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While the previous review encompassed the Rh blood group system (Chou ST, Westhoff CM. The Rh and RhAG blood group systems. Immunohematology. 2010;26:178-86), this update focusses on the RHCE gene and its variants. Four new antigens- PARG, CEVF, CEWA, and CETW (RH60 to RH63)-were reported since the last update. RHCE*cEMI (RHCE*03.31) was amended from a null allele to an allele encoding very weak antigen expression. The following topics are discussed: cross-reactive alleles [such as RHCE*ceHAR (*01.22.01) and RHCE*ceCF (*01.20.06) which may type D+ with some monoclonal anti-D reagents], issues with hybrid alleles and allele dropout, common haplotypes (association between RHCE alleles and specific RHD alleles), and clinical considerations. While the detailed description of new Rh antigens has become rare, many RHCE alleles have been reported since the previous review, a result of increased adoption of DNAbased testing for red blood cell antigens in immunohematology laboratories. The Rh blood group system has fascinated generations of immunohematologists and is likely to continue to do so for decades to come.
BACKGROUND: Patients with chronic transfusion needs such as those with sickle cell disease face a high risk of developing antibodies against high-prevalence antigens in the RH blood group system, complicating transfusion therapy and potentially necessitating stem cell transplantation. Molecular characterization of the RH system is hindered by hybrid alleles and high sequence homology between RHD and RHCE, limiting the effectiveness of conventional short-read sequencing. STUDY DESIGN AND METHODS: We analyzed 11 control and 20 patient samples, some of which could not be reliably genotyped by standard methods. RESULTS: Nanopore sequencing with adaptive sampling enables targeted, amplification-free long-read sequencing of the RH locus, resolving homologous and complex hybrid structures and enabling complete haplotype phasing for all samples, including samples that could not be accurately determined by standard methods like serology and short-read sequencing. Four new alleles were identified and for 13 out of 20 patients the results led to a change in the transfusion regimen. DISCUSSION: These findings show that nanopore sequencing with adaptive sampling allows unambiguous genotyping of the RH system, improves detection of complex variants, and supports better-matched transfusion strategies for chronically transfused patients.
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BACKGROUND: von Willebrand disease (VWD) is a common inherited bleeding disorder caused by low levels or activity of circulating von Willebrand factor (VWF). Genetic susceptibility to VWF antigen (VWF:Ag) below normal (≤ 50 IU/dL) in the general population is underexplored. OBJECTIVES: To identify genetic variants influencing VWF:Ag levels ≤ 50 IU/dL. METHODS: We performed a genome-wide association study in 926 cases with VWF:Ag levels ≤ 50 IU/dL and 12 846 controls from 7 studies from the Trans-Omics for Precision Medicine program. We then examined whether significant genome-wide findings were also associated with clinical diagnosis of VWD in 5 biobanks with 708 VWD cases and 1 286 069 controls, and with 6 bleeding and thrombotic disorders in FinnGen. RESULTS: Variants at 2 loci were associated (P < 5 × 10-9) with VWF:Ag levels ≤ 50 IU/dL: ABO and VWF. The VWF index variant, p.Tyr1584Cys, is a rare (0.22%) missense variant with odds ratio (OR) of 78.58, while the ABO index variant is a common intronic variant with a smaller effect (OR = 2.52). Notably, both VWF (OR = 7.16) and ABO (OR = 1.57) variants were also associated (P < .025) with diagnosed VWD. Among p.Tyr1584Cys heterozygotes, the penetrance of VWF:Ag levels ≤ 50 IU/dL was 24.2% and the penetrance of diagnosed VWD was 0.3%. p.Tyr1584Cys was associated (P < .0042) with increased odds of heavy menstrual bleeding (OR = 1.27), iron deficiency anemia (OR = 1.55), and intrapartum hemorrhage (OR = 2.20), but decreased odds of deep vein thrombosis (OR = 0.54). CONCLUSIONS: Although there are currently conflicting interpretations of pathogenicity p.Tyr1584Cys, our results suggest that it is a low penetrance pathogenic variant that contributes to VWF:Ag levels ≤ 50 IU/dL, bleeding, and VWD.
BACKGROUND: Qualitative and quantitative alterations of the D antigen, including weak D and partial D phenotypes, may lead to hemolytic transfusion reactions and hemolytic disease of the fetus and newborn (HDFN). Among these variants, the Partial DLO phenotype is clinically significant due to its potential to induce anti-D formation upon exposure to RhD-positive red blood cells. This study aimed to determine, for the first time, the prevalence of RHD variants in eastern Iran. METHODS: Between October 2024 and October 2025, fifteen blood samples exhibiting weak D antigen expression from blood donors in eastern Iran were analyzed. Serological phenotyping for D, C, c, E, and e antigens was performed. Molecular assessment of RHD variant alleles was conducted using PCR-SSP, Real-time PCR, and DNA sequencing. RESULTS: The analysis of samples with serologically weak D expression revealed three different partial D alleles. The highest prevalence was observed for the Partial DLO allele (80%), followed by the Partial type 11 allele (13.3%) and the Partial DV type 2 allele (6.7%). Additionally, the Partial DLO phenotype was predominantly associated with the DCce antigen profile, with fewer cases showing the DCe profile. CONCLUSION: The high prevalence of the Partial DLO phenotype (80%) among weak D individuals despite being reported as rare in most populations worldwide highlights a potentially unique genetic pattern in eastern Iran. These findings underscore the importance of implementing molecular RHD genotyping to improve transfusion safety in this region.
Normal human serum subjected to sucrose density gradient analysis exhibited multiple sedimenting species of properdin antigen. Properdin antigen distribution was dependent on serum concentration, ionic strength, temperature, and the presence of C3, and was not dependent on the presence of divalent metal cations or blood coagulation. In mixtures of purified components, properdin sedimented heavier in the presence of C3, C3b, or C3c. Addition of factor B to mixtures containing C3 and properdin was without effect. These data provide insights into earlier discrepancies concerning the sedimentation behavior of partially purified properdin, indicate a propensity of some constituents of the alternative pathway to form protein-protein complexes, and suggest caution in interpretation of immunopathological studies in which properdin deposits are found in the presence of C3.
A serum agglutinin reactive with red cells in the presence of polycarboxyl groups is reported. It is likely that this represents an additional example of the type of agglutinin previously described as agglutinating red cells in the absence of ionized calcium. Experimental evidence is presented indicating that it is free polycarboxyl groups that potentiate agglutination and that any metal ion, such as calcium, capable of chelating with these groups will prove to be inhibitory.
Alloanti-D is still one of the most common causes of severe hemolytic disease of the fetus and newborn in China, as rhesus immunoglobulin (RhIG) prophylaxis is not a routine practice throughout China. HLA plays an important role in the susceptibility to alloimmunisation against red blood cell antigens. This study was designed to identify susceptible and protective HLA alleles for alloanti-D immunisation after pregnancy in the southern Chinese D-negative (D-) pregnant women. In this study, a cohort of 116 true D- pregnant females who had not received prophylactic RhIG prophylaxis, had two or more pregnancies, and did not produce alloanti-D (non-responders group), and 122 true D- pregnant women with alloanti-D immunisation (D responders group), were enrolled. HLA genotyping (HLA-A, -B, -C, -DRB1, -DPA1, -DPB1, -DQA1, and -DQB1) was performed by third generation sequencing with nanopore technology. The phenotypic frequencies of HLA alleles were compared between the D responders group and non-responders group. The results showed that the phenotypic frequencies of HLA-DRB1*08:03 and HLA-DQA1*01:03 alleles in the D responders group were significantly lower than those in the non-responders group: 1.7% versus 13.1% [Odds Ratio (OR): 0.116, 95% CI: 0.026-0.518; pc = 0.029] for HLA-DRB1*08:03 allele, and 5.2% versus 18.8% (OR: 0.235, 95% CI: 0.092-0.600, pc = 0.019) for HLA-DQA1*01:03 allele. Our findings indicated that the presence of HLA-DRB1*08:03 or HLA-DQA1*01:03 alleles can be considered as a protective factor for alloanti-D immunisation in the southern Chinese D- pregnant women.
BACKGROUND: Immune hemolytic anemia poses a significant challenge in transfusion medicine, as identification of underlying alloantibodies can be masked by warm and/or cold autoantibodies. This increases the risk of transfusing incompatible blood, which can precipitate or exacerbate hemolysis. Identifying alloantibodies in the presence of autoantibodies remains difficult with standard serologic and genotypic methods, often delaying accurate diagnosis and appropriate transfusion strategies. CASE REPORT: We describe a 63-year-old woman with autoimmune hemolytic anemia who suffered near-fatal hemolysis following transfusion. Despite extensive serologic and genotypic testing, the cause of her hemolytic transfusion reactions remained elusive. Given her clinical course and transfusion history, we hypothesized that her acute hemolytic transfusion reactions could be due to immune sensitization to a high-incidence RBC antigen. Research whole-genome long-read sequencing (LRS) revealed homozygosity for a rare KEL*02N.16 allele, consistent with a rare Ko phenotype, which was validated by Sanger sequencing. Retrospective serologic testing with Ko RBCs further confirmed alloimmunization within the Kell system. CONCLUSION: This case highlights the limitations of conventional serologic and genotypic methods in detecting rare blood group phenotypes, and emphasizes the diagnostic power of long-read sequencing in transfusion medicine. Early molecular testing in complex hemolytic cases can facilitate targeted transfusion strategies, reduce the risk of severe hemolysis, and improve patient outcomes. As sequencing technologies become more accessible, they have the potential to revolutionize blood group typing and alloimmunization risk assessment in clinical practice.
BACKGROUND: A minority of blood donors are Rh(D)-negative, and Rh(D)-negative red blood cell (RBC) products are often overutilized. As such, Rh(D)-negative RBCs may be difficult to maintain in blood bank inventory. STUDY DESIGN AND METHODS: We changed our blood bank laboratory policy to approve non-alloimmunized Rh(D)-negative patients to receive Rh(D)-positive RBCs for routine transfusion under defined criteria. Those criteria included Rh(D)-negative males (all ages) and females (aged >50 years) who were designated as do not resuscitate (DNR), either with or without intubation, in the electronic medical record. RESULTS: From August 15, 2024 through August 15, 2025, a total of 204 Rh(D)-negative patients met the above criteria and were approved to receive routine Rh(D)-positive RBC transfusions. Within that group, 23 patients received Rh(D)-positive RBCs. The remaining patients either did not require transfusion or were issued Rh(D)-negative RBC units. Since implementing this practice, a total of 68 Rh(D)-negative units were conserved during this time frame. Notably, 28 of the 68 units (41%) were type O, Rh(D)-negative. DISCUSSION: Rh(D)-positive RBCs can be routinely given to non-alloimmunized Rh(D)-negative patients who are not at risk for developing hemolytic disease of the fetus and newborn (HDFN). By creating clear guidelines for the routine administration of Rh(D)-positive RBCs to patients who are not at risk for HDFN, the inventory of Rh(D)-negative RBC units can be directed to those patients who would most benefit from this limited resource.
Plasmodium knowlesi, a zoonotic malaria species, has become a significant public health concern in Southeast Asia. In regions such as Malaysia and southern Thailand, P knowlesi incidence has risen, even as other human malaria parasites are nearing elimination. Similar to its close relative Plasmodium vivax, P knowlesi relies on the Duffy antigen receptor for chemokine (DARC) as a key receptor for erythrocyte invasion. Only Duffy-positive individuals are thought to be susceptible to clinical infection. Here, we demonstrate that P knowlesi possesses greater invasion plasticity than previously recognized. This parasite can bypass the need for DARC, as shown by its in vitro adaptation to invade and replicate within Duffy-negative (Fy-) erythrocytes. This adaptation is stable and independent of DARC binding, enabling the adapted parasite line to be maintained in Fy- erythrocytes and to resist inhibition by α-DARC antibodies. Genomic analysis identified a genomic recombination event between the parasite's dbpα and dbpγ genes, resulting in a new chimeric gene dbpαγ. Using CRISPR-Cas9 targeted reversion, we could demonstrate that dbpαγ is essential for invasion of Fy- erythrocytes. These findings shed new light on the invasion plasticity of P knowlesi, with implications for the parasite's potential spread beyond Southeast Asia and for understanding the complex host-cell specificity and atypical invasion pathways seen in P vivax.
BACKGROUND: Recent research have underscored the relation of ABO blood group system to cerebrovascular disorders predisposition. The present investigation endeavors to delve into the relationship between ABO polymorphisms and ischemic stroke (IS) risk. METHODS: A cohort of 646 IS patients and 649 matched healthy controls was recruited. Genotyping of five SNPs within ABO were conducted by Agena MassARRAY platform. Logistic regression models were employed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Additionally, SNP-SNP interaction was assessed by multifactor dimensionality reduction (MDR) method. Furthermore, Analysis of Variance (ANOVA) was utilized to explore the association between genotypes and blood lipid profiles. RESULTS: The study identified an elevated IS risk associated with rs8176740 and rs8176720 in the overall population. Notably, ABO rs8176720 emerged as the most informative single-locus model for IS susceptibility. These variants were related to an elevated IS risk, specifically in female subjects, the subgroup aged > 64 years, non-smokers, drinkers or non-drinkers. Moreover, rs8176749 and rs8176745 were associated with red blood cell count levels and total bilirubin levels. CONCLUSION: This study firstly demonstrated the association of ABO rs8176740 and rs8176720 with IS incidence, which increased the understanding regarding the effect of ABO on IS pathogenesis.
Bone marrow transplantation is emerging as a viable therapeutic approach to a number of diseases that are usually or uniformly fatal. We review here recent experiences in bone marrow transplantation in man at UCLA and in various other institutions throughout the world. We examine marrow transplantation in immunodeficiency diseases, acute leukemia, and aplastic anemia and consider the problems of infection in the transplant recipients. The applications of tissue typing to marrow transplantation and immunologic manipulations, which may influence engraftment and graft-versus-host disease, are also reported.
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