research article phenotypic profile of rh and kell blood...

Research ArticlePhenotypic Profile of Rh and Kell Blood Group Systems amongBlood Donors in Cote drsquoIvoire West Africa

L Siransy Bogui12 B Dembele13 Y Sekongo12 S Abisse12 S Konateacute1 and M Sombo24

1 National Blood Transfusion Center 52 boulevard de Marseille BP 15 Abidjan Cote drsquoIvoire2 Laboratory of Immunology UFR of Medical Sciences BP 34 Abidjan 01 Cote drsquoIvoire3 Laboratory of Immunology UFR of Pharmaceutical and Biological Sciences BP 34 Abidjan 01 Cote drsquoIvoire4Hospital and University Centre of Cocody BP 1843 Abidjan 08 Cote drsquoIvoire

Correspondence should be addressed to L Siransy Bogui lsiransygmailcom

Received 24 May 2014 Accepted 25 August 2014 Published 24 September 2014

Academic Editor Silvano Wendel

Copyright copy 2014 L Siransy Bogui et alThis is an open access article distributed under theCreativeCommonsAttribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Few countries in sub-Saharan Africa make systematic searches for antigens C c E and e of the Rh and Kell system antigens inthe donor and recipient thereby exposing transfused patients Purpose and Objectives In this paper we propose to determine thered cell Rh and Kell blood groups among blood donors from traditional techniques to improve medical care of transfused patientsThis study will allow us to assess the frequency of blood group antigens in these systems Study Design andMethods We carried outa study on the red cell typing in the blood donor population of the National Blood Transfusion Center in Abidjan This study wasperformed on 651 blood donors Results For the Rh system the antigen frequencies of D c e C and E are respectively 92939985 9985 2197 and 1382 K antigen is found in 077 of donorsDiscussion and Conclusion Although the frequencies ofthe most immunogenic antigens are lower than in the white race lack of preventive measures makes the immunological risk highin Africa Furthermore Africa is full of specificities that are important to note for a better care of our patients

1 Introduction

In Cote drsquoIvoire and in other African countries [1 2] mostof transfusions are done only based on ABO and D antigensAlthough blood transfusions can save life they are notwithout risk Blood transfusion can carry immediate ordelayed immunological risks the most common and mostserious is the hemolytic transfusion reaction by antibodyincompatibility Knowledge about the frequency of red cellsantigens phenotypes in Ivorian population is important forthe creation of a donor data bank and to minimize risksof alloimmunization This requires the determination ofthe immunological characteristics of blood products andblood recipients by performing immunohematology analysissuch as phenotyping in Rh and Kell blood group systemsCurrently there are thirty-three major blood group systems[3] but analyses recommended in the usual situation areABO Rh and Kell typing and detecting red cell antibodies

Unfortunately in sub-Saharan countries few practice thissystematic search for antigens C c e E and K in the donor

and recipient thereby exposing the transfused patient to highrisk of alloimmunization [4]

Very few studies are available reporting antigens frequen-cies of Rh and Kell blood groups in sub-Saharan countries

This study is the first report on the frequency of bloodgroups system Rh and Kell in blood donors in Cote drsquoIvoireThis work will perform Rh and Kell red cell typing amongblood donors by traditional techniques to implement this intothe routine for blood donors and recipients It also allows usto determine the frequency of the major Rh and Kell bloodgroup antigens and phenotypes commonly found amongblood donors from Cote drsquoIvoire to improve transfusionpractices

2 Materials and Methods

It was a retrospective study conducted at the Laboratoryof Immunohaematology of the National Blood TransfusionCenter of Abidjan the capital of Cote drsquoIvoire

Hindawi Publishing CorporationJournal of Blood TransfusionVolume 2014 Article ID 309817 4 pageshttpdxdoiorg1011552014309817

2 Journal of Blood Transfusion

21 Blood Donors We analyzed grouping data in Rh and Kellblood group systems from651 volunteer regular blood donorscoming to the national blood on one year The blood donorshave an age range from 18 to 60 years

Those excluded from donating blood fell within thefollowing categories

(i) taking drugs for high blood pressure or heart failure

(ii) having Hb below 11 gdL (for females) or 12 gdL (formales)

(iii) testing positive for HBsAg HCV and HIV antibodiesand syphilis

(iv) having had jaundice liver disease epilepsy diabetesduodenal or gastric ulcer asthma tuberculosis orother pathology

(v) taking self-injected drugs

(vi) having sickle cell disease

(vii) being a prostitute andor homosexual

(viii) having severe weight loss within the last six months

22 Methods For optimal results the determination wasperformed using a tube freshly drawn into ethylenedi-aminetetraacetate according to manufacturerrsquos instructionsThe techniques are direct agglutination of the antigenswith slide technique for Rh system antigens and indirectantiglobulin technique by tube technique for Kell systemantigens Rh phenotyping was done using five monoclonalmonospecific antisera anti-D anti-E anti-C anti-c andanti-e while Kell phenotyping was performed with anti-Kaccording to manufacturerrsquos instructions All reagents weresupplied by Orgenics PBS Eurobio

Positive and negative control red cells and Coombsrsquocontrol cells were also performed as controls Data wereentered and analyzed with Epi Info version 61

3 Results

We determined blood group antigens in 651 donors with sexratio 36 in favor of men

605 blood donors representing 9293 of the blooddonors were found to be RhD positive while 46 blood donorsrepresenting 707 were found to be RhD negative (Figure 1)

The c and e antigens have the highest frequency with9983 C and E antigen were less frequent with 2197 and1382 respectively (Table 1)

Seven phenotypes were detected among the blood donors(Table 2) The most frequent phenotype among the RhDpositive was R

0r 6512 followed by R

1r 20 and R

2r 1273

Among the RhD negative the most frequent was rr (8043)In the Kell blood group system 5 blood donors (077)

were typed as K antigen positive and 645 (9808) as kantigen positive antigens Accordingly the Kminusk+ phenotypewas the most common in these donors (9892)

9293

77

Blood donors RhD positiveBlood donors RhD negative

Figure 1 Prevalence of RhD antigen in blood donors

4 Discussion

Our study focused on 651 regular and volunteer blood donorswho have made donations at the National Blood TransfusionCenter The techniques used were the traditional techniquesof agglutination on slide or in tube (indirect antiglobulin)Although recent years have been marked by the appearanceof microtechnology we wanted to show that even withtraditional techniques such typing can be performed in adepartment with limited resourcesThe findings in our studywill introduce plan for better care of the patients

41 The Rh System After ABO blood group the Rh system isthemost important in transfusionmedicine In Cote drsquoIvoirethe blood transfusions are done only regarding ABO andRhD antigens exposing patients to high alloimmunizationAkre [4] found that 628 of patients suffering from sicklecell disease and transfused were immunized against Rh andKell antigens systems Rh was involved in 4444 whileKell was involved in 2778 in sickle cell patients transfusedagainst 38 for both in France [12] The most frequentalloantibodies were anti-E anti-C and anti-KEL1 developedafter transfusion of standard red cell units

In our study the frequency of D antigen was 9293Thisis comparable with the findings in the north of Cote drsquoIvoire[3] and in the black population [13] It is higher in othersub-Saharan Africa countries [1 2 5] and non-sub-SaharanAfrica countries [7ndash10] (Table 3) Frequencies are lower in theUS France and Nigeria where the authors found respectiveprevalence of 854 85 and 815 [6 11 12]

The prevalence of the RhD negative is 77 These resultsagree with the work of Seka [14] who found 728 and thework of Cabannes [15 16] that quoted values ranging from170 to 93 in sub-Saharan Africa

The frequencies of c and e antigens in our study arehigh (99 85) (Table 1) while the frequencies of C and Eantigens are lower respectively 2197 and 1382 Amongwhites European and Asian people e antigen is the mostpopular and then comes C antigen [17] As regards to C and Eantigens frequencies are higher than in our study (C 70 andE 26) [5 9 12 17] Among RhD negative donors E antigenis absent

Journal of Blood Transfusion 3

Table 1 Rh and Kell antigens frequency among 651 Ivorian blood donors

Antigens RhD negative donors RhD positive donors Total119899 119899 119899

c+ 46 100 604 9983 650 9985e+ 46 100 604 9983 650 9985C+ 9 1957 134 2215 143 2197E+ 0 0 90 1488 90 1382k 650 9984K 5 077Kpa 4 061Kpb 539 8280

Table 2 Rh and Kell phenotypes frequencies in Cote drsquoIvoire blood donors (119899 = 651)

Antigens PhenotypesGenotypes

Number Frequency Wiener Fischer

raceRh positive donors 605

D+CminusEminusc+e+ R0rR0rR0R0

DcedceDceDce 394 6512

D+C+Eminusc+e+ R1rR1rR1R0

R0r1015840

DCeDceDCeDceDcedCe

121 2000

D+CminusE+c+e+ R2rR2rR2R0

DcEdceDcEDce 77 1273

D+C+E+c+e+ R1R2

R1R2

R1r10158401015840R2r1015840RZrR0Rz

R0ry

DCeDcEDCedcEDcEdCeDCEdceDceDCEDcedCE

12 700

D+C+E+cminuseminus RzRzRzRz

RzryDCEDCEDCEdCE 1 017

Rh negative donors 46DminusCminusEminusc+e+ rr rr dcedce 37 8043DminusC+Eminusc+e+ r1015840r r1015840r dCedce 9 1957

KellKminusk+ 645 9908K+k+ 5 077Kminuskminus(k0) 1 015

Table 3 Antigens frequencies of Rh blood group compared with published results

AntigenOurstudy(119899)

Ourstudy()

NorthCote

drsquoIvoire[3]

Mauritania[1]

Guinea[5]

Cameroun[2]

Nigeria[6]

Antananarivo[7]

Morocco[8]

India[9]

Iran[10]

USA[11]

D+ 605 9293 925 942 959 95 815 989 905 944 902 854Dminus 46 770 75 577 406 6 185 11 95 564 98 146c+ 650 9985 975 739e+ 650 9985 975 979C+ 143 2197 95 759E+ 90 1382 925 295


In the Rh system seven phenotypes on eighteen known[13] were identified in our population (Table 2) The phe-notype most frequently encountered is the phenotype R

0r

(6512) regarding RhD positive blood donors and rr 8043among RhD negative blood donors This profile is differentfrom that observed in the whites where the phenotype R

1r

or R1R1is the most popular [12 13] RzRz was found in one

donor

42 The Kell System The importance of this system is due tothe K antigen which has strong immunogenicity It is amongthe most immunogenic system after the Rh system

In theKell system k antigenwas found in 9892of blooddonors which is comparable with frequency in whites

The prevalence of K antigen was found to be 092 ofdonors enrolled in the study contrary to France where 9of individuals are K+ [12] and to Germany where 4 expressthe K antigen [18]

The most common phenotype was Kminusk+ which is alsocommon in white people The antigens Kpa and Kpb werefound respectively at frequencies of 061 and 8280 in oursample against 02 and 998 in whites [17]

5 Conclusion

Immunohematology data on blood donors are very fewin West Africa The ABO and D antigens are the mainexamination other investigations are not performed

Furthermore Africa is full of its own specificities that areimportant to note for better care of patients by improvingroutine tests like phenotyping red cells screening andidentifying red cells antibodies

Research in that field should benefit from commonwork fromWest Africa national blood transfusion centers toenhance safety in transfusion medicine

Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper

References

[1] C T Hamed M A Bollahi I Abdelhamid et al ldquoFrequenciesand ethnic distribution of Rh(D) blood group in MauritaniardquoInternational Journal of Immunogenetics vol 39 pp 151ndash1542012

[2] S H Mandengue G Lehman Leopold P Assomo-Ndembaand M Mbangue ldquoDistribution des antigenes des systemesABO rhesus Kell MNSs et Duffy chez des drepanocytaires etdonneurs de sang benevoles a Douala (Cameroun) risques dereactions transfusionnellesrdquo Medecine drsquoAfrique Noire vol 50no 1 pp 22ndash24 2003

[3] A Santovito C Burgarello P Cervella et al ldquoErythrocytepolymorphisms in five ethnic groups ofNorthernCote drsquoIvoirerdquoInternational Journal of Immunogenetics vol 36 no 3 pp 189ndash191 2009

[4] D P Akre J Seka-Seka S R Dasse et al ldquoAlloimmu-nisation anti erythrocytaire post transfusionnelle chez lesdrepanocytaires au CHU de Cocody Abidjanrdquo InternationalJournal of PharmaandBio Sciences vol 9 no 2 pp 64ndash70 2008

[5] A Loua M R Lamah N Y Haba andM Camara ldquoFrequencyof blood groups ABO and rhesus D in the Guinean populationrdquoTransfusion Clinique et Biologique vol 14 no 5 pp 435ndash4392007

[6] A G Falusi O G Ademowo C A Latunji et al ldquoDistributionof ABO and RH genes in Nigeriardquo African Journal of Medicineand Medical Sciences vol 29 no 1 pp 23ndash26 2000

[7] Z A Randriamanantany D H Rajaonatahina F E Razafi-manantsoa et al ldquoPhenotypic and allelic profile of ABOand Rhesus D blood group system among blood donor inAntananarivordquo International Journal of Immunogenetics vol 39no 6 pp 477ndash479 2012

[8] A Benahadi R Alami and S Boulahdid ldquoLa distributiondes antigenes de groupe sanguins ABO et Rhesus au MarocrdquoTransfusion Clinique et Biologiqu vol 20 no 3 p 313 2013

[9] N Agarwal R M Thapliyal and K Chatterjee ldquoBlood groupphenotype frequencies in blood donors from a tertiary carehospital in north Indiardquo Blood Research vol 48 no 1 pp 51ndash54 2013

[10] M R Keramati H Shakibaei M I Kheiyyami et al ldquoBloodgroup antigens frequencies in the northeast of IranrdquoTransfusionand Apheresis Science vol 45 no 2 pp 133ndash136 2011

[11] G Garratty S A Glynn and R McEntire ldquoABO and Rh(D)phenotype frequencies of different racialethnic groups in theUnited Statesrdquo Transfusion vol 44 no 5 pp 703ndash706 2004

[12] I Mendel Bases Immunologiques de la transfusion sanguinehttpefs-alsacefr

[13] G DanielsHuman BloodGroup JohnWilley amp Sons HobokenNJ USA 2nd edition 2002

[14] S S Joseph Contribution a lrsquoetude des groupes sanguinserythrocytaires en Cote drsquoIvoire Inventaire et repartition selon lesethnies [These medecine] Faculte de Medecine Abidjan CotedrsquoIvoire 1985

[15] R Cabannes ldquoHematologie des ethnies de Cote drsquoIvoire Sonapport a la connaissance des populations de ce paysrdquoMedecinedrsquoAfrique Noire vol 28 pp 65ndash72 1981

[16] R Cabannes A Senarail F Pene A Sangare F SomboMamboand P Kple Faget ldquoEtude hemotypologique des populationsde lrsquoafrique de lrsquoOuest Reference particuliere aux populationsivoiriennes et aux Peulh de lrsquoafrique de lrsquoOuestrdquo Annales delrsquoUniversite drsquoAbidjan Serie B Medecine vol 13 pp 11ndash16 1979

[17] M A Kahar and R D Patel ldquoPhenotype frequencies of bloodgroup systems (Rh Kell Kidd Duffy MNS P Lewis andLutheran) in blood donors of south Gujarat Indiardquo AsianJournal of Transfusion Science vol 8 no 1 pp 51ndash55 2014

[18] F F Wagner D Kasulke M Kerowgan and W A FlegelldquoFrequencies of the blood groups ABO Rhesus D category VIKell and of clinical relevant high-frequency antigens in South-Western Germanyrdquo Infusionstherapie und Transfusionsmedizinvol 22 no 5 pp 285ndash290 1995

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014


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EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

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OphthalmologyJournal of


Diabetes ResearchJournal of



Research and TreatmentAIDS


Gastroenterology Research and Practice


Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom


21 Blood Donors We analyzed grouping data in Rh and Kellblood group systems from651 volunteer regular blood donorscoming to the national blood on one year The blood donorshave an age range from 18 to 60 years

Those excluded from donating blood fell within thefollowing categories

(i) taking drugs for high blood pressure or heart failure

(ii) having Hb below 11 gdL (for females) or 12 gdL (formales)

(iii) testing positive for HBsAg HCV and HIV antibodiesand syphilis

(iv) having had jaundice liver disease epilepsy diabetesduodenal or gastric ulcer asthma tuberculosis orother pathology

(v) taking self-injected drugs

(vi) having sickle cell disease

(vii) being a prostitute andor homosexual

(viii) having severe weight loss within the last six months

22 Methods For optimal results the determination wasperformed using a tube freshly drawn into ethylenedi-aminetetraacetate according to manufacturerrsquos instructionsThe techniques are direct agglutination of the antigenswith slide technique for Rh system antigens and indirectantiglobulin technique by tube technique for Kell systemantigens Rh phenotyping was done using five monoclonalmonospecific antisera anti-D anti-E anti-C anti-c andanti-e while Kell phenotyping was performed with anti-Kaccording to manufacturerrsquos instructions All reagents weresupplied by Orgenics PBS Eurobio

Positive and negative control red cells and Coombsrsquocontrol cells were also performed as controls Data wereentered and analyzed with Epi Info version 61

3 Results

We determined blood group antigens in 651 donors with sexratio 36 in favor of men

605 blood donors representing 9293 of the blooddonors were found to be RhD positive while 46 blood donorsrepresenting 707 were found to be RhD negative (Figure 1)

The c and e antigens have the highest frequency with9983 C and E antigen were less frequent with 2197 and1382 respectively (Table 1)

Seven phenotypes were detected among the blood donors(Table 2) The most frequent phenotype among the RhDpositive was R

0r 6512 followed by R

1r 20 and R

2r 1273

Among the RhD negative the most frequent was rr (8043)In the Kell blood group system 5 blood donors (077)

were typed as K antigen positive and 645 (9808) as kantigen positive antigens Accordingly the Kminusk+ phenotypewas the most common in these donors (9892)

9293

77

Blood donors RhD positiveBlood donors RhD negative

Figure 1 Prevalence of RhD antigen in blood donors

4 Discussion

Our study focused on 651 regular and volunteer blood donorswho have made donations at the National Blood TransfusionCenter The techniques used were the traditional techniquesof agglutination on slide or in tube (indirect antiglobulin)Although recent years have been marked by the appearanceof microtechnology we wanted to show that even withtraditional techniques such typing can be performed in adepartment with limited resourcesThe findings in our studywill introduce plan for better care of the patients

41 The Rh System After ABO blood group the Rh system isthemost important in transfusionmedicine In Cote drsquoIvoirethe blood transfusions are done only regarding ABO andRhD antigens exposing patients to high alloimmunizationAkre [4] found that 628 of patients suffering from sicklecell disease and transfused were immunized against Rh andKell antigens systems Rh was involved in 4444 whileKell was involved in 2778 in sickle cell patients transfusedagainst 38 for both in France [12] The most frequentalloantibodies were anti-E anti-C and anti-KEL1 developedafter transfusion of standard red cell units

In our study the frequency of D antigen was 9293Thisis comparable with the findings in the north of Cote drsquoIvoire[3] and in the black population [13] It is higher in othersub-Saharan Africa countries [1 2 5] and non-sub-SaharanAfrica countries [7ndash10] (Table 3) Frequencies are lower in theUS France and Nigeria where the authors found respectiveprevalence of 854 85 and 815 [6 11 12]

The prevalence of the RhD negative is 77 These resultsagree with the work of Seka [14] who found 728 and thework of Cabannes [15 16] that quoted values ranging from170 to 93 in sub-Saharan Africa

The frequencies of c and e antigens in our study arehigh (99 85) (Table 1) while the frequencies of C and Eantigens are lower respectively 2197 and 1382 Amongwhites European and Asian people e antigen is the mostpopular and then comes C antigen [17] As regards to C and Eantigens frequencies are higher than in our study (C 70 andE 26) [5 9 12 17] Among RhD negative donors E antigenis absent




c+ 46 100 604 9983 650 9985e+ 46 100 604 9983 650 9985C+ 9 1957 134 2215 143 2197E+ 0 0 90 1488 90 1382k 650 9984K 5 077Kpa 4 061Kpb 539 8280








R0r1015840

DCeDceDCeDceDcedCe

121 2000



D+C+E+c+e+ R1R2

R1R2

R1r10158401015840R2r1015840RZrR0Rz

R0ry


12 700







Ourstudy()

NorthCote

drsquoIvoire[3]

Mauritania[1]

Guinea[5]

Cameroun[2]

Nigeria[6]

Antananarivo[7]

Morocco[8]

India[9]

Iran[10]

USA[11]

D+ 605 9293 925 942 959 95 815 989 905 944 902 854Dminus 46 770 75 577 406 6 185 11 95 564 98 146c+ 650 9985 975 739e+ 650 9985 975 979C+ 143 2197 95 759E+ 90 1382 925 295



0r


1r


donor





5 Conclusion






References
























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



















c+ 46 100 604 9983 650 9985e+ 46 100 604 9983 650 9985C+ 9 1957 134 2215 143 2197E+ 0 0 90 1488 90 1382k 650 9984K 5 077Kpa 4 061Kpb 539 8280








R0r1015840

DCeDceDCeDceDcedCe

121 2000



D+C+E+c+e+ R1R2

R1R2

R1r10158401015840R2r1015840RZrR0Rz

R0ry


12 700







Ourstudy()

NorthCote

drsquoIvoire[3]

Mauritania[1]

Guinea[5]

Cameroun[2]

Nigeria[6]

Antananarivo[7]

Morocco[8]

India[9]

Iran[10]

USA[11]

D+ 605 9293 925 942 959 95 815 989 905 944 902 854Dminus 46 770 75 577 406 6 185 11 95 564 98 146c+ 650 9985 975 739e+ 650 9985 975 979C+ 143 2197 95 759E+ 90 1382 925 295



0r


1r


donor





5 Conclusion






References
























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of


















0r


1r


donor





5 Conclusion






References
























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of





















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















research article phenotypic profile of rh and kell blood...

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