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Overview of molecular methods in immunohematology
Author(s) -
Reid Marion E.
Publication year - 2007
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2007.01304.x
Subject(s) - library science , citation , computer science
B lood group antigens are inherited, polymorphic, structural characteristics located on proteins, glycoproteins, or glycolipids on the outside surface of the red blood cell (RBC) membrane. RBCs carrying a particular antigen can, if introduced into the circulation of an individual who lacks that antigen, elicit an immune response. It is the antibody from such an immune response that causes problems in transfusion incompatibility, maternal-fetal incompatibility, and autoimmune hemolytic anemia. The classical method of testing for blood group antigens and antibodies is hemagglutination. This technique is simple, inexpensive, and when carried out correctly, has a specificity and sensitivity that are appropriate for the clinical care of the vast majority of patients. However, hemagglutination, which is a subjective test, has certain limitations: 1) it does not reliably predict a fetus at risk of hemolytic disease of the newborn (HDN); 2) it is difficult to type RBCs from a patient who recently received a transfusion or those that are coated with IgG; 3) it does not precisely indicate RHD zygosity in D+ people; 4) a relatively small number of donors can be typed for a relatively small number of antigens, thereby limiting antigen-negative inventories; 5) it requires the availability of specific reliable antisera; 6) it is labor-intensive as is the manual data entry; 7) the source material is expensive and diminishing; 8) the cost of commercial reagents (Food and Drug Administration [FDA]-approved) is escalating; 9) many antibodies are not FDA-approved and are characterized (often partially) by the user; and 10) some antibodies are limited in volume, weakly reactive, or not available. The understanding of the molecular bases associated with many blood group antigens and phenotypes enables us to consider the identification of blood group antigens and antibodies using molecular approaches. Screening donors by deoxyribonucleic acid (DNA) testing would conserve antibodies for confirmation by hemagglutination of predicted antigen negativity. The purpose of this overview was to discuss how molecular approaches can be used in transfusion medicine, especially in those areas where hemagglutination is of limited value.