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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 3  |  Issue : 1  |  Page : 26-29

Red blood cell phenotyping of blood donors in Islamabad, Pakistan


1 Department of Pathology and Blood Bank, Shaheed Zulfiqar Ali Bhutto Medical University (PIMS); Department of Zoology, PMAS Arid Agriculture University, Rawalpindi, Pakistan
2 Safe Blood Transfusion Programme, Ministry of National Health Services, Government of Pakistan, Karachi, Pakistan
3 Department of Blood Bank, Husaini Haematology and Oncology Trust, Karachi, Pakistan
4 Department of Bioinformatics and Biotechnology, International Islamic University, Islamabad, Pakistan
5 Department of Zoology, PMAS Arid Agriculture University, Rawalpindi, Pakistan
6 Department of Pathology and Blood Bank, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

Date of Web Publication5-Apr-2018

Correspondence Address:
Dr. Usman Waheed
Safe Blood Transfusion Programme, Ministry of National Health Services, Government of Pakistan, Karachi
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GJTM.GJTM_54_17

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  Abstract 


Background: There are 33 blood groups identified so far representing more than 300 antigens. The blood transfusion services in resource-limited countries including Pakistan only test for ABO and RhD antigens during cross-matching. However, the transfusion of ABO-RhD compatible but unknown phenotype blood may result in alloimmunization, especially in multi-transfused patients. Aims: The aim of this study is to investigate the prevalence of clinically significant minor blood group antigens in population of Islamabad, Pakistan. Settings and Design: A prospective study was conducted at the Department of Blood Transfusion Services, Islamabad. Subjects and Methods: Blood samples from 625 randomly selected blood donors were collected for extended antigen typing. Blood grouping was performed using commercially available antisera. The statistical analysis was done using SPSS version 20.0. Gene frequencies were calculated using the Hardy–Weinberg equation. Results: Of the 625 blood donors, 575 were RhD positive (92%) and 50 (8%) were RhD negative. The frequencies of A, B, AB, and O antigens were (24.64%), (34.72%), (9.28%), and (31.36%), while antigen frequency of K was 4%, Duffy (Fya) 58.24%, Duffy (Fyb) 39.84%, Kidd (Jka) 65.28%, Kidd (Jkb) 42.24%, M 86.88%, N 46.24%, S s49.44%, and s 30.4%. Calculated gene frequency for Kell K was (0.04), Duffy Fya (0.481), Fyb (0.519), Kidd JKa (0.538), JKb (0.462), M (0.699), N (0.301), S (0.445), and s (0.556). Conclusions: The current study depicts the prevalence of the blood group antigens among Pakistani blood donors to be statistically different from those in Caucasians, Chinese, and African populations.

Keywords: ABO, alloimmunization, Islamabad, red cell phenotypes


How to cite this article:
Jabin F, Waheed U, Ahmed S, Arshad M, Arshad A, Zaheer HA. Red blood cell phenotyping of blood donors in Islamabad, Pakistan. Glob J Transfus Med 2018;3:26-9

How to cite this URL:
Jabin F, Waheed U, Ahmed S, Arshad M, Arshad A, Zaheer HA. Red blood cell phenotyping of blood donors in Islamabad, Pakistan. Glob J Transfus Med [serial online] 2018 [cited 2018 May 22];3:26-9. Available from: http://www.gjtmonline.com/text.asp?2018/3/1/26/229337




  Introduction Top


Human blood group systems are highly polymorphic. Antigenic substances (proteins), resided on the surface of erythrocytes, make the base of different blood group systems. These antigens are the inherited characters.[1] Over 300 blood group antigens present on the surface of red blood cells [2] and 33 blood groups have been recognized so far by ISBT.[3] Transfusion therapy becomes complicated due to alloantibodies and cause immediate or delayed hemolytic transfusion reactions, with an incidence of around 1/7000 RBC units transfused.[4] Apart from major blood group systems (ABO and Rhesus), minor blood groups including Kidd, Duffy, and Kell blood group systems play substantial role in clinical transfusion practices because their antigens are more immunogenic and active at body temperature (37°C)[2] In routine blood banking, blood transfusion services are confined only to ABO and RhD antigen typing, particularly in resource-limited countries,[5] including Pakistan. Normally, it is considered secure and time-saving, but for the multi-transfused patients (thalassemic and anemic), the extended phenotyping for the determination of minor antigens is also necessary. The frequencies of clinically significant blood groups antigens (Duffy, Kell, Kidd, and MNS) should be determined while dealing with patients who have multiple alloantibodies.[6] Complications related to blood transfusion can be avoided by having proper knowledge of the minor blood groups, their medical significance and the laboratory methods such as typing and cross-matching, etc.[7]


  Subjects and Methods Top


After taking oral informed consent, a total number of 625 blood samples were studied, including 425 males and 200 females. Blood donors were between 25 and 29 years old (P< 0.05) from both genders (male, 68%; female, 32%). Blood samples of both volunteer and replacement donors were collected into citrate EDTA (Ethylenediaminetetraacetic acid) vials. Extended antigen typing was performed for the major (ABO and Rh) and minor blood groups antigens including Kell, Duffy, Kidd, and MNSs by tube method using commercially available antisera (Bio-Rad Laboratories, DiaMed, Switzerland). The statistical analysis was done using Statistical Package for Social Sciences, version 20.0 (IBM Corp., Armonk, NY, USA). Qualitative or categorical variables were described as frequencies and proportions. Hardy–Weinberg equation was used to calculate the gene frequencies where P + q = 1 and P = {2 × obs (AA) + obs (Aa)}/2 × {obs (AA) + obs (Aa) + obs (aa)}; hence q = 1– p.


  Results Top


The present study was aimed to determine the frequency and differential expression of major and minor blood groups (Duffy, Kell, Kidd, and MNSs) antigens in blood donors visiting blood bank of Shaheed Zulfiqar Ali Bhutto Medical University (PIMS), Islamabad. The distribution of antigen frequencies is illustrated in [Table 1]. Most common phenotypes in Duffy, Kidd, and MNSs blood group system were Fya + b-, Jka + b-, and M + N-, respectively [Table 2].
Table 1: Antigen frequencies of blood group antigens

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Table 2: Distribution of genotype and phenotype frequencies of blood group systems Duffy, Kidd, and MNS

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Gene frequencies

The calculated gene frequencies for minor blood group systems were Kell K (0.04), Duffy Fy a (0.481), Fy b (0.519), Kidd Jka (0.538), Jkb (0.462), M (0.699), N (0.301), S (0.445), and s (0.556) [Figure 1].
Figure 1: Gene frequencies of minor blood group antigens

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  Discussion Top


In humans, different combinations of blood group antigens are present, producing a unique spectrum for every individual. Distribution of blood group antigens varies significantly in different populations and racial groups. It is important to study the prevalence of different blood group antigens (both major and minor) not only for transfusion medicine but also for genetic research and organ transplantation.[8] All the blood banks should have the data bank on various RBC antigens in local population to prevent the risk of alloimmunization in multi-transfused patients, young females, and pregnant women. However, there is no such study until now on Pakistani population. In this study, we examined the phenotype frequencies as well as the genotype frequencies of clinically significant blood group antigens in population of capital territory Islamabad. The results of our study are compared with other published data from neighboring countries including China, Iran, India, and Malaysia [Table 3] and [Table 4].
Table 3: Comparison of genotype frequencies for the Kell, Duffy, and Kidd blood group systems with other published data

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Table 4: Comparison of most prevalent phenotype frequencies in the present study and other ethnic populations

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The antigens of ABO blood group are found in the entire human population, but a considerable difference has been observed in their frequency distribution all over the world.[13] Studies show that distribution of blood groups in different provinces of Pakistan considerably varies.[14] The current study has charted out that the distributional pattern of ABO blood group antigens as follows: B > O > A > AB. Similar results were found out by previous studies in Pakistani population in both the genders.[15] With the Rh system, the present study indicated 92% RhD+ and only 8% RhD- donors. These indications are consistent with the previous findings among Pakistani population.[16]

The antigens of Kell blood group system are the third most potent for triggering immune reaction.[3] The Kell (K) antigen was observed in 25 (4%) studied blood donors and its genotype was recorded as 0.04. Overall, there was a low prevalence of KK antigen among Asians in China it was recorded 0,[9] and in the state of Parana, Southern Brazil, it was 0.0025 and 0.8.[4],[17] With the Duffy system, it has been reported previously that the Fy a is very common among Asian populations. Similar results have been observed in this study, the incidence of Fy a and Fy b antigen was 58.24% and 39.84%, respectively, which is less as compared to India (87.3% and 58.3%).[5] The most prevalent phenotype in Duffy blood group was found to be Fy a + Fy b- with 34.56% which is significantly different to that reported in Iran, 22.8% and 47.4%,[10],[18] India 41.7%,[5] 74% in Malays, 85.4% in Chinese, and 40.8% in Indians,[11] whereas Caucasians and Africans have low prevalence of this phenotype 17% and 9%, respectively.[12] In Kidd blood group system, Jk antigen acts as the urea transporter and its antibodies are difficult to detect. The antigen frequency of JK a and Jk b was recorded as 65.28% and 42.24%, while Jk a + Jk b- phenotype with the frequency of 40% was found to be the most common phenotype which is found to be different with Malays 36%, Chinese 24.5%, and Indians 35%.[11] At the same time, Persians showed the expression of this phenotype 34.7%,[10] Caucasians 28% and Africans 57%.[12] In the MNS blood group system, the most common phenotype in our study was M+N-, with the frequency of 53.92% which is much greater than observed in Indians (38.5%),[19] Malaysians (37.5%), Chinese (34.3%),[11] Persians (43.3%),[10] Caucasians (28%), and 26% in Africans.[12] In case of S + s- phenotype, the prevalence was found 36.96%, which was about three times more common than Indians 12.4%,[5] Persians 15,5%,[10] Caucasians 11%, Africans 3%,[12] Malays 1.5%, and Chinese 0.7%.[11]

These findings suggest a unique distribution pattern of some blood groups among the Pakistani blood donors. The information about the minor blood group antigens prevalence can assist in the management and prevention of erythroblastosis fetalis and providing antigen-negative compatible blood to patients with multiple alloantibodies. Based on the current study, it is inferred that a large population carry the studied minor blood groups antigens which can cause severe hemolytic transfusion reactions.


  Conclusion Top


Thus, there is a need to perform the extended antigen typing for minor blood groups as well, in all the blood banks of Pakistan on a routine basis. This study provides us a population profile with known antigens which can be helpful to provide antigen-matched blood to anemic patients, pregnant women, and chronically transfused patients.

Acknowledgment

The authors would like to thank the technical staff of the blood bank at SZAB Medical University, Islamabad, for providing assistance during research work and Sindh Medical Stores, Lahore, for the availability of antisera (Bio-Rad Laboratories, DiaMed Switzerland).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Iqbal M, Niazi A, Tahir M. Frequency of ABO and Rh blood groups in healthy donors. JRMC 2009;13:92-4.  Back to cited text no. 1
    
2.
Mohamed S, Muna I. Characterisation of Rh and other blood group systems amongst the Maldivian blood donors. Med J Malaysia 2013;68:393-6.  Back to cited text no. 2
    
3.
Flôres MA, Visentainer JE, Guelsin GA, Fracasso Ade S, de Melo FC, Hashimoto MN, et al. Rh, Kell, Duffy, Kidd and Diego blood group system polymorphism in Brazilian Japanese descendants. Transfus Apher Sci 2014;50:123-8.  Back to cited text no. 3
    
4.
Zacarias JM, Langer IB, Visentainer JE, Sell AM. Profile of Rh, Kell, Duffy, Kidd, and Diego blood group systems among blood donors in the southwest region of the Paraná state, Southern Brazil. Transfus Apher Sci 2016;55:302-7.  Back to cited text no. 4
    
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Lamba DS, Kaur R, Basu S. Clinically significant minor blood group antigens amongst North Indian donor population. Adv Hematol 2013;2013:215454.  Back to cited text no. 5
    
6.
Makroo RN, Bhatia A, Gupta R, Phillip J. Prevalence of Rh, Duffy, Kell, Kidd & MNSs blood group antigens in the Indian blood donor population. Indian J Med Res 2013;137:521-6.  Back to cited text no. 6
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Mitra R, Mishra N, Rath GP. Blood groups systems. Indian J Anaesth 2014;58:524-8.  Back to cited text no. 7
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8.
Manoharan S, Kaur AP, Imanina CW. Distribution of ABO blood group and Rhesus factor among students in ASIA Metropolitan University, Malaysia. Int J Biol Med Res 2013;4:2962-5.  Back to cited text no. 8
    
9.
Liu Z, Zeng R, Chen Q, Li M, Shi GY, Wei P, et al. Genotyping for Kidd, Kell, Duffy, Scianna, and RHCE blood group antigens polymorphisms in Jiangsu Chinese Han. Chin Med J (Engl) 2012;125:1076-81.  Back to cited text no. 9
    
10.
Keramati MR, Shakibaei H, Kheiyyami MI, Ayatollahi H, Badiei Z, Samavati M, et al. Blood group antigens frequencies in the Northeast of Iran. Transfus Apher Sci 2011;45:133-6.  Back to cited text no. 10
    
11.
Musa RH, Ahmed SA, Hashim H, Ayob Y, Asidin NH, Choo PY, et al. Red cell phenotyping of blood from donors at the national blood center of Malaysia. Asian J Transfus Sci 2012;6:3-9.  Back to cited text no. 11
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12.
Beadling WW, Cooling L, McPherson RA, Pincus MR. Henery's Clinical Diagnosis and Management by Laboratory Methods. Philadelphia : Saunders Elsevier; 2007. p. 614-7.  Back to cited text no. 12
    
13.
Daniels GL, Bromilow I. Essential Guide to Blood Groups. Malden, MA, USA: Blackwell Publishing Ltd.; 2007.  Back to cited text no. 13
    
14.
Ilyas M, Iftikhar M, Rasheed U. Frequency of ABO and Rh blood groups in Gujranwala (Punjab), Pakistan. Biologia 2013;59:107-14.  Back to cited text no. 14
    
15.
Khan MS, Farooq N, Qamar N, Tahir F, Subhan F, Kazi BM, et al. Trend of blood groups and Rh factor in the twin cities of Rawalpindi and Islamabad. J Pak Med Assoc 2006;56:299-302.  Back to cited text no. 15
    
16.
Khan MS, Subhan F, Tahir F, Kazi BM, Dil AS, Sultan S. Prevalence of blood groups and Rh factor in Bannu region NWFP (Pakistan) Pak J Med Res. 2004;43:8-10.  Back to cited text no. 16
    
17.
Guelsin GA, Sell AM, Castilho L, Masaki VL, de Melo FC, Hashimoto MN, et al. Genetic polymorphisms of Rh, Kell, Duffy and Kidd systems in a population from the state of Paraná, Southern Brazil. Rev Bras Hematol Hemoter 2011;33:21-5.  Back to cited text no. 17
    
18.
Tashfeen S, Salamat N, Ahmed S. Frequencies of Duffy blood group alleles in Northern Pakistani donors. Transfus Apher Sci 2014;51:39-41.  Back to cited text no. 18
    
19.
Thakral B, Saluja K, Sharma RR, Marwaha N. Phenotype frequencies of blood group systems (Rh, Kell, Kidd, Duffy, MNS, P, Lewis, and Lutheran) in North Indian blood donors. Transfus Apher Sci 2010;43:17-22.  Back to cited text no. 19
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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