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ABO maternal‐child discordance: Evidence of variable allelic expression and considerations for investigation
Author(s) -
McKnight Tristan F.P.,
Strain Jonathan E.,
Vege Sunitha,
Lam Christina,
Hubbard Eustratia M.,
Kopko Patricia M.,
Westhoff Connie M.,
Allen Elizabeth S.
Publication year - 2021
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/trf.16263
Subject(s) - abo blood group system , allele , biology , genotype , genotyping , genetics , serology , sanger sequencing , antibody , microbiology and biotechnology , gene , dna sequencing
Abstract Background We report a case of apparent mother‐child ABO group noninheritance. A Caucasian mother initially typed as group O and her infant group AB. Investigation ruled out preanalytical causes such as mislabeled samples and in vitro fertilization. Materials and Methods Red blood cells were characterized by routine serologic testing. Genomic data were analyzed by targeted polymerase chain reaction–restriction fragment length polymorphism and Sanger sequencing. Transferase structures were modeled using PyMOL molecular visualization software. Results Serologic testing initially demonstrated the mother was group O, father group AB, and infant group AB. Further testing of the maternal sample with anti‐A,B demonstrated weak A expression. Molecular testing revealed the maternal sample had an ABO*O.01.01 allele in trans to an A allele, ABO*AW.29 (c.311T>A, p.Ile104Asn), determined by gene sequencing. The sample from the infant carried the same ABO*AW.29 allele in trans to a B allele, ABO*B.01 . Conclusion ABO genotyping revealed an A transferase encoded by ABO*AW.29 , with apparent variable activity. Although A antigen expression is well known to be weak in newborns, it was robust on the red blood cells (RBCs) of the AB infant and undetectable with anti‐A on the mother. Variable expression of weak subgroups may reflect competition or enhancement by a codominant allele, as well as glycan chain maturation on red cells. Previous examples in group AB mothers with A weak infants suggested that the decreased expression is primarily due to glycan immaturity. To our knowledge, this is the first reported case of the ABO*AW.29 allele presenting with weak A expression in a group A weak mother and robust A expression in a group AB infant, suggesting the in trans allele is an important factor in determining transferase activity and may override age‐related effects.