ligation-dependent probe amplification

MeSH Terms

Alleles
Asian Continental Ancestry Group
Erythrocytes
Exons
Genotype
Humans
Multiplex Polymerase Chain Reaction*
Phenotype
Rh-Hr Blood-Group System
Transfusion Medicine
Rh-Hr Blood-Group System

Reference

1. Daniels G. Human blood groups. Oxford: Blackwell Publishing Ltd;2013.
2. Wagner FF. RHD PCR of D-negative blood donors. Transfus Med Hemother. 2013; 40:172–181.
3. Shao CP, Maas JH, Su YQ, Kohler M, Legler TJ. Molecular background of Rh D-positive, D-negative, D(el) and weak D phenotypes in Chinese. Vox Sang. 2002; 83:156–161.
Article
4. Wagner T, Kormoczi GF, Buchta C, Vadon M, Lanzer G, Mayr WR, et al. Anti-D immunization by DEL red blood cells. Transfusion. 2005; 45:520–526.
Article
5. Yasuda H, Ohto H, Sakuma S, Ishikawa Y. Secondary anti-D immunization by Del red blood cells. Transfusion. 2005; 45:1581–1584.
Article
6. Kim KH, Kim KE, Woo KS, Han JY, Kim JM, Park KU. Primary anti-D immunization by DEL red blood cells. Korean J Lab Med. 2009; 29:361–365.
Article
7. Yang HS, Lee MY, Park TS, Cho SY, Lee HJ, Lim G, et al. Primary anti-D alloimmunization induced by “Asian type” RHD (c.1227G>A) DEL red cell transfusion. Ann Lab Med. 2015; 35:554–556.
8. Kim JY, Kim SY, Kim CA, Yon GS, Park SS. Molecular characterization of D- Korean persons: development of a diagnostic strategy. Transfusion. 2005; 45:345–352.
Article
9. Kormoczi GF, Gassner C, Shao CP, Uchikawa M, Legler TJ. A comprehensive analysis of DEL types: partial DEL individuals are prone to antiD alloimmunization. Transfusion. 2005; 45:1561–1567.
Article
10. Dajak S, Krstic JL, Kormoczi G, Dogic V, Burilovic V. Characteristics and frequency of DEL phenotype detected by indirect antiglobulin test in Dalmatia county of Croatia. Transfus Apher Sci. 2014; 50:210–213.
Article
11. Chen DP, Sun CF, Ning HC, Wang WT, Tseng CP. Comprehensive analysis of RHD splicing transcripts reveals the molecular basis for the weak anti-D reactivity of Del -red blood cells. Transfus Med. 2016; 26:123–129.
12. Seo MH, Won EJ, Hong YJ, Chun S, Kwon JR, Choi YS, et al. An effective diagnostic strategy for accurate detection of RhD variants including Asian DEL type in apparently RhD-negative blood donors in Korea. Vox Sang. 2016; 111:425–430.
Article
13. Luettringhaus TA, Cho D, Ryang DW, Flegel WA. An easy RHD genotyping strategy for D- East Asian persons applied to Korean blood donors. Transfusion. 2006; 46:2128–2137.
Article
14. Haer-Wigman L, Veldhuisen B, Jonkers R, Loden M, Madgett TE, Avent ND, et al. RHD and RHCE variant and zygosity genotyping via multiplex ligation-dependent probe amplification. Transfusion. 2013; 53:1559–1574.
15. Haer-Wigman L, Ji Y, Loden M, de Haas M, van der Schoot CE, Veldhuisen B. Comprehensive genotyping for 18 blood group systems using a multiplex ligation-dependent probe amplification assay shows a high degree of accuracy. Transfusion. 2013; 53:2899–2909.
Article
16. Goldman M, Nuria N, Castilho LM. An overview of the Progenika ID CORE XT: an automated genotyping platform based on a fluidic microarray system. Immunohematology. 2015; 31:62–68.
Article
17. Paccapelo C, Truglio F, Antonietta Villa M, Revelli N, Marconi M. HEA BeadChip technology in immunohematology. Immunohematology. 2015; 31:81–90.
18. Aubin JT, Le Van Kim C, Mouro I, Colin Y, Bignozzi C, Brossard Y, et al. Specificity and sensitivity of RHD genotyping methods by PCR-based DNA amplification. Br J Haematol. 1997; 98:356–364.
Article
19. Wagner FF, Frohmajer A, Flegel WA. RHD positive haplotypes in D negative Europeans. BMC Genet. 2001; 2:10.
20. Daniels G. Variants of RhD--current testing and clinical consequences. Br J Haematol. 2013; 161:461–470.
21. Peng CT, Shih MC, Liu TC, Lin IL, Jaung SJ, Chang JG. Molecular basis for the RhD negative phenotype in Chinese. Int J Mol Med. 2003; 11:515–521.
Article
22. Xu W, Zhu M, Wang BL, Su H, Wang M. Prospective evaluation of a transfusion policy of RhD-positive red blood cells into DEL patients in China. Transfus Med Hemother. 2015; 42:15–21.
Article
23. Flegel WA. Molecular genetics and clinical applications for RH. Transfus Apher Sci. 2011; 44:81–91.
Article
24. Sandler SG, Flegel WA, Westhoff CM, Denomme GA, Delaney M, Keller MA, et al. It's time to phase in RHD genotyping for patients with a serologic weak D phenotype. College of American Pathologists Transfusion Medicine Resource Committee Work Group. Transfusion. 2015; 55:680–689.
25. Li Q, Hou L, Guo ZH, Ye LY, Yue DQ, Zhu ZY. Molecular basis of the RHD gene in blood donors with DEL phenotypes in Shanghai. Vox Sang. 2009; 97:139–146.
26. Veldhuisen B, van der Schoot CE, de Haas M. Multiplex ligation-dependent probe amplification (MLPA) assay for blood group genotyping, copy number quantification, and analysis of RH variants. Immunohematology. 2015; 31:58–61.
27. Ji Y, Wen J, Veldhuisen B, Haer-Wigman L, Wang Z, Loden-van Straaten M, et al. Validation of the multiplex ligation-dependent probe amplification assay and its application on the distribution study of the major alleles of 17 blood group systems in Chinese donors from Guangzhou. Transfusion. 2017; 57:423–432.
Article
28. Wang YH, Chen JC, Lin KT, Lee YJ, Yang YF, Lin TM. Detection of RhD(el) in RhD-negative persons in clinical laboratory. J Lab Clin Med. 2005; 146:321–325.
Article
29. Srijinda S, Suwanasophon C, Visawapoka U, Pongsavee M. RhC phenotyping, adsorption/elution test, and SSP-PCR: the combined test for D-elute phenotype screening in Thai RhD-negative blood donors. ISRN Hematol. 2012; 2012:358316.
Article
30. Scott SA, Nagl L, Tilley L, Liew YW, Condon J, Flower R, et al. The RHD (1227G>A) DEL-associated allele is the most prevalent DEL allele in Australian D- blood donors with C+ and/or E+ phenotypes. Transfusion. 2014; 54:2931–2940.
31. Keller MA. The role of red cell genotyping in transfusion medicine. Immunohematology. 2015; 31:49–52.
Article
32. Chang HE, Hong YJ, Kim H, Hwang SM, Park JS, Lee SW, et al. Genotyping of 19 red cell antigens, including RHD, using liquid bead arrays. Clin Chim Acta. 2016; 462:111–117.
33. 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; 95:985–991.
Article
34. Lim CS, Kim YK, Lee KN. The Duffy blood group genotypes in Asian populations. Korean J Blood Transfus. 2007; 18:145–151.
35. Nathalang O, Intharanut K, Siriphanthong K, Nathalang S, Kupatawintu P. Duffy blood group genotyping in Thai blood donors. Ann Lab Med. 2015; 35:618–623.
Article
Full Text Links
  • ALM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr