Phenotyping of clinically significant blood group antigens among the South Indian donor population

Subramaniyan, Rajeswari

doi:10.1016/j.htct.2021.11.012

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Hematology, Transfusion and Cell Therapy

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Original article • Hematol., Transfus. Cell Ther. 45 (suppl 2) • July 2023 • https://doi.org/10.1016/j.htct.2021.11.012 copy

Phenotyping of clinically significant blood group antigens among the South Indian donor population

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

Data on the prevalence of clinically significant antigens (Rh, Kell, Kidd, Duffy, MNSs, Lewis, P and Lutheran) among the Indian donor population is sparse.

Objective:

This prospective study was aimed at determining the prevalence of 21 clinically significant antigens for the first time in the South Indian donor population.

Method:

A total of 672 regular O group blood donors were enrolled for Rh (C, c, E, e) and Kell (K) antigens typing. Of these, 188 donors were typed for other clinically significant antigens (k, Kp^a, Kp^b, Jk^a, Jk^b, Fy^a, Fy^b, M, N, S, s, P1, Le^a, Le^b, Lu^a and Lu^b).

Results:

Antigen frequencies were expressed in percentages. In our study, R1R1 and rr were the most common phenotypes among D+ and D− donors, respectively. Among the Rh antigens, the e antigen was expressed by 97.5% and 100% of D+ and D− donors, respectively. The K antigen was found in only 0.15% of donors. In the Duffy and Kidd blood group system, Fy (a+b+) and Jk (a+b+) were the most frequent phenotypes, respectively. In the MNSs blood group system, M+N+ and S−s+ were the most common phenotypes reported. The Le (a−b+) was found to be the phenotype with the highest prevalence in the Lewis blood group system. The Lu (a−b+) was the only phenotype found in the Lutheran blood group system.

Conclusion:

Knowledge regarding the prevalence of antigens in a given population is essential in developing cost-effective in-house panels and a rare donor registry comprising donors typed negative for a high-frequency antigen or a combination of common multiple antigens.

Keywords:
Blood group antigens; Prevalence; Phenotype; South India

Antigen	Antigen Frequency Among D + Donors Present Study (n = 359) Number (%)	Antigen Frequency Among (%) D + Donors Setya et al.⁹9 Setya D, Tiwari AK, Arora D, Mitra S, Mehta SP, Aggarwal G. The frequent and the unusual red cell phenotypes in Indian blood donors: a quest for rare donors. Transfus Apher Sci. 2020;59(4):102765. (n = 6264)	Antigen Frequency (%) Among D + Donors Thakral et al.¹⁰10 Thakral B, Saluja K, Sharma RR, Marwaha N. Phenotype frequencies of blood groups systems (Rh, Kell, Kidd, Duffy, MNS, P, Lewis, and Lutheran) in north Indian blood donors. Transfus Apher Sci. 2010;43:17–22. (n = 1158)	Antigen Frequency Among D− Donors Present Study (n = 313) Number (%)	Antigen Frequency (%) Among D− Donors Setya et al.⁹9 Setya D, Tiwari AK, Arora D, Mitra S, Mehta SP, Aggarwal G. The frequent and the unusual red cell phenotypes in Indian blood donors: a quest for rare donors. Transfus Apher Sci. 2020;59(4):102765. (n = 414)	Antigen Frequency (%) Among D− Donors Thakral et al.¹⁰10 Thakral B, Saluja K, Sharma RR, Marwaha N. Phenotype frequencies of blood groups systems (Rh, Kell, Kidd, Duffy, MNS, P, Lewis, and Lutheran) in north Indian blood donors. Transfus Apher Sci. 2010;43:17–22. (n=82)
C	327(91.08)	88.25	90.15	17(5.43)	11.59	8.54
c	180(50.13)	52.62	49.48	312(99.68)	89.37	100
E	63(17.54)	20.67	18.9	4(1.28)	6.04	3.66
e	350(97.5)	98.3	98.1	313(100)	99.52	100

Phenotype^a* a* Indicates the presumed Rh phenotype of the population.	Present Study Number (%) (n = 359)	Agarwal et al. (n = 368) (%)¹¹11 Agarwal N, Thapliyal RM, Chatterjee K. Blood group phenotype frequencies in blood donors from a tertiary care hospital in North India. Blood Res. 2013;48:51–4.	Nanu and Thapliyal et al. (%)¹²12 Nanu A, Thapliyal RM. Blood group gene frequency in a selected north Indian population. Indian J Med Res. 1997;106:242–6. (n = 265)
R1R1	178(49.58)	42.93	42.64
R1r	110(30.64)	35.6	35.09
R1R2	38(10.59)	13.04	12.08
R2r	15(4.18)	5.98	5.66
R2R2	9(2.5)	0.54	2.64
R0r	8(2.23)	1.63	1.89
R1RZ	1(0.28)	0	0

Phenotype^* *Indicates the presumed Rh phenotype of the population.	Present Study Number (%) (n = 313)	Agarwal et al. (%)¹¹11 Agarwal N, Thapliyal RM, Chatterjee K. Blood group phenotype frequencies in blood donors from a tertiary care hospital in North India. Blood Res. 2013;48:51–4. (n = 140)	Nanu and Thapliyal et al. (%)¹²12 Nanu A, Thapliyal RM. Blood group gene frequency in a selected north Indian population. Indian J Med Res. 1997;106:242–6. (n = 177)
rr	292(93.29)	95.71	89.83
r'r	16(5.11)	4.29	8.48
r"r	4(1.28)	0	1.13
r'r'	1(0.32)	0	0

Antigens	Present Study (%)	Setya et al. (%)⁹9 Setya D, Tiwari AK, Arora D, Mitra S, Mehta SP, Aggarwal G. The frequent and the unusual red cell phenotypes in Indian blood donors: a quest for rare donors. Transfus Apher Sci. 2020;59(4):102765.n = 6678)	Thakral et al. (%)¹⁰10 Thakral B, Saluja K, Sharma RR, Marwaha N. Phenotype frequencies of blood groups systems (Rh, Kell, Kidd, Duffy, MNS, P, Lewis, and Lutheran) in north Indian blood donors. Transfus Apher Sci. 2010;43:17–22. (n = 317)	Kahar et al. (%)¹³13 Kahar MA, Patel RD. Phenotype frequencies of blood group systems (Rh, Kell, Kidd, Duffy, MNS, P, Lewis, and Lutheran) in blood donors of south Gujarat, India. Asian J Transfus Sci. 2014;8:51–5. (n = 115)	Makroo et al. (%)¹⁴14 Makroo RN, Bhatia A, Gupta R, Phillip J. Prevalence of Rh, Duffy, Kell, Kidd and amp; amp; MNSs blood group antigens in the Indian blood donor population. Indian J Med Res. 2013;137:521–6. (n = 3073)
K^* *The K antigen frequency was calculated in 672 donors.	0.15	5.14	5.56	6.09	3.5
k	100	99.98	100	100	99.97
Kp^a	0	ND	0.95	1.74	ND
Kp^b	100	ND	100	100	ND
Jk^a	82.98	84.22	82.65	80.87	81.4
Jk^b	62.77	62.91	66.56	71.3	67.6
Fy^a	87.77	85.23	86.75	46.96	87.4
Fy^b	60.11	59.15	56.15	13.91	57.7
M	84.57	75.89	75.39	76.52	88.8
N	58.51	62.04	61.51	62.61	65.4
S	49.47	59.66	56.47	51.3	54.8
s	93.09	82.84	87.38	91.3	88.7
Le^a	21.11	15.18	20.82	16.52	ND
Le^b	61.11	67.91	60.57	65.22	ND
P1	77.5	71.23	71.92	64.35	ND
Lu^a	0	ND	0.95	0	ND
Lu^b	100	ND	96.8	97.39	ND

Phenotype	Present Study (%)	Setya et al. (%)⁹9 Setya D, Tiwari AK, Arora D, Mitra S, Mehta SP, Aggarwal G. The frequent and the unusual red cell phenotypes in Indian blood donors: a quest for rare donors. Transfus Apher Sci. 2020;59(4):102765. (n = 6678)	Thakral et al. (%)¹⁰10 Thakral B, Saluja K, Sharma RR, Marwaha N. Phenotype frequencies of blood groups systems (Rh, Kell, Kidd, Duffy, MNS, P, Lewis, and Lutheran) in north Indian blood donors. Transfus Apher Sci. 2010;43:17–22. (n = 317)	Agarwal et al. (%)¹¹11 Agarwal N, Thapliyal RM, Chatterjee K. Blood group phenotype frequencies in blood donors from a tertiary care hospital in North India. Blood Res. 2013;48:51–4. (n = 508)	Kahar et al. (%)¹³13 Kahar MA, Patel RD. Phenotype frequencies of blood group systems (Rh, Kell, Kidd, Duffy, MNS, P, Lewis, and Lutheran) in blood donors of south Gujarat, India. Asian J Transfus Sci. 2014;8:51–5. (n = 115)	Makroo et al. (%)¹⁴14 Makroo RN, Bhatia A, Gupta R, Phillip J. Prevalence of Rh, Duffy, Kell, Kidd and amp; amp; MNSs blood group antigens in the Indian blood donor population. Indian J Med Res. 2013;137:521–6. (n = 3073)
K−k+	99.47	94.88	94.32	98.03	93.91	96.5
K+k+	0.53	5.12	5.68	1.97	6.09	3.5
K+k−	0	0	0	0	0	Rare
K−k−	0	0	0	0	NA	0
Kp(a+b+)	0	ND	0.95	ND	1.74	ND
Kp(a−b+)	100	ND	99.05	ND	98.26	ND
Jk(a+b+)	45.75	47.12	49.21	46.06	52.17	48.9
Jk(a+b−)	37.23	37.09	33.44	30.71	28.69	32.5
Jk(a−b+)	17.02	15.78	17.35	22.83	19.13	18.5
Jk(a−b−)	0	0	0	0.39	0	0
Fy(a+b+)	47.87	44.38	42.9	48.03	9.57	45.3
Fy(a+b−)	39.9	40.85	43.85	36.22	37.39	42.1
Fy(a−b+)	12.23	14.76	13.25	15.36	4.35	12.3
Fy(a−b−)	0	0	0	0.39	48.69	0.3
M+N+	43.09	37.93	36.9	54.72	39.13	54.1
M+N−	41.49	37.96	38.5	35.83	NA	34.6
M−N+	15.42	24.11	24.6	9.45	NA	11.3
S-s+	50.53	40.34	43.53	47.63	66.96	44.7
S+s+	42.55	42.5	43.85	38.98	NA	43.9
S+s−	6.92	17.16	12.62	13.39	NA	11.3
S−s−	0	0	0	0	NA	Very rare
Le(a-b+)	61.11	66.85	60.57	24.81	65.22	ND
Le(a+b−)	21.11	14.12	20.82	16.14	16.52	ND
Le(a−b−)	17.78	17.97	18.61	59.06	18.26	ND
Le(a+b+)	0	1.06	0	0	0	ND
PI	77.5	71.23	71.92	60.63	64.35	ND
Lu(a-b+)	100	ND	95.9	99.61	97.39	ND
Lu(a+b+)	0	ND	0.95	0.39	0	ND
Lu(a+b−)	0	ND	0	0	0	ND
Lu(a−b−)	0	ND	3.15	0	2.61	ND

Phenotype	Present Study (%)	Setya et al. (%)⁹9 Setya D, Tiwari AK, Arora D, Mitra S, Mehta SP, Aggarwal G. The frequent and the unusual red cell phenotypes in Indian blood donors: a quest for rare donors. Transfus Apher Sci. 2020;59(4):102765. (n = 6678)	Thakral et al. (%)¹⁰10 Thakral B, Saluja K, Sharma RR, Marwaha N. Phenotype frequencies of blood groups systems (Rh, Kell, Kidd, Duffy, MNS, P, Lewis, and Lutheran) in north Indian blood donors. Transfus Apher Sci. 2010;43:17–22. (n = 317)	Agarwal et al. (%)¹¹11 Agarwal N, Thapliyal RM, Chatterjee K. Blood group phenotype frequencies in blood donors from a tertiary care hospital in North India. Blood Res. 2013;48:51–4. (n = 508)
M+N−S+s−	4.26	7.46	7.9	7.09
M+N−S+S+	19.68	17.64	14.8	14.96
M+N−S−S+	18.09	12.86	15.8	13.78
M+N+S+s−	2.13	5.48	3.47	5.12
M+N+S+S+	17.02	15.68	19.55	20.87
M+N+S−S+	23.4	16.77	13.88	28.74
M−N+S+s−	0.53	4.22	1.26	1.18
M−N+S+S+	6.38	9.18	9.46	3.15
M−N+S−S+	8.51	10.71	13.88	5.12
M+N−S−s−	0	0	0	0
M−N+S−s−	0	0	0	0

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[1] *Corresponding author at: Consultant. Department of Transfusion Medicine, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore 641014, India. E-mail address: arthisoundarya@gmail.com