FY GINOTYPlNGlY PCA-ASP .. iii u IIUJIIor DNA II'Omfrom penpnem 01000 CIIUL pertphen1 blood cellL M : 711 419 DlSCUSSION TheFYbJoodgroUpsystemfl polymorphlc In lPOItpapUa In 603 I&tIODl, with \WOaDel-. lY and~,1npeople olBuropean 310 andAllan orf8in and I thJrdalleJe.~ wh1cbpnxIUC8I no fy- or .". on red ce1l8. ID people of Alrfcan orlsm.14..1 We 310 ~1'1' Fy,.,..Ft'fIY' ...AJ. Jo ..,r--Fl.. 2. 2. RIp~ alp.""" lY pnotyplnl 8bowta8the.. pi ~ pi pi*'~ p8t18m8 0""- FY FYpnotyplac pnotyplac pat18ml patWnl o...,. 0""- ha" dewlaped I FY-genotyplnctest bued aD the LIM of PCR-ASP. The forward primen are speciftc elther for the seq\1lDce of the ~ llleIe or tor that of thelY o r PIaDel. In the S' noncodini region of the FY gene, and the reverse primen areelther lpeclJlcfor thel8quence of thePI aUeJe or for Ihat of the FY"or Pyalle1eIn the codlnl restonol the .60wb4the.- la ddllCUdJ. G8aoiJp88 ID la ddllIUdy. G8IGtJP8lIa berlpchandp8II8Ilnvolve the..., ", 81.. ud ,... enthe Py uWe ud W8n therlpch8nd rt..uh8Dd p8M1lnvolw ,... InYOMthe""'l d DUllIeI'8d In -pa. h.. bI8dISouda MrlC8D don.. only. c:uuntend AfrIca cIonononly. countend In In -,.. lImP" rro. hin bI8dI bl Souda lYpbenolJpe(abow)aIMIFYpnoCyp8(beiow) de8lpa'" FYpbenolJP8(abow)aM FYpnorype(beJow) 818del"'.'" IN' 88dl1U1pI8 C818pry. Pour I , pie... lIIowa, ror88ChlU1pI8C8t8p1'y. PourW. ... ...,.. an 1Ih0WB, D I_Table 2).2). MM corr..pondlJlllOp~ ma. B, A.C, B,lIId C.8Dd D (- Tab18 epreI88l8 the 1IIO1cuIa'" muar ll8ID repr8I8d8dMlIIOIecuI8r... 18" ~l7tBP ~ 7tUDNA DNA II81II Ull Tedu,-"" G81tJI8nbarJ,HD).ArrowIto the... de(Ul8 T~ Gllt118r8bar8. MD). Am", 10 the IletIM.. oflb8..pUW DNArnp.a. hm th8 ABa18ftdepietlb8 ål oIlb8 _plUW DNA,., from theA8O .Ut-bp) ud Pr (711-bp) UIOW8ID dl. rtpt ... the (tll-bp) ud Pr (7l1-bp) amJW8 ta th. rtpt ~.. -- gene.Th, telt ts reltablt androbust,IIvtDllOO-percent toprllMr ID""'" bp)bp) aI...altbe ~(~.. ...(ID(ID al af -- -- concordancewith I8lOlotPcallydetermlned pbenotypeL PmIolllly dllCrlbed metbodJror FY pnotypinl haveInvolYedthe UIe of the r8IIrIctIonendonucleuee BanJand Sl)tL M ..., Th. medlad we haw delCrlbed ts more economil:al,1- tfme.cof1lUJD.in&and euter to perform:lt re- ... dM DNA" DNA rr.m-... quin8onlyPeR.with DOdJtudODst8pi JtrequJr8DODpen8iv8 nIIIt11ct1oD eozym.j carrfed out la lO-J1L~1II. and the ampl1ftcadoDl cm be whJch reducee the qum1Ity CIllndlcatedhetemzyJoåtyforthelY a11eI&TheM8k PI' PCRIndlcatedhetemzyaoåtyfor the1Y aIleI& Thew.t lY' ,n wu coDIrmId byweakreactkm8 apIDIt apaDå 9pI'8I8Ion WII COD8rm8dby weakreactkm8 apIDIt a panel ,fcWrenrntand-~ reapntland Wo by ablOrptIon-and- conawned.Theproceduretab8 1- than 2.5 boun from start to l8IUIt. adudJnl the DNA prepuatlon Itep.'Ib8 Ull ofheat-actlvatedDNApoJymerue(AmpU'Dlq GolcDprevent8tm.posJdYI r-=dona bymhibltlquupe- lOdaD studJeL ntradoDl c11IcmJsprimlnl of retpnu ofdUrermt antl-Pf reqentland Wo by ablOrptIon-and- with tbeIe ceII8 and poIydonal or elutlon atud1eLntradoDl with tbe8eceII8aod poIydonal or 10noclonaJ and-Py3cUdnot Ibow signUlcmdylow8r tltrImonoclona1anti. PySdJdnot Ibow sipliftcmtly loww titta:00KOnt thaDwer8seenwith control ceDa.Phenotype tion KOrM tban we18 seen with control ceDa.Phenotype Delpmotypl correIaUona andtheca1cuIated pmetmquenand IPIDOtypecarreIatIoDaand the cak:uIated pne fnlquenI. are aummarlzedJa~1e 3. ct. are .wnmarfzed In nble 3. M expected,primermixA, madeto det8Cta bypothedM expect8d.primermJxA, made tOdetlCt. hypotbedIl,ca1, sUent, recomblnantaDelecarryll1I both the GATA-l .Ilent. recomblnant allela carryll1l both the GATA-l aodf-d1arupdf1l mutation and the Fy"poIymorphJamat motlf-dJarupllnl mutation and the Fy" poIymorphJam at ucllOt1de 131 ('JW)Je 2 andPt..l), D8V81' yteJded8positIve nucleot1de 131(1ible2 and Ft..l). n8V8ryIe1dedI positive Iactlon with the samplelltUd1ed by 01. Und! sucb an alreactlon with the sImples ItUcfied by UI. Unt1llUcb an al~eleJe JadeftDed. thJI primer mJJ elther can aerveu I nepII deflDed. thII primer mil elther can serve u a nesavethe controllor unapecUlc ampUftcadoD of the. FYFY pRe conttollor UDlpecUlcampUftcatlon of the pRe roduc:tI or can IJmply be be omJtted. DNA obtatned horn productJ or can slmply omltted. DNA obtalned horn nnJodc tJuJd pwsave l'88uJu 81dear andand eully lnterpreted amnJodc lJuid re8uJtI u dear eully interpreted . durlnl dut 1D1dII ph... of PeR. PbIDOtypeand pol frequend. obtaJnedfrom the 100wblteSwed18h lubJectI ""M qu1tec10181y with thON determJned from pur8ly8OIop: anl1yllJ of red ceJla from BuropeIDIandwbtteNa1hAma1caD8.11PrpaefreqUIDd.ln peop1801Mrtcan ortpJ aremorevutab1e. Fy18receumtoJYand~, and10 lt II not poIIible to detmDIDe aUe1e Crequeocl. d1rectIyfrom 88I'OJopct88tl. Prom 100 bl8ckSoutbAlr1c:an donom, weroundthatPyb rr. qull1CJof 0.798.Of the 159Fy,n.. detected.aJ)bad th8 codoRrorAlp at poaIdon44.theHquenceencodlnt for PI: no PyllleleencodlQ thellqU1DC8for fy- WlllouncL whk:h ,uppom prevfOUlOblllVldooa...t.., No ~ allel. wu detected1Jn0DIrh, 100wIJlt81. Of the 200 dOnoR telt8d, rhree bad wealc exprMIlon 01 Py'. 1\w of the thr8e wue Swedish .. TA.Lls. PhInotype. genoIyp8. andIII'" fl'8qlMftcIM Inthe~... 8ouIh Afltan graupe, . del8rmlned SW8dI8hand the bI8cti pnuntld PCR-AIPFY~ lN8hod PtwIotypI~) BInoIype('%) AIIII ("t 8Itak Wtft8 Blå WtItI8 BIa. WtIII ~"') :yc8+b+) 4 2 :YC.-b+)31" 21 Fy'F)4 O 21 FY- <4Ot f'Y"P1 ~ 4 2 o 4Ot fY Fy 83 O 3t Fy'to/' PI'F'1 :y(e-b-) 113 o PtFY , lncb8I CN Fl"'" W88IdW~ ~I two w. I .. fAl. . o a 41 '7.r!llt 78.8 o IYPI pnotype and rheOtherwal . blactMrlca withthe D wbJtee with the JY~genotype. 'l11.eW8akPf and. B8I1Imayrepl'8l8ntthephenotype caUedFf, ..,11 but,81themoleculv b8818ofl'f hu norbeendetennlned, P'I' could be heterolenooua and _ol d reprel8ntanywelt expreuJon alP-/'. Mall/naoner aJ.'round no devfadonafromrh,conaenlUl/ypno \."uu& sequence whenInvesrlptlr1lrwuIn. dJvlduall carrylng /O)"gona. Weak- V.me 38. FIIJMIy 1- TRANSFUSION 171 OLI8QIIIT AL REFERENCES 1. HadJlfTJ,DIVtd PH.McGInniI MH, M1IIerUt IdeDltJIca. tIon oflll eryduocyt8 componeat curytnl the Du", b1ooct POuP Pr andpD.Sc:Iem:81984:223:587.11. 2. l1t.uIht.1'tA. ZbIZ8lll8 V, JohNon C. et al Purl8cadanlDd ~ of ID 8rJduoc:yIImembnn8 pnIIIIn compta curylnl Duft'yblood poup andpnJctty.PoIIIbIe... C8p1llr m PItIunodhun IIII!II and PIIIsmodlum ma1ad8 puultL J BIaI01Im 198'.284:13770-4. 3. CIauAud A. PoIyåDvaJ 1.hn8m8Y, et II. 00nJncof ..,. copnllllln D cDNA. which encoclnlhe nJar IUbunlt of the Dulrybloodpoup Iystem Uld the receptor ror the Plarmodlum låtIx maIu18paul.. Proc Ned MId Sd U SA 1993;11:10795-7. .. Wualawlb I. HadIeyTJ.TheDuft'ybJoodFtUP and.ID updIae.TI'IIIIfuI Med 11ft 1994;8:281.& QI, 5. ,.1'f A. PoI}'llrova J. Zbrzema V. PcwIAO.ThecodiDll8pJIDC801DuIfy bIoodPOUPpn8 IDbWIWIIand 8imIII8 remldlon fnameDt len'" polymorphl8a,II1IIbodyUIdmaIarIaIparulUI spedlcldeI,and~ In lIOD8IJIbmtd tll8u81D Dutfy-neptlw lndIvtduI& BIood 1995;8:815.21. I. TOll-m.. C.Le Vm 11mC.Gue P. et al MolecuJub8III bo..., I lOd PCI-DNA typJJ1Iof tba lyA/Fy" blood poup potymor. sultable for tbJafuDcdon. pbl8a.HumGenet 1995;95:"-10. 7. lWUIIIIIDSo0mI T. ~ B, Ibmatu S.GIaom1corpnJzatian afd1egIycoproteID D DuJI'ybloodpIUI) ""'1"1aDo-'1JII8ID II t.~ with poIymorpbiImat .. shown by the IIIUIt8 of te8tI on . DNA derlv8d from amnfocyta BecauIe a f8tua with W8It PyI' would belnterpreted II beJnc Py(b+), wbIc:h couIdraI8e the 4HmJno KId r8IIdu8. BIood 1!ll5;85:8Z2-& 8. N-IItG. Soo a, Sc:hd TJ. et aJ.MuWlona In the ayth- unneceaary CODClm for bemolyUc dJ8eue of the newbom, the 18UIta of retal pnotypq need to be Intmpntld In Ch8 rocyIII cIIemoIdDe r8CIIptOr(DuI'y) l1li8: die moJecuIu H" Idel.'ttfLo.ttnq of a cIeIIdoDID contat of otblr tndfc:e8 of t'8talb8molyII&M polntl!d out III oItbI.".'Py"an by Mwpby_11.,17mIItyplq ofblood lampl. with. WIIIt PyItcu eutJyOCcul, dependlnton ~. and-~ reapnt ~(~ uaed.AltlJouF the dInka1"p'lft~nC8 of traDIfu8InsID Fy (b+ ~ bloodun1tby mJ8taketo . patientwttb ID and- P'/ hu DOt buD 1lUb1tlbed,the rl8k for sec:ondary Immun1:lAdan and ID lCC8IInted c1euanc:eoftranlfu8edceDacannot be ududed. If trulJ{JtnIdcally) Py(b-) blood 1818quJred. tbeD pDOmk: typins of thePY1ocua In blooddonon the DaIf ... 01an appIlIOdy b8Ithy Indfvtdual wtth tb8 Py(..+J pbeDotype. Hr 1 Hum8toII995;90:82S.1. 9. IwuaoIDS.U 1.0mJ T, et Illctendbdon of. uonIlIDD and Ipbd (mm ofDuffy mINA tb8t 18tba predomJnaDt tI8DIaIpt In bodt erytbroid and poItcaptllaly ".1118 IIIdcJtb8bI. 1UoocI19ll8;87:37H5. 10. Neo_r. M_TY. lCoIUawUILP lr, Scb8I111.PuDCdanI1 md bb:berulicfl anaJyiJI oltbe cloned DufyandlIB JacertalnJy ID optfoa. Id_. UtJ wtdI the red bJood ceD chamoktne rec:lptor. BIood 19M;I8:44-52. Il. CbaudlartA. Zbaema V. PoIyUova1.et Il ExpI8lan tb8DuIPf antlpn ThI8 coJlabondon wouJdnot haV8been pouiblt wtthout the CDn tfnUOUl support 01Prole8or Dmd J. Anat. . the 1n18m&- ttonaI BIood GIoup RåeDc:8 Labcn1Dry (Brl8toL Ut) lUr I wbtch MLO II *' mucb!Ddebc8d. BUzabecb Smert81theNatI! BJoodTruIJfu8IonServk:e, PID8towa, SouthAtttca,II thuIuId mlldnrl ndabJe la lS82 ceUl. Bvldenca that It 18the bu. l1I8D8IJIbrocyI8cbemotInerecaptDr.lBIoICbem AC KHOWLIDQMINTI b bIood 1Imp1. from South AfdC8Ddonan. 1994;287835-1. 12. DvbcaI8 wr. lUceGe, MobJerMA.et U. Redblood«:6 III . .. rorIDtmieukfa8, altutoc:yte chemotuln. JCln lDV8It1.1;81:1382.9. 13. 0\ttnI8 CH,ClludhurJ A. Horut Roet U. 1bI dolDllDon th8 DulI'JbIDod poupIDdpDforblDdJntPIIattIdIum..... lIId P.btowIIIt maIWJ puultel ta eryduac:vteI.Jl!Ip Med 18;184:1531.8, 112 o, TAANlFU8ION VoU'nI 38, FIbn8y 11181 FYGINOTYPING lY PCR-AIP 14. Iultt PD.ApplJ8clbloodPOUP..roIOlY. Miami: Mon.,mtry Sc:Ientlftc PubllcadoD8, 11185. 15. Dam. G. HUIDII1blooctIJOUpe.Oxford: BlIckwlil, Ux. 1995. II. Mou1dIJM.HayeISo W.u. TD. N8WDuJfJ lfHUIfnqU8Ddll In blKb U d8t8rmID8d by PQ-RPLP (ab8tr8ct).TranIlualon 1991;!8(suppij:48S. 17. Murpby Mr. TempllltoaU. FI.mlnl J. et al. Compertlon 01 II. Py(b) 8t&tuI u d8t8nnln8d mop:.uy and pnedceBy. TranIAaIMICI1997j7:13S-41. TOWDImlUt C.CoIIn Y.Cartron JP.1.8Van Dm C. DUrup- tion of a GATAmodf In the DuIfy lene promot8r a~ erythold pRe apn8icJIIln euay.nepöw lndJvlduda.Nat . q. Genit 1985;10'.224-8. lwunoco S.UJ. SuatmolO N. ICal OI8nctartzadon 01rh. Dufry pne plOmo 1Vld8nc:. ror d81u.-spec:Ulc abolltb- ment of apnIIIon In ~) ofbl8clt lndlvfdual8. BIoc:bemBIophyI ReaCoIIUIIUD 1995;222:852-8. 20. tnD8CrIpdoor.:taraIn bemato20. Oddn SH.GATA-bmcIIJII poledc caDa._ODd lH2;80:a75-8L .J. MUItrSA,Dyt8IDD.,.., ~ HP.A Ifmple out pMCldwe for aA...m.. DNA hm human nw:leatld ~ Nuclek: Add8 Rel19l8;18:1215. 22. SambruokJ.Pdt8cbBP.MmIItI8 T. MoJlCIIIar cIoaJn.. A Iabontoly lD8IIU8I.2nd ed.CGIdSprint Hubor, HY:CoIcI SPrinllivbor Pr-. 118. U. Avent HD. M8rda PG.Kel typInt by l11e1e-epedftc PCI (ASP).ar J Humatot 119l;9S:72NO. 24. Ma1JIuoD Go au.. °,Kå So et al.A CauClllu Indl. vldU81wttb lb8 Py(...o-) pbIaotype bu . DDY8IdaIec:tin the FYpne (abInctI. TrIDIb Med 1998;5(Suppl):11. AUTHOR8 Martin L Qtuon. PhD.MO.StalPhyatclan,BIoodCenflr. Uni. verlfty HoapItaI.5-22185 Lund.SwIdm Ut.pllnt reqUUIII CuoIa H8J18IOII. 8Sc,l88I'Cb Stud.,t, BIoocICenta'.UnIVIIfIIIIV y,nUy HOInltaL HOIpltaL N.U D. Aveat, BSe,PhD,Mu , MoI8cuI8rGenedc8Seetlon.latemadonll BIoodGroupI18ference Laborahxy,BrlltaI. ~ lnpIa 8.Ak8oa. SIInIorMtdbI TecbnoJoaW.BIoodCenter. lJDMntty HoIptIId. - - ~ c.,. n A. GNID. PlBMS. a..rcb n_n-.. Sde'1dIt. -__n. BrIItoIlnIdtuta ror'1'raa8taIIon SdInceI, IrII&å, UJ:. ~ GeoffL.~ BSc.PhD,SIllIorR-.di 1brTranaluåonSel_ca VoIIIn8 38, FebMIy 1988 PeDow.BrI8toI TRANIPU8M)N 171 ~ .- t ~~ .... RAPID COMMUMCA 'nON - Molecalar Ba.l. 01 01tbl the -eli Kell ,(Kl)I.J ...ue.v~J"'T By R81d, BySooN8 LM. Xu Wu. Marlon "-Id ., (I.~ I.. ~~--.a I1811; .. _.8 - - "'-'.1 . fil 11.1 - ..1.111'.. III- . ..IQIICIDNA8 J.II. N' II_. ~ 1"""""'" II8UIt .. ..... , fil.. ft8'I It.. 181 .111.""-' h8m8IyIIa nIn8 ~ ... 1['la. fil 1MW .. Ad .III - L-1Id.A.. 81 MIll, 8 C te T .... t8 ... - - - fil ........ 1- T18II........... 818 II _Me."'" X. 11Irt8M III "~I\. 8Iv88..b... .. ~ ..,. C.. T no ...... 8811 Z8IInlld,Iftd CoMnRedm8n lA8L .. ... I - 11--.. -II ~" 181"""" fil__11M . r_""" ..,.. III41..... ~f Ildl. ... 1111 t 1['. te""""""'" """'4 IIRI 1181111 .. III.. fil tI88111,"111." .. _.tIL .. 1(1 ..natHl6-"""'". _.- 1 1IUtUJ-.11/11, UI th8 ~ 111'8'1 a (lit"""" w ~~.,.~ th8 th8 ",.~""'II L- IIIJII. N""" th8,. - *1181 8M tI88~ . I 1111111.. . . IIIIII"1 l8M8I... , THB A 18"" ~ytic IQ, ... .. 1181"""" ni..'" fil th8.11fl118O1VRL-",Ilh..L ... .......... fil...... ... (aufil. I"" II r\18IIII ,..,. DNA'" P.I .. I k ... .. Or- 6r n. --11M 01 uw.. . III .. 1181 fil '18n'!lld..,. MoIecuI8'cJoaiqell8bU8bed dIIIIKel! bloocl~ -IN C8I'ried OD. 93-tD typ8 D aIY "" Je Kål proIDiDh8 . lIIIJIt, 46 lIIDiDolåd. N-termia8IdoaIIiai8 die ~ lIId C-fIIInDiD8I pordoa. 01665....... ... . . add8, OD die WInIaI..ta::e 01die RBC. AD of die c:artdydr8eI Me N-IIabcI' I lIId are prob8bIy 10C8IIId la, K3 (Ep-). ICA (Kp"). lIId IUI (Kp"); Ull , " samplel. Amoaabiocid JI'O'IIII8Im.I'-wd by 1IJoi...M_..I... 1108, Itl (It) il pobebIJ 8DIII onIy ID D(D) la ~ RII sy"'" U ID i , tb8 di8eue ID d8Wbon ". .KeDsyIf8m 18 compIa II1II l'DIII8l1l8I 20 diIffnaI ~reI88d -a-baw... id88d8ed. K8U ...,... ID be l!I8IXIdId la II... alllditbedcal p8ind aDeIe8 Idp. ad low-prevaJlace1IId 'IbuI. Kl (K) ad K2 (t) ... prodLICt8 KUli h 11"~"jII" t' r.. III fil I 1~ 8 . R 1111. c... BLOOD GROUP sylfem il ~ iD Mfjba Ilet ca c.f1I8dicx.ID lI'8II8Iu8iCI8al i8c"..Ic'" bIood .... KEU. lnDItuioa ~. -- L K6 (J., II1II K7 (JI'); KI7 ad KIl; 8l1li lU4 ... 1t14. However.a 11UJDber al ~ - . ! . lUdI . KJ2. KI3, KlI. ud K22. Ull indDpelldeallye~ Ibae ret lIId th* pl8ce in the KeII syItaI ba... beea w-t ltII'ouPthe )'18ft ." ..-oIoP; lDIIyI8 al iDformaåw rlmi1ie8.14A reccndJ developedim a"p: IDC8OCIoaIaadbody-lp8Ciic i hIH,..u., al ~ upuaaiDel93. s1Udie8MI""" "'. \91,34.5. ud 6%7. BartybioriIeabc:8I dill KeD N8Id808 . proIIiII whole c:oaIormadma la Iuply dl!pt"" ,. boad&. 12 011 cIiauJftdII lCeJIproIIIia- 16C)'II8i8 -d18. 1 in die er..rep. lIId I' iD ilie portk& Je Redacdaa ofUCIbysuUhydryl paa... iD- 01K8D -- u8CHpi~ 12.1) rocyt8 (MAJBA), .- 1IIODOC1oa8I_b0die8 The rnoIecuJ8r'-il 01 die cIift'8ea&KeD ~ 11M o cIift'err8 KeD.-I... iDd~ - cIifti:raII -paa Dat ... de8armiIIed.EqnI8toa 01 K.rI pnIIIIa la )cc...ID..,..wJydiIdDCt "'0lIl al cbe~ 'Ibaa. traDIfect.edceD8UIiD8. wild-type cONA"'" la IM I(IIK2 andK6iX7Ull dOM 10""'. KJlK4epitope detectioa01 the biJb-prevaJeace JC2. 1t7, Kl. . in a diI'feNnt loc:8do8 8l1li KIl 18in yeI anodI8r pro88åI bill not01... Iow-prn"'" -l1li8 Kl or KJ.I) 11å 10II18in.'lDMritIDce188IIIiD8OmIII ad c:odomiMIIIandKEL ftndiq i"""'" thai leV"" 8l1li..- 1118)' be curi8d OD. ... m8pp8d CD,~0ID080ftI8 71133.'" Ii. proI8UIandtb8Ilow-prevllence-.prob8bIyreexpoIUN 0110II1II ... An utibody CDIt I. named 1C81aftIr 118pI'OIICIIitul, lada with lppI'Oaim88eIy 9* al ra8IDm red b&oodc:cII (RBC) ... side ODvlrilac procaina.Haviq l1Udted lI8IUC:IunI 01... KelI ... 1dead8ed die 19 aoII8 dill ea:ode lCeIIpro- tela.1.we have now "".Aiood 1',." lIItIoII . LI1rtbII1I'. Otrt8IIIIIMJrt:It ~ tf. New Ycri c.ar. N.. fort. NY:.. ... Ifj lÄc ..." ~ UrtMrrIq tf ~ c.-.. $"""'" C1c8*r 17. 19H:~ MrUUeM Id, 19M ~ J.r J rMI III ,." ,..." I tf "... c;,.. No. HLJJMI MIll ",. SMrr'o.. 11ft, (III CL1 MIll lDlCO,. No.ItIAJJfJI - '" ~', ., .."., ~"tJa "11"01... (III r.L). AMrwa ,."." , ", tÄlt1III PItD.111Newr "'* lIItIoII c..r. JIt, . 67 sr. 1hw rort. Nr 10I1Z1. 7"- pIIIJIftIIM aM8 tf tIfI6"'*'- w,. ..".,. III ptIIf ", "". c""'" "."".,.. nu "~I' ~ d' .. axlfJ,,-" -- wifillI ".. u.s.c "* j8:I. o ItJIJS '" 111 SocWt7 t( H--. OOtJtJ...491/~J$J.OOAJ "2 DNA ud stillldo8 iii tf"~ ., die moIecuI8rb8i8 01 die KIIK2poIymoqäIm by ~ "" -.,., ".".. 1714""'. theemDI of Kllltl dIemIDK2IK28CIqUIIIC88. A b888... ~ eKOII 6 of tbe K IJItJ paocype predic:CI . .. lIIJåIo -- 8cld chuIp. 11IU"- IUbttiIUåGl creafe8 ~ ZYI1le lite dill wu t8IIId ia more lb8I 40 diffeNa& l8IIIpII8 10 c:oD8mIdill lh8b888 subIåIudCIa ideDtift.... Kllltl aeDOtype. _u. UIWI " MA1tRIALSAND MITHOO8 . ln88 . ~A"""'" ~ ...... IIIDDII 6'18 42 ,... .1aI W ~ baw ... ... ,. DNA WII "'- I ID5 .. 01 wI8oII CIIIIIIc8IIIwtdI '-""""'" ar, IUICI... reI8IIWd.., c:8IIII:ifIIpda 1.000, rar 10"'" lnI8 ... . .. .. . buI'y COlt.la boIIIc-. ptOCIdI8Il1dI8atbed .., JaII8 lICaI'l III DNA lII8d.Sew801- DNA"""" ... ... Y8I .. Ne. I,*-, ,ta.,.. PIt81M18 ICILL \1(1 I "1 JIt4INO1VPI . u.A.JIIw. IM . ,...-,..- .. ,. dIIatbAi ~.. Id~ ...... ... dill d8 L (#'C-J, T.. DNAjICII)..- ... cIH17I ... ~ (M8IIII8,WI).X..QII.. ta. ~ . coli: -4 .- C8III, ... ... ... h8 ra...... ........ --L.Ir (~ , .. MD).T4 DNA .... dill Pr (88wdJ. MA). ~ ,... .- ........ ... ... I lra8 New s lIb88i8Idf 81Dad C' OdwrNI"" at dIe8I EJ.. lC2. dI88I ta. ... n - . . ~.... . . MA~ 72"C -'\ CA). TII8 DNA Illa (1" DItW" .. -- ~ ... .. ta. NIm88 (JIII6a8. WI) .. ()då Spill CaI88 (o.~ -y.--) far DNA r-il &t'~ ... rra. UIII. IN). bIIa8 (8) pII8IIiII . RlIUL Yl c,.",..,.. oJ~1 aM n DNA NiDIplin all'anrlld Ind mene priDMn ... U88dID..,uty die 19 KBL ac8. Tb8 al die prima'I ud die .... ao8 -- ini ... Kl ~ iii T8b18I. n wde ... ... u DNA from. boamyl1li DNA. ID aDC88, ID 1-' kb ..... la.. fram O.'" pIOdDcII obIaåIId(fia I). Al 011188PCR pIOCIucu ud ~ Kl DNA ... .,-r.d w1* dill of Ja DNA.MI.at n. -r- ,. 01 eDCOcIecI ideadc8l1IIIi8o addI80.. olJa DNA. escept. ~ e dl88l1a . PCIt pradIIaI - .... HOIII , ad 6. la ddI PCRprocIDcc. wIdd8.. iD .-, ~ lI8IdIDd sc..In iDa ...( , 8&:dI .. lJI8 . QIdck.. .sp. . L ~.., ... mo) coIIaa. DNA ... .. JIIIriW , - ~ .. -Il."'-1tJ 1.2.0:AppW B~, ."'.,I ~ tbI8I PCR - far ... " DNA ...-- ~L ro.r 0,. (MadII373A. V..... CA). a- I .. Tb8 PCR dII8::dJID dI8 (10 pI.) ... opda88d I .., :2pI. al 35 ", MA. I pI. al 10 IIIIIIIIUL - '-,111I~ I. 10 lI8IIIIL I71T. I "a. allOX aI 1NftIr. 4 ,L al -. ... :z IL al , UIIIL ... L '--1ooJ8 ...to..Md 65"C. Tb8 DNA .. IM l8IXIo8 mIAtIn lII8IJ8d ltJ .. o.a. ....... ... . ,. 90-- su""I""1.J8. ~ ~- I'~ C""'" I 4 . oJlelln poIyrrtD"".,.", B- J tIIfIIIpU. l'eIIIk1ia8 ..,... .. cbaqD tbaJeI paotype. dUarep. W8I lID8IyDId iD 41 The C ID T 1Ub8dblda8 c:n88 witlllp8Ci8dty f~ .. Idooootil'- . L ToCODfIrm tbatdUa... ~--T8III8 -- TCC TCC GMn:ACIC1' etT ,.."" I'.QC TRI CIC1'CCAGAGNIf TCCCAT.., I'-GM GCITCIG8aN: CM Mlf 11M QM.a' I'-IICA CICIG TTTCICIACICACITCATG~ 1'.mNlfCCTCACTCCCATGCT~'" I'.TAT CACICA OGTcm:: eR: TCT~ I'-ATATTCca: N:C TCCCCACACC'TCW' ,'-AX 1M: GGTGCTCAGGCTCT'CC'J'C.3' I (1') ID1IIIIbioniM c:b8a8I 81 .. " , .~ 740 bp eytD8iM (C) ID lbymi88 . N-aI)tcoIyladoe.. (Aa. X. 11Ir).T1dI cIIft'w. eacebetweeaKl lIId lt2 occun18... 6 <PIt2). Bec88 dill !bl oa1ydUfcnace bctweIIIaJeI lC2--w.. ch8a8eI la lIIDIDo~ II ... nid- dieb eaaiDe 10 medaIc8i..cbaqe wouId ~ N-8IJcoayl8lDa81..... &iDe191iD pro8IIiDa upreuiDI K l, tbu8 ~ IM DI JU polymarphianL .- - fICII daIre .. . ~..Å .A - IIIPCII- " a. lA P, ~ 4 1.1 0.74 "-QGAACICAM OGAGTGAGGN:r AA/W' 7,I, . U 11 1.2 t1 1.8 12,11.'" 1. U 14.,11,'1, 17,11 1.1 1" UI I'.TQCI CAT CCA TOG TAC eR: ATG CJM.a' . I'-GAGGCTTTTGM N% CCAGGATQA.I' ... TTC ca: 7 NJIC CAC CTO CCA TCT CA T.., I'-ca: TTTTCCMG GCIT CAGMG C'TCW' I'-GGGI eTT ATT TGA ca: CCA GM TCT.., . 1'.a:T MT ca: TOGAM etT GCCTUT.., I' ~ . TOA GGA CAT CTO CM AM AOIW' I'.TCC nITGGA ca: TCC ca: TreM T., -- IIdiefaN8Id I'.GCJCICG8 Ma 'Ole ini IN naIIndiegIII8- ... ,. . PeR " -- CCA Mlf GCC NJIC m - ... - -- 8ddIdIDer.- .. &an2 dill eldnaI-- .. ~ T., II... ... .. lir-~. PCII " - . dieI' ...1(PCR tJI , tJIPCR . ,... " .. 11(PCR . .... (PeR 1- 2t.M -. ,.- 1IfIn*. TII82 G TII8PCR tJI COW8Nd lir PCII7. ". LIlITAL KIIK2hctcrotyaoca (I... 6 lIDd1) CM be cuily diJUisbed from !ho Kl hoInozypMa becaulCdie 74C).bpb8nd ils !Ip"t procIucuof ~ of K 1/10 i, men prunounced _2m'" " . . . ~7- nPl'"UAlu""'7 .- ...,.,..- I"'t'""'-,.. n.n- L -- .L - ", --- phenoIypeand lllliboda to K I In developedin about,.. of perIC8 ~vlJII . MaJeuDit of incomp8tible bIood." IfemoI1tk: &JåeIIIe of Ilie IICWhonI(HDN) i. uawdly 1IIIJCi. lIICdwidl rnIICnI8IaJloIrnmuIIizadon to IUl(D). buaKl inc:olllpllilhlida c:8It aJsoCMIIC SCYeft HDN....J.Detcnaå8- 4 1.6 Kb tion of die moIecu.. buil o( tlle KIIK2 poIymorphåvol will allow fI8OCYPinI from DNA AIUIIpIaand!dxluld prove 18fu1 iii ~ di8po8h The pm"" lCeUpMnoIype ja K:-I.2.-J.4.-6. 7.9.11.12.14.18,19.22. W~ ha~. in a prnious study.deftRed ~ 1.0 Kb 4 O., Kb the 19aons 01the KEL F8C 01 . pedO8with coaIIDO8 Kell phenoIype.buathe moIecu.. ... for the K I JeDOIYP8 kaowa.'. PalyIlllX'plllc:difTcrcncesilie clUIOdby WIll IlOl ... 1. ,... -...- 11PCII - PCIIJ " . L."" III n.PCII~-l.1II ... IM ... , , 111M IIIPCIIJ '." JA - ... di 8--*., ... ... ... , ~ , "" I'I"'ll"~, . ...... .. 1." penonI of known K 1/K2 phenoIype.Included la thae S81ftplaWCIeDNA from 1 HuUerifa, bec:... funiJy !ItUCJIeI indic8ld Ihdr KelI JCIIOIYpn.An od8erl8IIIpIa were fJ'OlDwuel8ledperIOM. The 140-bp PCRproductdI8 ~ eKOIII5 and6 (flCR J. Table I) W8I lreatedwlm 8SIf8 I. A KI/KI JC!IOIypedIouJd yleld !wo f...ameru. of S4O and 200 bp; the UIIO pnocype will field the UIII:UI740bp PCR prodUd W1dKina hctcrozyptca should yjeld 3 ff88IRCIIU.",<40. SolO.und 200 bp. or the 42 DNA sampla I"'" 12 WCIeeicher Kl or D homozyJOla. 6 WCI1I K I/D hctcrozypet. and 24 wae Kl. Kl phenolypa bal conlaåJledlow-prcvaJcnce or l'8ft Kell phenoIYJICILTheIe pllenotypell inc:ludedV. K6. K 10. Ko (...",), . KI4IK24 he8eluzy.,.. and. Mc:Lcod~ c.c.. the /km I FJ1OCYpina ..- wim the KeJJ pheftocypeslh8I Wenl deaermlned by !!eI'Olop: aulytris o( RBeL In 2 ~.Ionotypinl identilIedoneor ilie SImples as K21K21111d theod1eraa. Kl/Kl hcteI'oZYpll and theIe 2 'UU1IpIeI were !CI'OIop.-aJlyidmtilied as bavinl "weu" K I phenoIypel. Nonc allhe otherlow-Pftvl1lenccor me Kel' pbcnocypa Jisfcd8bovchId the C lo T buc subelitUli08ia C"GII6indicatinl fl... this c.:h8npil speciftc:ror the KI/K2 poIymorphism.&amplesof relec&edreMI'b lire 5bow1lia Fil 3. II some CIIICI(lana 3. 4. lIIId 17). the K I homozyJ*l. in addltiOlt ID d1owin8b8ndI ... S4Oand 200 bp. '-'Oftf8ined . rainl h8ndid 7-80 bp caUllCdby inawnpietedi~ The .. rearr8I""" M! daiped . !ICria o( pril8ell I" wouJd.lIplUy ... 19 C:uu d Ihe DNA ~ of KIIKI I1IIcIIC2IIC2 DNA. The only buc d88nte dill would ax:ode a different _no acid W8I found in aM 6 ud cb8apet . lhnoniIIe 10 . medlioaiaeIII . conaenna N-")'COIYI8IIo8 mod' (As8.X. nr ~ Mec).T1dac:hu.. wouJdpI8Ve8tNo linked ,aya.ylarioa .. Chi. s.18~.Baed on the amlaoIdel ~ of KeY proMin 01comrnoaphenocype.theft .. 6 paaible N-JIyaJ8yl8lioasi_lit 8IIp8nIine raidua 9J. I I'. e:lOftl of KEL lIId III diffcftnl In 40 of Ilie 42 maJ be c:IUI8d by or ahcra8d~ aplkfn8. To deIami8e the moIecuJao buis 01 K 1lIC poIyll'lOtplaism. -- ~"'IIII.~" .I lN4.. T'" ,TII8""" .~ la lllllmo acicI poildJon8. 191.34'.6'l7.- n4. Howew:r.Ihe paaiIioa 724 il prob8bIy noI pycosyl8led McaUM it ja p8I of . se.-. AlA. Pm. Ser lad tbe pre1C18C8 01proIiM bIIwea ... Jefil,1eItheo8188 In1Ubic8N-8IycoqIadaa. . 01 dnaIi.. 10 raedriordn8 .. po8Jdo8 193 would pmJlycu8ylarionII Ii- 191. Thus. Kl puein would be compoeed014 illsad 01, carboIJydn8e moiedea. Anumilll u avaap ~ sia 01 .. N-lInked oIip-=clwtde 10be abouI 2.' ltD. the K I pnMei8 sbouId be 9CU kO . ..ooIp8Ied wiU8 the 9J-kO proIeia tII8I c8ria the CCJl1U8l8 KcII plKnotypa. " 1'hia dåft'cnnc:c i8 sim il diJIkuJc to dI:8Ict bJsodium dodecyJsuJfaee-polya-ryl8mide pi declmphoIaiI becaaMe aJycopmccitendto mi . t. --IIr' ,.., "_'--L__- ,. na MI m MI - MI C18 .. CYT ni .N liIr a -- -- n- -- - -...I. Ct8, .uti111 -. ,. - . diI1'uIe lt1f - ,. - na - MI - m - MI . 1 - .- 'M - -. - - -. . t8 ........ C18 - CYT nw ... ,., Pall ... 1 ... , " ... . ... . MIt. lin'" ... - -- we.. 11I~.M" II DM. fte... 111 l T el . el . ... ... ... ... ... ~ .. Ylleel II 118M la - ... .., ... In 118M - ... --la C.. , IDI..1III 1fMla kilt""""" . _. *' laIn .. -Å-M la, ....... ."""'ttlll.. la "8 l 2 3 4 S 6 7 8 9 10 11 12 13 14 IS 16 17 18 1920 : ~j8 tg .200 bp ... .. .., Kelpltl~a1VPne filfet-- a ...A~"-'" ...,..- ...~.. ... ., JCHI. ... ~ 11.11 , afal'aJflJ -Ål.""""""'" ..... t ,- a... J"... 11. PCM'" Kt t Inl) .1. In. ~ J""" tt L~ J -., hl ) .r'1 II tCI""<t ~"" ..-,Ktllll""'-.~_"" II. _IL--t""-I 11., 11«'" ... tC:1,J;...". fL--1..u,.-4;'" 1&tC:-t.a.t.-7:'" ta MotC:-,.a.t8:...,.. !C:-t,z,tfoMl""" 111'""'11.1L1.-1:"11..-,.. tC:-t.J,Al a --'-"""""K111Ct '--4>'" tetllllllWl".,~"I"'" J ilie-- ' -- ... ... ........ handa. NeYertbelna. unalyllia by WeI8em illlnlllJlObtolaIlSini rabbi. lIIIIibDdy to . syDlhelic peptide derivcd from the cylOplMmicdotmi. o( ICeIlprotein.1,1 I~ !bli K I proletn mi sHpdy lIhe8d01 the KeD pr'DICindill c:arria comIIIO8 Kel phenotypes(datanot showa).Lack ola c~ ,'i,,~ \~ hydn8e s~ c:haia ma)' CIIIX* differenl JWU 01 the proteiD ladini 10 inI~tJ. Thia ia 8JIIw oampteolof aJ)'COIYIIIion in l1li RBC surface pro8ein 10 . chM.. in blood poup phenotyp8. The Webb aI)c0ph0ri8 C variaal allO lucb 811N-sJycllll..n 'The paj.. imI from C to T iII Om! 6 cra8a a new mltric:tioft cnzy.. site, "-OAAIOCT-J'. dI8I caD be cul by BlM I. ThU l'CI8ricUoeCIIZ}'IIW dI-allowIthediffenmti..ioa 01 KIIKI and K21K2 homozyJC*8 and o( Kina hetcmzyJOfa l81dshuuld be I8CfUl II 18diapollic JCDOIypo proa:dure. A pouible drawbKk II ch8I. in very rare cllCl. RBCI do DOIclIJftSI any Koll and In 11111 phenoIype. knowlI - KolnaR).lite R~ lIfIPC8I' noc lo -.. ..y KcU proIeln (1ftthe RBC membnae. Yd,lftliminllry capcrilllCllla in our labcnIory indkalc dIIII 2 Ko penoaI C'OIM8in lCeU mRNA in peripMraJ bloocl and th8a the sequeace 01 the mRNA (101ftthe initiation A TO codon 10 the poIy A taill. IcJendaJ 10mRNA abc.ned (rom penonI wldl commoa lCeU phenoIype.mi IIndJn8Indicllles dill the ... sequenc:a in lhe 19 CUIIII 01 K2 and of some Ko penOIIS 1ft Idcndcal. Thcrcbe. PCR ampliflcatioao( c... 6 and pnoI)'pinl by tIaImaII widl S. I wouldindic:8re a 1(2 JC1IOI)'ptla Ko pcnonL Scrolop _,sil cull)' ddcctsthe Ko homozygote. buI tbe Ko bctcrozyP*5 would be ~ icIeaIilied DI K2 or K 1 and BVIt IlIIIalysia would allO nocdilc:riminate. Prrsulll8bl)' the gme would oa:ur i. the Kmod phe8otypeI in wtlich cxprasi08 01 all KeJl-rebuaduri... 1ft waItaIed. The PCR method dncribed could euily be appIied 10 DNA 1IUIIp- obWnedfrom amniodcfet&!celllllllll"'ld prove 111 detenaiaiftt the K I ... K2 FIIO8ypa of the fdUa.nål ... C8II pocea6aIJyIdcntif) thmc preananciCI lit risk rar hcnIoIytic:cIiseue 01 the newborn. AEF!IENCES I. ~ WL: fjllDDd af -IM C8UII, iii SwWw 5N (edI~ CliabI Pr8cticeuI BIoa6T,.., Yart. HY. Cllun:hil-Uvlnpt-.. 2. MIna!WL ~ bk1od.."., "y*- I 911. P 79 CM:RecdI..elopmmllla . KlI T-'UI J. MInI! WL ~ review. Tr"-"" LO, New Med 1:4. 1911 CM: 1'118K.eJJbIaod lfOIIP s}'18a8:A :JO:".. 1990 4. RNIrIMCM. M8I'IIIWL: 1111K.elI and Mcu. ... cet...'" All" PC,C JPtå): l'IoeIta81ood 0.0.. A 01 ne ,... bl Cell:SIrwIuIIr, fu8cdaa A8d CIWcaI Slpifte8ce. ~ Mo. ~. Haf*i8, 1992.p') CM, M8nIIIWL: 1'118 W bIood~ 1'- MIl tIIIeMd..eodpbe8alype.SeIIIin HemIIoI »'209. 199) 6. ,.., AC. DI8WI OL npp811P: Appllc8lo8 01 ... MAIEA uaay lO. Ken bIood PvuP I""'" Voa s.., 66:216. I,.. 7. ZeI8Iti T. CopIM O. Myll Y. 511.RIC. ...1.. ..... --'- u. ,, ... ..,-..illducible . o u "'- ""-- "--'1 , 5, WhiII - ---."-- pnIICillod: ProwlsiunII_JIIIIIeIIIol KEL - . u .-- .-. 101:_I. lUI8 n88 ~ :1:1:1.".1,",1 I. ~ MT. ManiIa8 N. MillI JS. "'RH. Sp8II' NK. 8D1d E: ~ of ilie KenbJood paap locuI cKEL11ocInnIu8ome 7qJJ-q3j by nuurc.:ac8 .. lIitIIltJ. bridlzadaa:Evldna fe.-dI8 poIypqMidt lIIIhII'e of v.. 110M. .. GenIt91:~. 1993 .,. LlI ET Al 9.... SoZ8mII8 B. M8nh \VI., RedIu8 CM: 1118humu Kel! .. .Jw8oIonI87qJ3... I. bIoodpuup i8 re- lCrict8d10~ ccl'" BIaod 1':2804, 199] lo. LIe So z.BD, WL CM: MoIIcuIIr clallåll pr!.-, ~ K8II bIDad poap pnI8IiaL Proc N811AcM Sel USA 11:6353, 1991 II. CM.... S.T- - eL. ay. .. MInIaWL: ~ lfaåIi8D. ~ 139:-I- BI.J.. ud c:hi1llpllll8l lC8I bload P'DIIf ~ 1\""'" 11. Do MIIII8dI H. S1 Slak A. ... D:DI8uIIIde baadI ~ ~ ltaI CIftwrt8I8(Yl") bJaad paIIp .. . -.. H- ... iDtlpity.SrJ S4:S73, 1913 I J. R- D. LIe S, W. bIood 11'0IIII ud die Ix"",- C: TIJIIDIaD01 tbe Id ~ muJdpla by lI'IIIIfec:t8dcetla.BIaad 84:3-'11, 1994 14.LleS,Z8II8B.8eda8C:Or.. """"01......... iq KeD"'" die 15.Jaha SWM, W .~ cIur8 for R8 19:401,1991 pIIIp"'" o. JIIIII8Ik DNA f'nn 16. ZIIII8i T: 11Ie18~ BIaad 15:1364.1995 RoSc:rtwr C'I.:AnpId..a.Ir.ocytIL NIId8ic AådI ~ DNA IWIIokåoft ~ wiIII bIDod ,. paey. ~ 31:762. 1991 17. Mu" T, PritIcIIi EP, ~ J: MoIIcu&8rCbinF A """""'.1 CoId s,ri8a Harbar. NY. Cold SfIrIJIIHIIIIar L.Ibu.~, 1912 II. OIbId Ea: A c:rttIq..0I1heIbeo huInI o( n. VI i:ill ll8IIWioIL T,.., 1:233,1961 19. MlynlKM, Baw8' PI, PnII& Ok". lipilcu&:8 01... K8IJTT ,'"-"iii pNJII8IIJ.ClillLIII H II2:379, 1990 20.DllpIdJD(, lInIIIIiIDw IM:~7. ben.. ID...1(. Voas-. ":8, ,. 01dia... p, J8IU8-DupIa p, DailIo8Mo VI"'" 21. ~II bI8a& V: A cI- 1990 c:I8 01 dl.- 011118 Mo o.- newbar8 -- - ID _-K (Cd8ll). Acta""""'85:45, 1991 22. C-" "I.. O. PIIqjIIIIa8N, W J8: And-1Cat11n ..... .-y. 8r J ~ O~ 91:943.1991 23. HM. Oib8l1M. 8ImI8 sa..R8d MM: AJlå-K8I.. JII'8PI8CY. ar J 0bI8II ay...I9I:I62, 1991 24. lIcnmIa 1M.Pallock1M.MInniD8f A. ex. MnIiCUl- S: KelI biocidpoIIIIlIIaI_0tII8II0,-79:239,1992 25.... B:SInII:bnI B*,- 1 2O9:JJ I. 19IJ 01N-tlycalyl............ 26. Te118MI. Le V. Kl. C. 0IIiuD MI., CannI8 lP, CoIII Y: Erydncy.. WIbHJpe "~Ia C vlrillltl8cU N-aIJcoIylldae due10.. 801818 .1bo'1 A. l 37:", 1'11'1 27. C'IIu8S.RetdMoCoIIIIa7 J. K8nY. Moh8adM N: MoIeC1IIIr c:1wa:IertzadaJ al erydInIcJII 8IJ~ In C v8ri BIoad 17:644.1991 7) IIIUIOII11T010&1 MåANITAL Differentiatlonof autologousABa,RHD,RllCB,lUlL,JlC,andFl' blood group genotypesby analysisof perlpheral blood samplesof patients who haverecently receivedmultiple transfusions P. Roim8n, T. Dovt, and C. Gassner . .. ..... MC:KGIUJND: 1*1 nUIIpIe logIc ~ al --- **V'" II bkIod group phellCIIWI88 almbIIdR8Cpapll8loo8. The «9) ..lAt - 8U8DIogoIII bIoodgroup... g8ft.... p8I8nI8enddanenW8r'8818IyZ8db8b8 end ~ 8\I8få. An 8Wf8II8al U ,.. . fram 21 -.. WBC-r8cb:8d R8C unII8 ... ... 8\8'8g8 888 al U ~ lIdrnInIII8r8d JI8r 118n8fu8lan 8'tI8rII.The lr8n8bIan8 ~ Al .,. .. ~ AllO,Rh,K8I.l<Idd, Ini ~ ~ paeIIrwIIfuIIan ... bucc8I 5.3 phelåyp8db framP8I8r* W8r'8 .. con8IPOIldIng~ . unIIIrm PCR88qU8I ~ pm. JJR*IcaIIh8t 8IIDw8d g811G1yped b lh8Ir8InUI8n8ouId8I8m118 .-do..... 3 hour8. RUUL1'8: Al poIIr8n8IuaIan lIIhIIII8d~ caI popNh18 al V8tou8bIoodgroupsy8I8mIan ..... logIcl8IIIng.Gel~ fram...lpheIaI bIood~ duc8dl8UII8 Id8nIIc8IID .. . ~ II bIoodgroup phallCIIWI88o I~"'" al.. amount albIood... fuMd 01al "18ngIh al.. ru.Ion. l8IIpIng p8fIod8ft8rnr. CONCLUIION: A f88t end raII8bI8 åftc tI'U1IIuston ABO/Rb-comp8dble pr8dk:e requJns RBC units ue th8t trula- fu.secI to . patient. Other Rh systemand..... such. c. c. Boand e, . weil. an,. In the KeD.KIdd, Duft'y.and many otIw systems. ue not maldled unIeIa the p8dent hu deYeIoped respectM aDoandb0cUe8 antIbodIes can C8UI8hemoJystI of tr'8nIIu8I RBCs.dIII'8r- endadonof ortpI8I bIoodJI'OUP an.. lt8tUI II lD8Odatory ror c:onftrmadonof andbodyldetadfbdon and ftutIwr .. traDIIusaon8of aIIIIp8db1,e RBC unttIln such cues.' Aa. . pedent rec:etved mu1dpIetraI1IftJ8Iol18,the donorRBCapenIIt In bli dn:uI8don ror weeb. and thecWrerendlldonof ortpJaI bJoodPOUPphenotypeIbecomes difIcuIt beca8e~ themI8d-ceI P'1P"""'" ~. espedaDy"no pretI'8nIfu8Ionspedmen II 8Vd8b1e.1-3AJthou&h the padent'aown RBCacan be l8p81"iIåIdhm the transrusedor8 by vartouamethodsand typedserolop:alJy.JIn pmctIce.the l8IUJtsarenot aIways~~ n.nbe, DNA medIodI o«er aIc8madve me8JII 01decInnInIn8 artaIn8I AllO,Rh.Kell,1Jdd.~ andod8 dInIcdy Important bIoodpoupa. The PCRwith sequence-sped8cprimln8 (PCR-SSP) to be moIIt U8Ad ror this purpoI8."lI AIIbau8h pnedc typIn&can be pedormed on dIIue8 such II naJI8or bw:ca1 ceUa reprdJesaor tranIIusIon or - -- PCR~......... pfInw DNA glllOtypk1g ~ b alauIDIogatll AllO, blood onIy due to prevIou8tr8nIIusAonsor prean8Ddea. I Becau8e RBC STUIWDEIIONANDl8THOD8;BIood ... pertodal bIood""'111 umnt 18 .. gellCItW*1G al NJA Rh. K8I. l<Idd,endDuIfy.... CDIMbe \.-lID ~ C . Rh, K8I. KIdd, end ~ bIDodPJP8 canbe ,:J8fbmedan ,."",.., lfD9I thepaIenI8 t-.. ~ C8Md muIIIpIe lr88fu8IcIna. bIood ,. _~I ~ re8trtcttan cilie ~w P"'P"-'-'W; . MU". 1eqU8llC8-spe- ~ Fromdie~ Ii al ~. BIood1'r8nI6asIonC al SIonnI8.1Jub sau-.18:endtheC8IIIr8IInsdtuI8AIrlIIDodTr8nIIuIIonendlJnmunoIuttc8I ~ tu-1I, Gerw8IendUMwIIty HOIpbI01II1I1Ibnd.lnnIbruå. A... trta. Adrt88,."nnt ,..,... ID:PrImoi Roim8n. MD. Dep8tal ~. BIood1'r8nII8on Cenå'8al s ~ I. 51.1000 ijubI8n& SIowwII8:..111811: p~unI-'Å AIr1""""'-'" ~.. 14.1_1ftIIIoa... ceIYed Ju.-y II. 2000.lIId lIX8pI8d 18I1U8Y31. 2000. TUNSftJSION 131 TRAN8flU8IOII1VolWM 40, AuguIt 2000 . ~ tqment JenadIpoIymorpIdIm; SSP 2000:4O:t3I-NZ. GINOTVPtNG N'TIIt transpi8nt8tJonhlstor...1Z pertphera1blood samplesare more aslly obtaJned.R8c:enc reporUIndudeclravonbl. ~D~~~~~~m~~~ but the technique8UIeddId not aDowlmrned!8teacquJ81don 01resuJtalJor Wen!UmlhId to . determJnadon01Rh polymorph8m. 14lnthis study.we thenlore testedthe 8bIIIty 01. nnIy "-4~ uniform PeR-SSPprotocoI ror simultaneouaand... det8mdn8donoI8UtoJoFusABC.Rh. J<eJl. lUdd,and ~ mttaen au m the pertpheral bIood samples01p8denb who repeacedJy recelvedmultiple tI'an8fusionI 01blood mBtchedfor only the ABCand D Indiens. PretranstusIonand poettnnsluston samples from etaht patients andthe correspondIJ1IBBCunIt8 thai weretru8l'u8edwenI both pt.notyped by routIfte seroJop: testsand genotyped.The resuIII WIn then comp8l'l!dto the reaa1ts' 01bucca1DNAtyp~ 01the patients. MATERIALS AND METHODl AllO. Rh. KeD.XJdd. and Dutry bJood POUpl Wen! Jmesd. gated metaht &duk p8dent8 who have repelltedIy receIved MULTIlU T'MN1llU1ION1 tranIfusIons. AD~ muldple Ir8nIfusIonL penonI (3 men 8nd 5 women) were whJte and h8d or bad expertenced CI'8rdoph8rtnaI (PIdeJIt 1), po1ytram1a with withrupcwed spleen (PatIent 2), myeloftbrosta (Padent 3), poJytrauma polytrawna (PIdent8 4 and 8),l'nIctured femW' (PatIent 5), coron., surJ8J (PIdent 8), end c:ornpbdanI8ftIr ren8I tr8nIp1antatJon (Patient 7). Patients 1 throuah 8 receMd multiple b'8rIIIuIIonI al p8Cked RBC unb on 3. Z, 2, 3. I, Z. 7, and 8 0CC8II0nI, rapectMIy, tbr . tot8I al 28 tr8nIIu8kJn ewntL The tI'8nIbed RBCawerenot WBC reduc:edbelcn tnuwfusion.UnIII 01RBCawer8 _Jected to match p8dent ABO ~--_nandaen st8tUL and D lIJd&en statua. TheIe un1ts were befon dw tnnIIu8Ion lMInL PM p8d8ntI ~ fOR the tranIIu8ion nent. PM p8derds (PIs. 1,2.4,5, and 7)receMdlDIn8 ABO-noeddeaö:.l RBC ABC-r1OI noIddlaldc..I 7) nc:eMd lOIJ18ABCddendcaI RBCa RBCa(aDbIood poup O) bec8use of the !C8I'Ctty of blood of Id _nn- ~~oI~~albbd~~~~M awnp 018.1 non-WBC.reduced RBCs W88 d per tr8nIfusIon ewnt (r8na8.1-381unlts) tr'8IIIIu*m ewnt. 8dm1ntsteredp8'W88 the tI'8IIII\II8d RBCa 5.9 (ran&8, - - days . - --""""""""'" the b'8IIIft8ed RBC8 ..nmltn..~tno' erqe perlod oIbIood ... -_o. 5.3d8J1f .. __00 VoUn840. AuguIt 2000 TJtANIIrUIllON l'cP-AJlI1' AL The perlph8'aI bIood samples 01the p8denC8 cdlec:ted Inta lt8I1dIudEDTA tubes beIor8 the ftnt tr8nIAIaIon ewnt. - weil. ... e8ChtransIuIIonewnt.Thebucc8I sampletwer8coDectedfrom mouth scrapeI8ft« eech plldent1l\8lt tr8n8fuIkm. ucept ror PIdents 1.5. and 8. who had dled or had been moved to another ha8p1taL The samplel 01 don8ted unJC8were töen from the standard pilot tube8 with CPD. The ABO. Rh. KeD. KIdeI. and Duft'y status of the pmnuuIusIon and posttru18IuskJn gmpJes from the p8denC8 ... deUrmIned MI'OJoIkaDy and by DNA typln8 methodl. ... each tI'1InIIuIion event. The pIIenotypes of l:r'8I1Sfu8I uniC8wen c:W8.1I1h.edMI'OIop:aIly. AddItIon81 pllOtypb. 01 the buccaI sam'" 01the mdI8bIe padenC8 (PatIenCs2. 3. 4. 7. lind 8) pedormed. The l8IUIts oIPCRSSPpnotypInc for ABO. RHD. RHCB. KEL.}1C.and FY lod 01 the pertpl8al bIood sunples drawn betan and after eech tr'8nIfuIian IMInt were then compered to the IeJOIop: ... rnub 81111to the nsuIts 01buccaIplOtJpinl. S8roIogIcbIood group typIng The ABO. Rh. KeD.KJdd. and Duft'y blood group phenotypes were determ1ned by usInR . commerdalJy avallable881card tatIn8 system (DIaMed-ID MIcrotypInl System. DtaMed. Cresaler. Swttzerland) and commerdaI blood grou~typIn& re..,.ts (Biotest AG. DreIek:h. Cennany) Kcordlni ID the JI181UIKturer's Instrucdons. DNA blood group typIng: 18Oi8IIon 01 genomlc DNA hrtphenl blood sampIes 01donan end n!dplena were coIIeded kl J!D'ä Bua:8I cell tom moudIlCI'IIp8 d lh8 pIderD 'MInt ~18d In O.9-.-ant N8CI. W8Ihed wtIh PBS(pH 7.27.4). end .-.pended In I mL ofPBS. DNAW8S--.el from 200 el wt1OIeblood 01' buCCII ceD lU8p8IISIon by usIn8. blood kJI (QJAamp.QIAoGENCmbH, tfII88n. Germm1y) Kc:ordIn8 to the marU8cturw's bIood and body ftWd spn protocoL DNA wu qllU'lt:1fted by uslnl . spectrophotometer (CeneQ\8nt U. Pharmada BIotech. UppuJa. SWeden). 131 TRAN8IIUIION VcUn8.eo. AuguIt 2000 Ge«mY .. ( tV:;; If!? \ : ror the detectkm T1W8II'U8ON8 SWtt28rI8nd). Concentnldons w. IW. KldII, 8IId Dutry genotwpIng The aDeIIcvariants 0I8lJ KEL. IX. and FY A gene lod ... clearly disdnpJsbable by spec:Iftc point mutadon8. whkh aUow8 the deCecdonola sIntIespedftc nucJeotlde !8qU8IC8 dtfla e.1Cebetween KELl or KELZ.)1CA 01' )XB. and FYA 01' FYB. WIll performed the pnotypinI 01KeD. KJdcL and Dutry SJS8mS by a newIy desIIP aed, unilonn PCR-SSP protoco1. uslnl six penDel PCR-SSPL The sequences01prtmen detecdn8 the K1JL.]lC.and FY l8f'8 lod we... desllfUld to lit the l81li8 PCR C}dIna .... ~ MUl T1PLI 01 pm.. for the detec:don 01 RHC.DL. J/C. and FY Wf1l8 0.25 JIM 8nd thoIe 01the contIOl prtmers1Nft 0.01 JIMfor 1CBL. J/C. and FYand 0.01pM for the RHC.-pedtk re8Cdon.AmpWlc8tJan carrted out po8idon 8. whereal RHC-endIor RHc(qt4I)-1pId8c reKtJon In aon 1wu movedto ractJon poIIdon 13 ur-. 1B). men . was used N"T!R of BlId RHD. I' Prtmer sequenc:es ror pnotypinl the lUlL Iocus with the aDeles. c:odIntfor the lik polymorphlsm. were choIen on the bals 01 the prevtoul data.ll.l'n. same approach wu taken In choolln&the prbnen for FIOtJPInI of the ]X pneaoa.. with the common aDel..)1CAand}IUJ. codlnl ror the Jk8/~ po1ymorphlsm.ll.l1.1I. weil 88 the prtaBs ror pnotndnl 01FY.... loa.8 with the aDeIe8FYA and FYB. codini ror the Py-~ polymorphtsm.1."D The DNA lIIqU8IIC8I 01the prtmen U88d f 01' KeD.KJdd.and Dutry detIecdon. theIr names.IDCI theIr comblnatlon8 In the varIou8 l'I8CtIon8 1ft! 8fW!nIn 1åb1e2In uch of the sbl para1Iel PCR-SSI'I, a 434-bpPCR hllJD8l1t from the human growth honnone Iocus pmltlon 5559 to 5982 W8I c:oempJtfted. a ~ contro1~ to an 8It8b1lhed method. D 8 .-qv------. 1 2 J . . . 1. . t. 111211 R-'Ian R-*'n 1 2 I . I . numbIr numbIr ConInII b8nd (434 bp) ii~.~~ ! i! g . I I '! il! I I !! SC*IID I I 5 i PftICW(bp) . J Pd8nt 8 8fIIr nn.fU8Ion I.""'" -"\'", .. ... II "" fII",-",= ~... ~n.. L . ~+aIIIt, C8å Pr.- Cb8..J J... """"""""al ta .. ,." .. ..... ~~... .-;t)'" fIICb8IJ CIIII888,It............. - C+c+~;K-II+:""");... " b~... ~ "'*il ... ..).. Ev8lu8don 01 the ~ PCRthIt , -"""""""" il""""""" SSP genotypInB technlque W8I per- :.twd D DC""" Mt7I 111 , il fonned by tBdn& 300 DNA umpof c.D,.. 1.1Jt'. ~. ".. "-,,.. A8 known KeD.lUdd. IDCI~ phenotype. III"' ~. il ForKeD... lUdd,aDaenotYPInIleSUJts ",,1Ir 1IIID-9III 3, 4. s... 7. .. ... II correlat8d predlely with the known selid' . ~ J .. JII8I8hoI;Cb8,... rotype8 (data not shown). SJmtlarIy. ev8luadon 01DuJfy pnotyplnB rna1ed ..-III JrIUDU"" ~ IDdie A...IlS approp1al8 8CCUr8CJ". further detadl 8D.... \; pIIIIIIIIL AcanI8 III'" are de8crIbed eJInbere. D fil... ~., ... MCPIIII ca.- C. .' ,... .. -oM. - . ~... ~... PCR pm. seIecdDn- pedormed with a computer pvpam (M8cVec:tor. venlon 405.3.Kod. New Hawn. CT); - oJJsonudeoddes synthedzed by a synthesll service (MJcrosynth. BaJpch. .. ,... "",~ Jo "" . -..., (Hal.z.tt. c88llll1IJ". D+_.1" "-'I' ... (lit.. ... ... ..... .~. - L - ~~.,. ~......... _.~ .. .. ...- . ". -:J MIlt lir. ..."". .. . dlllIID (NIt..'). ..,.... II"'" alb . alKa. ~ MIlt .. ... , ... ..., .. ... t'.II8dJ.... - a. a ... "InII1.... ........ VaUn8 40, Augu112000 TIWf8PUIION 131 ROiMMITAL In 8 final volume ~ I O.-Locontatntna50 mM XCJ.I OmM Tris/HeJ(pH 8.3).O.OI-percent .latln. 5.0-percent 1IiJ'ceroI. I 00 ... per ml r:I a'88OIred. 200 ...vr:I e8dJ dN'I1'. I 00 mM W88 second8. 94"'C. 1OIncub8donc:ycleIfor I O.xnII8I g.rc and 80 sec:ondlId 85"C. and 20 Incub8tlon c:yclesror 30 second8.H'C. 80secondIIlIt81"C.... 3O.xnllu 72"C. PCRhtPents were!ep88ted by sI:IeIn . 2-percentapr088 pi contatnin8 0.5PI per mL or ethkUumbrand" vi~..I""'" with uv 1I&ht. and documenJedby ~PIi. RESULTS 1b detemdne the Ippralllm8te l8I1dtvtty ror contammatian with roretanDNA of our PCR-SSPsystem. one represent8ÖV8 rncdon (AB() reectIon 2. spedftI: ror non-Ol se~ .. tIII88d withmI8d[lilA58IIIpIeI ~ heCI!rozJpIS AIOl and homozysous 0101 DNA. and the mtnIm81 absolute unount al AIOl DNA needed for a reliable PCRSSPstpI WIS establJshed..The rnJnImaI amount ~ AlOl DNA needed ror a reliable PCR-SSPsipI8I W88reJadveIy 10 pen:ent and the rnInim8I abIoIuC8 amount 01 AlOl hetengyJINI ~~C D N A needed ror a weå TRANIPUIION samples.wben t8Steet(5/8 padentl). Theposttr8nafusIon..1OtypInBIeIUItIIwerenot 1nfJuencedby eMherthe unount orblood tr8nItuIed In a b8Wrustannent (rmp. 1-38urdtI) or the S8II'IpHna periodart.. a transruaIonevent (1"8np.severa1hours-Z4 days). Patient 4. ror 1nst8nC8.who la A; D-C+c:+E-e+:K-t+; jk(a+b+):and Fy(a-b+),rec:eJved Z 0+. 1 E+. and Z Fy(a+) unJII 01 bIood dur1n8hJI sec:ondtramrusJonevent. CetIOtypb. or the S8II'IpJe th8t ... drawn lmmedIaceJJli- t.. tr8nIftJSkm l'IIVe8Jed no RHD. RHB. or FrA 1II1e1lcmat8riaL wh1n8 the seroIop: teItInt round MCPs In C. D. B. Fy8, and FyllphenotypJnt. SImiIarIy. Patient 8. whma autolopaa phenotype la A: D"+C+c+E-e+: K-k+: ,Jk(a+b+): Fy(a+b+), rec:eMd 4 unAtII(3 B+ 8nd 1 K+) ornon-WBC-rw- duad RIICsdurtnthI8fint tran8fusIon8ftI1t. ~ undertaIcenon the sameday reveaJedno evldenceor donor RHl/and ICBLaIIe- In hå perlpheraJbIood sample. SeroIap: typInB.howMw. rew8IecIMCPsIn pheno~ E. Ko.Jk'. Fy". and ryaan... (... 'Dible 1), PCR product W88 l O 111- In aU pretranaruslon samplel hm the padents. the ABa. RHD. RHCB. D!L./IC. and FY l8ftOtYp8I and the all'responcllnt serokJ&Ic phenotype8 correJ8ted prIIdIeIJ Aa expec:ted bucc:aIDNA typeI te8ted (Pta. 2. 3. 4. 7. and 8) were IdendcaJ to tho8e 01 the respectIYe stardnt blood samp1e8. Resu.lts01 serolotJlc and DNA 1mestIpdon8 .... pen In TIIbIe l. It.. evident that aD 01 the 28 ~..'*'usIon samplel exhlbtted MCPs In varIou8 systema oIblood poup antf&enI as seroIo8kc:onsequencea01muldple tranIlusionI al nonIdentk:8I RBC unlts (see'DIb1eI). AJthouahthe Intenllty 01 MCPs on pi cmla rouahIJ depended on the number 01 ABO. Rh. JCeI.lOdd. and ~ norddendcaI unJts that bad been transIuIed per tranIIIusIon ewnt, ene can nate that the transfusion of even a sin8Je nonJdentlcal RBC unit resulted In an MCP on sewnI occa8oJ.. Por lnItanat. P8dent 8. Wh088 autoJoaous phenotype II B: D-C+e+IH+; K-k+: Jk(a-b+): Fy(a+b+). recetved 12 unlts dw1n8 his fint transruston. 0nIJI unM 8Il1O" theIe W8I 1+. wtddt resuIted In an MCP In KeDphenotypIna efter tI'8nIfu8on. Alter the aecond trarIIft.8Ion ftent, when 2 0110 unIts were K+. MCPs penIsted (see'JWJIe I and'" lA). In aDpetlents. the resuits 01ABO. RHD. RHCB.JCEl..JK. and FY llllnotypIJ1I ~ the pertpheral blood samples aft8o multiple nnsIusIons coJndded completely with the resuItI NI oIbocb serolotk pbenoCyplnl 8nd IIf'OtypIna befont mu1tiple Ir8ndJsIona (Me FIl- I 8), AD rauJtII or genotypIJII 01 pertpher8J blood... 1dendca1 with those 01 buccaI VoIIm8 40. AugUIt 2000 Ontheod8 hInI. lOI1Ie sensItM technIquescandeteet certaIndonor DNAlII8rken alter transIusJon.1\vore. cent stucUes reported . -- -- the eDstenc:e 01 donor DNA In the perlp1881bkJodof recipientsup to 8 weeb alter tnmslu- GDCmJIING slon. with al appro8Ch t8ed on very senUtJw nesud PCR techrdqua... The crltic8J apect al the rell8bllJty al methodI ror blood IJOUPDNA typIna after multiple b'8nIIusIonIls the methodl' abWty to deted Iow propordons of DNA In mbI8d S8ITIpJeLHesIr8' et al. J1demonlCl'8hd thIIt the danar DNA In the 58Jf1plefrom pertphenI blood C8II be suJIIdent ror PCR-SSPaenotYPlnIwhen prnent In the ranp 010.2 to 8 pen:ent. A comparable PCR restt1cdon Irqment Ien&th poIymorpIdsm (RFLP) auay h8d a much Ioww sensitMty al only 13pen:ent. »The threshold lIJIIOUDt 01 foret&n DNA thaI can be shown by Dur reprl!M1'lt8dW lII8J wa 8bout 1O percent. whk:h makes thI8 a robust tesdnt system. lt 18 lJ\teI'I!IIq th8t thAI reIadw ln8ensIdYtty al DUr PCR-SSPI seem8 to be of advUIt19 ror the pretented purpo-. In OW'study. we attempted to seewhethlr OW'urdfonn PCR-SSP protocol ror sImultaneous Pnotyptnl 01 ABQ RHD. RHCB.KIIL. $. and FY an whJchcan be perIanned la a ~ wIttdn 3 to 4 houri, W8I canY8I1Ient re. !UChdetennIn8don.ResuIta Indeed show th8t. aft8I' muldple tranIIusJonI. DUr PCR-SSP...1CItypIns fmm perIphenI blood samplel reveeIed no ott. DNA t:ype8than tho8e oI8rwd In pretrarIIIlusbI sampIea.whAchaDowI the condullan th8 onJy autolcJtouaDNA wa demonttrable. Given th8t al approprtate interpretation 01pnotypåIR results Is uaed. the IftUJIS seem to be conslltent. fI!88I'dJe8 01 the qUUldty 01 the transIused blood unltI. theIr ap. or the pertad aft8r wbAch the sampJes wenI drawn after the tnn8fuIIDn evem. The reIUIIs W8I'8 not a6ded fRAN8IIU8ON8 01p8denII wtth c}toperU; In suchc-. mG8tprob8blyshouId be UMCI. buccall8II1p1e1 ACKNCMlIDGII8fR , n. 8Uthan Ida dw U88IIaI8' n., tII8nk~ - 1klor..01 SChO8111a.. MO... heIptuI dt8c:uuW1I8IId for c6rq ~ on DNAtypq 01 bIDodpIpI. lIId ,.,. W MO.lIId WA f1I8ILMC. ror An8IDAt LubInIIo, PhD. --- hefpluI""'" wIIb nIp8d ID RHC deI8ctIon. REFERENCES I. V TyIIrV.ed.TecInc8IlMIIU81. 12thed.Bed-.d8: Am8tc:8n A80d8donallIIaod""" 11181. 2. Hudr8Ibeck W.bnd S.SeroIap:8IIndIn. 8IIdelBctency al DNApI'IIlIIn8 in trwIIIu8d 8nd th8Ir an:e b ldIndtJ8ndpIDmItJ ~ .... Int J lA8II Med 191M; 101: I n-a. 3. IIIIU PD.AnII88 Dl. AppIIedbIood poup ,. 4th ed. NC:Mar1pn8I YSciInd8I: PubUCIItIonI, 1- 4. Y- P.aa- H.WhM8 T.et II. ~ !-il althe~ bIood.., ABO fII'IÖC N8Ue 19110:345:221-31 5. O"'" MI..Ch88I8rMA. A r8pd UId åmpIe ABOpnoIyp8 . rIOV8IBIO2 YL A/02 JII8Ihod 1J1111II~ """"'-' ~,,"'It cIIac:rtmbIat- at the ABOIoaa VOl ~ 1985;81".242-1. PM.et ... RhII. ..1OtJI*II bJ 8. F- 8f. SbI8k S. by the num- ber 01 non-WBC-reduced unlts of blood mat were rnar.fused. HaweYer. the munber al potendaDy Incompadble tran8lused RBC unItI sbouJd be conslderecl. and Interpnt8don 01~ resuI18shouJd be done with caution. Al 18111801 DNA typb1&01peI1phen1 bIood comdded with tho8e 01 the buct:aI samples. whkh aIJowedthe conclus1on tb81theIe methodl can be UIed for the determination 01 the autoJo&ousbIood poup pI1enotype status al adults aller muJdple tranIfustorw.. ThIs Is al bnpnwement (MIl' the 58'DIo8kmethod8.whkh showed MCPs. Our study only evaluated 28 multiple tran8fusIons amon. elpt patlen... Therefore. we c:annot exdude the posaIblllty th8t rhere mJiht be cfJ8cord81tfIndJnp In same paöenlS when tesC8dby feR after transI'uImn. The situation mlflht allo be cWferent In reprd to n1U8IYe trIInIIuslonl with bnmedt8te samplin& alter the admJnlstntlon al non- WBC-reducedblood uni.. and especlalJyIn reprd to 1nIants. In whom donor DNA h. been detected by PCR24 houn the tranItusIon alblood. JLDThenIore, we... with Wenk UId ChIararI" that the transf\.mon UId traMplantadon htstorte8 remaIn etMntI8I to the InterpretBdon 01 pnetic reM" Ior 1nIan... patlenlS with bane marrow tr8nIpIant8. and tmmunocompromII padenta: In theIe sjtu8donl, the raullI or DNA tyJJInI should be tnterpreted with caution. Sped8I problems couId artse In the pnotypfnt NIT!R IIUUIPL.8. '"'~ 1p8CMk: prIIMr empllfIr8CInn. BIoad 1IIH;I5:82I-32. 1. MaIDJ8onG. SooIS, Sd1dTJ.et 8l Mut8donaIn the ..,.. rocyt8d8naIdnI rec:epIar(DuI'y) ... ål alIh81'y81F)t1811d81na 8nd ~ the moIacuI8rbe01. d8Iedan IntheDIdI'y ... elUI Id)lII8IthJ lndhtduaI wtdI tII8 Fy(8-b-) phenotype. J H8maIaIIII85:90:I23-I. .. MI.McFuIandjG. I!ndaanDl. ~ el ICIlI.l . W bIoodpoup ~ UIdBU al thehl-. poI)-I. 1'r8n8IUIIan 11188;31:485-1. GMIIw C. Sd1manIa A. NU11b1wr8 W. Sch0nttz80 D. ABO ~ ~ by~ dan wq ~1P8dIC I O. bythe dI8In reKdon wttJaIIqII8IC»-Ip8d8c ptm8I. c..w ... C. Sch.U8/ da A. by poIym11'88 chalnl'I8ClIIaod 1-':1152-1. lIlJa-NOllar s.at ... cll8ln n8dtan -. llHD'CB l7P- MqU8I1C8-sped8c prIawI. TI'8I18AJ8on 1991:31:1020-8. Il. OU-.. MantmanM. BaIDy P... 8l ThemoI8c:uIarball el dielUddbIood.., paIymorpI8m 8nd ... lad el -Hum Mai Genat dIdon wtch typa l CÖIbet88...pdbIIty. 1911;8:1011-20. I Z. MaJ'WI. GIock8. DNA~ el padentIwtthpotend8Iy modI8ed padlmllII pertph.. bIood~. TnInIIuIbI 118;31:51 0-1. 13. 1WdMl,11IaaMoPuweI Y. a.laa-PIIrre D.BIoad pip ..1OtJPi. el bIoodsamplaahm ll8nIIU8adp8dInts (Ib1UIIct).Tr8IIIIuIIon19III:3I(SuppI):38S. Vokme 40. AuguIt 2000 TRANIPUI8ON 141 RoiMAN lIT AL. 14. Lepr TJ.1!b8r SW. LaIIoInek Klit'" andllHa ~ ... cornd AppIIc8dan of RHD bkIod waup ~.._.. tian In d1rar*8Iy tr8nIIuI8dp8dInt8.TI'8IIIIuIIan Z5. Wri RI!,CbI8IIrtFA. DNAt7JIInI ~ l'8CIp8ntbbId lftIr lII8IItN trInIfuIIan. TrInIftaIIan 1I11;3'1:I1"'IG. ZI. TInt A.MamIJ.StodIIrJW.1.euIIocyI8 ""-111 m8I trInIpI8nt8dan. 1911-,31:152.5. 15. K88p TJ,PauII8r MoCantU a A ...comI*1Idon hat spat In the Ah reve8IId by 8I181y8I801unnIM8d danarwwttb the r88 ~ -~ pe. Am J HUlD GenIt 1_;51: 1018-73; emåUD 8pp88ft Am J Hum GenIt 1917;10:741. 18. LeeS.Wu X. R8d K lit .. Mo1ecu18r ball of the W (K 1) P!W1OthA BIocxII915:85:tlZ-I. 17. LeeS.N8Ime os. lWd ME. Redm8nCM. MoIec:uI8r buI8 forthehlp-Inddmce 18m. 1'r8nII'uIk8 II. JI'CIUPI. 1'ranIftI8 b..1IpOrt . .1r lInuI8 TPOX.niD l. D1S1O.HIA.DQAI. bIood ... dw CSF1PO, n8II8d~ - DB. II al The 01-""" Ip«dk poaym... chaIn~ conam 01DIII88m8Ieotlt8a818dDl.wNn .. .. - wIIh.. ptaI8'I (PCR-ssp):8 caudan8rJ 8Jaod 1991;82:"'8. t.(f. AfaIIIIIA A. 31. C8ft ~ lt) obriI8 !8npIII.. ;t)ped AIr lmInun8 t}tope. IL cUIordIn. Am J 0bII8t Cenamk8188;4:471-17. l!nuI8 P. DNA typå1I and bIood tI'8rI8II8Ian. J PannIk 33. GynecoIl987;178:327-33. 1M ni. DonI8InI. SIdår S. 8I.-:b Mr. Tr8nI6Int InCI88 In ~ "'18uIIoqt8 ,. IrInIftutcJnIIn bnmwlOCOlDpet8l1t redp"..D compMIbII wtth danar c8I proIIfIndan. 8Iood 11185;85: 1D- 14. Wq-1IoctrIpa 1.Fry I. Mamno F. 8t al ~ 01d0nor ~ foIowtn8l1'8n11u81nIn (abIfna). TIWIIIu8on 2000 In pertpberll bIood trandJIIon. Sr J dI8InnIIIICdan ~ ~1PId8C with Mu mI8Mr88point muIIIdon8 In la,.. and C8II be d8I8d8d by PCR-SSP. ImmUIIDI, (In ...-. 23. ChenBY.LI8o YC.Smith DH. lit 81.1b8 human .-vwth horlIIDII8 1Dcu8: ~ btoqJ. and ftOIudan. Set 1_;41:85-7. pntI'8nIpI8nI8d H--mlllII:l02:10CM-8. BIood 1985;85:822-1. TRANtPU- Volln8 <tO.~ . LDLI. CYPA, HBGG. D7SI AS,&ur- M.C8rundaID L D8t8cdanal 30.C8It8r rnIcroc:Idn8I8n8ft8raIIap"* blaodtI'8nIfu8Aon .... 32. la P. ShpIb8n M. FnIUnII M. M8nny N. 1111eI'ed8 01 bIaod lr8nIIu8anI on PC1tDNA tJPåII 22. c.un. C,Kr88RL.Oo\'cT.et.. DUFFY n« la---ted 24. . In: Henry JB,Id. CIInIcII dI8pIDIII""II8I~" bJ""""'7 lIIIdtodL lIdI ed. PtdIIdIIIph8: SIundIn. 1-=514-111. C.lA Y8I1KImC.c.n. P.lit ... MoIIad8rball 8dd re*Iu8. II . ,. I~ el C1In 1Ma11815;Z:3OI-15. and PeR-DNAtypq 01the PyaIPybbIoocIwaup poIymarpI8a. Hum GenIt 11115;85:401-10. 21. ~ S.Ond T. ~ II. lMmocoS.GencIINc ~ tian 01the~0C8tn D... DuIJY bIood IJ'OUPPy"/~ a1Ia8ndpn., 18-.-t wtdI poIynD'phI8m the "...mInD .. lI1d CCIocLJ PCII'8I1ItI:Sel 1917:41:1154-1. bo '" pra88In.~ tir lpIIc8 ... muI8danIln JbuIIIndIYkIu81I. J BIai Ch8D 1~13: 1Z813-1O. 20. T~ 011 T~ 21.'a.o v nJOrdeIdoIlItsr.DouaI8kII.l8m.k",,_Mlm et'" m dIC8dIOII Of ~ In pII1pftefll and lUdd bIood II. LudIn N.SIdom-W8II8r P.0IIv8 a... Cha..;tc.~ 01 die enc:ocIn& the hunI8n lUdd bIoocIaroupl- '(. 19811:1:424-1. ZT. HuIdd8anIF. o.., 01theW bIoodpoup.,. 1917;31:1117-22. C8tn1nJP. RIpacheP. U IV. The e8Id 01bkJod b'IrIIft8IanI kacyt8 typq by~,. I99I:38(SuppO:38S. I] 1911:38CSuppG :315. ~ ~ ~e' ilC ',{ Q~.~:I all E/e GeaotJpl.. bJ Allele-Sp,cl. Prl..er A_pllkatloa By 8.H.W.F S. SIm88. '.M.M."""', M.A.M.av.bMII8, H.T!LM.~ A.E.G.ICr. VGft dIm lIam8. 8nd c.J. 'ten dir SchoCII . .. ... .. -- .. Al lJIU., tM lit CIII8 ~~I'" n. lit CIII8 ... .. IIIQ,..lo... ~ flII.....III. III. ... . Il 1:1 tfl ..w WII' ~ II ~ - .. -, III .. ... - .. ..II". ...... .. ;IWI ft8IICl11DNA ~- ... ~ I JII ,..,..~... . ... C ~.. la 118. fil .~ ...... III.. III. -".... l7W" IAIMI III ...A .. 871 el.. MI. II J. 11ft 'II Pil""""" & fil .. , 11M.r II!'ItH" .. m la CII8.... Alt .. '- ,. ... ... ., linI~I.M ~ l tir ... D4..~~..., . L thII 1M ..."n ull""" 8 J1 1a"8 ..ut.-., ful III ...,. IIR~.' el -~ ... ....-. ... .... R."...................... - 8M.. . ".. . .'..-1M ,NIuJ~IIJI pI Af'it 11111 IIID...... .. redlII8M .. lit ~ .'II1 III ' ~ 1/. pl\8..fW16. o '."'.--"""""""L .. -- -,r 178 fil tII8 .. . ... ... .. .. D r HIn ... - L rI f8r ilie... ,... L f. ... ....... TIIII- .... III III ........ - ... I' IlIlAllh n r II 171... .. ...la ,- . "'W. .. de8cribe- ..(PCIl) BI8 ~ lIIIdIod... . MilatWO ~ -. wtda poIJIII8U8 tb8 ]"'" .. JIDOt) _1OOntId.88 ~ 0lIl or badaprim8I l8JIIIIJ dI8 RIa B or lUs. 8DeI8 (8'I..I...Ip"'{'IAe ftc8daa (ASPA)]. W. .-L..-I 8D pIiD8..... --- tWOPCR880~ rn. miM... RIa B... .. . JIDCIC7P8I.. DNA .,. wbI8II... ~ wId8e~ b8d ... bIDodcbIon dill pb8aoIyped tar RIaD. RIal!Ie, lIId RIaCA:. MA1IJIAL8. AND MITHOD8 , bl lIIDod CIII8.. - [...~ .58"""" ~"""a.._"Dp "D~(IW (1I'8I8b8 .. lIIi ""') B, a.8) C. .. . .. . ~ lo ... D......... a.a,. fI.-. - I. I ("". r,Y, C a; . i r,M. ---' - C. .. . I - --- ~- L -- .. . 'j ,lir.. ... 'j III ,W 01 .., .. CIuIa . aL 18 To . - .. la lHpIc:IIa . ASP - -_o .~(~ ,... ...c...IlM ) ~... ~ I . ~ o.. lI1IIItI ..,. .. rA. .r..t J"'> /tir ..., .. ~ ~JI JDo~~A'II """""'~4. .., ~ .H.Jllf.dSl_. ~ ,..-. ,... c..r. "", "U ,Ä lIir"..,. . ~- 2J.19!N; .,.,., 0tåIr .J. 11M ,.",." , . C& ,,".fdIIIc lID. 1t8D,c.. ...~.".. lIå. '",. W O..., ~ IOIJI er A ]f ... n. NJ6j I A. lIir ~.Au ~ II aMII .".,. il ,." ., ,... INIl.t ..,., ..., "' '*'" ,., ...il7IIIr ... ... ,." ..w ~.M " U.s.C --Iw -.., 1114"'. , ..",.,. O 1- ., .", ~ ~ Il , hD- fJDtJI.IR IlfSlllSOJ.oIJDtIIJ. '*' Val ......I , 11. - .. - .. fAlla ET A&. ,.I nI"" TIIIII'. L111J "~1.111" PI"1 1'- .r MIA V I ~ lo fil T..- ,.".. CD..cDI . AlM - 2t II---31 co ca,"""'" c::D.-cIlIl 17 11 cOI,4a8 I. aDMe 1'1 /I ,100..4II18II cDIJaDI --1141 . 31 c.- 10 .. 11 cI/O8 I CM:I CDM:DI CDIMJI naIVP88- pa8dCI8 - + -- - + - - - + .,. -- + -- + + .... -.. + , J + + + + lir ... flmlly ......... ... -- -- .. IM ~ . E allele 01 me RIa CcEe .. ( _mi ~ becIUII of die ... 01 me 3'-- ..Jeotide 01pr;... R661c. wllicb il spcciIc for nuc:leotide676 0I1b8 Rh E aIJeJe.SeeB ampli.. . ~ -- lo« ... - ... b8Id w. llill viii... ch8IPti die MA concealnliOll8 rauJ8edla lb8 bl al ilie e-1p8CiJc II 1.0 nuaoUL MtCI1. Tbua.lb8 lHp8CiftcASPA i. opCimallt 49"C........ ini boollper 1I8int U nnoUL MA. s. A ampW1e8 101-.. pIir rep. lpOCiftcfot die RIa .... - lo« ... --- ...... - .. 8D547). To p8b8 betweeD46-c lIId 6rC. bIIIdI wereal..,. obcaiMd. How. ev".II lower ~. lDDI'8 UtlKlftc WW8 .... A hi'" concentr88iaa of MA resuhedin ICIOIIprb8nd8. The opdmII 00DdI 119Mrar tb8 B-1p8Ci8cASPA WtnI ID ...aInI l8mp8I'I&IU8 uf 6re 8Dd1.3 rnmoULMA. 1be CQfIIhI...ritwo( pm. B lDdC onI1pw aoad~ lit lUllle8Ji. t8IIIpU8IIIr8 al WC 8Dd49'C. At hi.. Ibee-eped8c .. lO8&" --- ..- + ... -'II."" ... ... i8'I"""'~~'" -- ... 181 ,. + . , . . ...... AlM II18II 11--- c::D.-cIC-", -. ~I"'. ....... + + + + + 11 ""'1 " 111M .. ---. !!!II (- .. ASPA.B wI6 l8t C: prinIIr R661, prin8: "CCAACmlI'CAACI'C1'O3', paIida8661ID 676)... prtRIOI (-an--. ,'CATOCI'OA1\.;II<A..wr3', 101 ID71'7). Al DNA., (Ap- -. lo) pi'" .-,-IIIDdII392. No Al.. CA), R661.. .. ..1 ... c:8ItItd88 (AfpI6Id --.J11 'I1Ia PC8 ...of-.50IL naA...wi . 8DI8Ivoa. ... ,n... 0.2~ IMIe. . crt.prtmm puri8c8åa8 .'" C!IJ, CA). 0.7 ". fil DNA A .. 75III of of cINI'P (,,*,. '. UJII88I8, S- :u ~ M,a. rar... B-If8CiIcASPA d88),1 U of 1'aq DNA ~ WI), wI6 18dia ....- ("" 1.5l8IIIIIM. MA ftIr"",,-,1I: wIdaa DNA ... c 9S"C. ... 1.3 (~( -~.-I 4IQ, ftIr 1.3 al ASPA.A CXIIIII'aI ...,.,. l8CII1dad. "..,... ~ of .. . eJder (IWId8 Bb8ar CT). widI to ,jII~.'. I al - - .. 62"'C rarpdnIIr A... . .wc rarprtm8 B ... C.... ......... r. 1.3 al 1:l"C. 1118pnIdIIc:ta-poIyllClJII8IWI .. , ~ CI8 . I~ ....... :!! ....... ~ lO. ) REIULTS R66lc1R768 (lit A). A), R4871JU68 R41711U68(lit <lit 8), 8). lad .... B R661tlRJOl(lit C) de8ipecl 8iped CD IDampIify lIIIpUIJ 1pICi& 8p8Ciftc ... 810lIl 011111 ab CcB88DdRIa Same .D D SomeeaperimaIII nperimeDcI PlI t. t 18u r J1~ I el.. MPA.. ... . ... ... . were bmed lo 8'l"ive . !be lIJeopdm8I coadIdoaI coediå08lo10... III ... ..... the pria8 PCR81WI1I .-tu ecI widI __H... lemIII&"'" wiIb ra. . .. ... .. ... CII8 ... ... .. ~ of wc. 49"C.5-'-e, ... 6TC. MA II'a III D ... . --.. ... . . ... . .. el .. III CI88 IN r' r ~ el .. ... MM. III doaaMR vIried Ihe opdm8I _H. ~ ipdmII --un,lIeoaper.duN A mmoIIL. .. A_'. mmoIIL: ... A III (1.0 mlDllUL,1.5 8IIOIIL, 2.0 ud . 2-' IXi le... el.. .. III MM. III multi naI 1IIowa).The COIIIbiudo8 01 ~ A lad .. c I~J le... .. , ... 8 worbd weil bl . 1... l'8nJI al __II.. l8aIpInIIU'eI; el t.t .. .. - . . II. fri.,... ... ~... 62"C. MA .. .. "- .. ... . elMI. . ,. u ...- .. "- ...... . .. - ....... . ...... ~~~ ~ . 8 6 M - zoobp - 100 bp 141 ~,- 101lip - .. lip- 11."""C 1111/. I'.' ... A 118M II:"" ,'- 41: -- .., ..14 1Ipt. ..,II8Iv.L III I. III _I: DNA""""". J 8M t: DNA""""" . ... . DNA DM. III. Lo.-' MI .. 8k lao. 8twll . PCIIIh -""""""'" aB - .... 8 11JI C8G18 "'. fil.. ... bp I'Clion in uon 4 common lo the Rh D JCIICund tbc Rh CcEe acne.The IOI-bp and the 94-bp bud weN ,,-oampIifiedhl Olle PeR. In Rh E-ncpdYCDNA ~ eN). oa1ythe controI fraame. of CMbp la found. wbere88 in Rh E-posilhe DNA gmples (ee or EE). the ,,'OIIU'OI hlment al weil u the Rh E-5pCICitk l08-bp fruammaareampli- lied eFiI lA). Set C IIIIIpliftn . 141-bpn:llon or lhe Rh CcEeJC11C 'lpeCiftcto the Rhe allele. Prinw R6611hM. 3' -endDUeJeollde (nucleoride676) 1- enabIeslhe primer 80biad 10the Rh D sene 81 wen WI to the JUl e allele of lhe Rh CcEe ICne. buanocto lhe Rh E 1111e1c. Primer RIO. ... . J'-end nudcotidc(at pcIIilion787)thai iA "f*itk for theRhCcEe acnebut not the RJtD JCII8.Whea prim« 5etI B aDelC ure u!led in the ASPA UI8Y. only the 94-bp COCIuol frqmeaI il aunplUicdiii Rh e-aepdve DNA sampla, wlUle in Rh epmliw DNA l8rf1IIn two b8adI ilie produced:the 94-bp control bind ;Iftd the 141-bp Rh ~-~iRc fruamentlFiI 18). All 01 of I"~ I" S8InpIe8 S8InpIe8 were~Iy seroloJic:ally pbe8otyped for All were pbenotyped far Rh Ch:. Ck:.BI.. EIe.aad a8dDD eT'" eT'" ,). 1).UsiRl Usm,tha theKb RJtSo S.aod lIDdKb RhooRh speciftc: ASPA. we typed aU 01... doaon for tbeir Kb B or Rh e IJenotype. The mul.. of the E-!.Ipeciftc:and o-!.Ipeciftc: ASPA and lite c:oncJIWo8i with repnI ta ... acaotYJ18are IislCd la TlbJc I. Thetw w. compIete IJIRCII18nt with the reMI'" of the lerotop: Rh EIe pbcaoIypin.. AJI of the gm. pleti I"" were scroIo8kaIJy typed . EE or Be produaId two III . . III. ... C... . ... ...... n I l..l III """'111 ilie ...,.- C"" II ... A A III A 88: ... .. ~bcd 10dctcrmincIlie Rh D JCftCICYpe at thepnomic: DNA levell"u In dw praenI 51Udy.wc lIICd two ASPA reactioM 10 detcrmi8ethe Kb EIe pIIOtype on JCftOCI1ic DNA. To "de ou, f8be.neptlwrad~ c:8U8Cd by in..f'Bdc8IquaIity~ the rapt1b or r.Uwe 01 the l'CaI:oo.. hsclf. we inc:ludcd ID inta'D81 CODUoI.pri.,.- setB. th8tahnys lives ... amptift- clI'ion productilmll*'iw: or the pflenocypt.We perfCJnllCd the raaio8I 011 DNA sampletfmm I,. votumeerblood cJoaoa.vi'" diverse ~Iy lletennined Rh CcDEe pbenocypes. The reeaJlIof our Rb E lUIcIKb e lenotypin. were iII run c:oacordance with the multi of the scrolop: phenoIypiltJ. By plMJlypin, DNA .ampta from donan wich ove allclet (CDE and CdE). it was !lhown thai only lhe ca "vmbiuhon.whic:his by f. IhcIl1Ol8 commoa. but abo ilie CE ~"nadon c:oukl be IlInpUfied. Rece8dy. Hy"" et II'" UNd M. I RfLP di_on pMteml ~ the )' noacodbtl repons oIlhc lenea lo dctmnine Rh EIe pIlot y... For e Ihey showed a I ()()II. c:onc:ord8a::e b8tweaI dill laUIb oI-mop: ~ lIId acnotypi., b8ud (8 RfLP Id ror E the conc:ordanc;e W8 onIy 94.3".ne disaepuclatbeyCou'"bd... d» resultlof seroloP: phenotypina and ~uJ. JCD08ypinl appelftd to be ~ wida the cB alJeJein D-neptive 5UbjectL The. ca ilie- i. Cour D-neladve donors whoN DNA W88 ca8III ""' . I:e. III JIIDOtYped No di8ctep8acieI were bandawhell usJnl primer !IetI A lUIdB i. theASPA ~~. wlleaIlie ca aj" occurrediII . hapIoIyP8 with theD ane. Pmmme. rauIII. the InYftdpcon concluded th8& cc only producedtU Iower band In this "*ti08 (Fil 2). This p8dem WIll round not oaIy la the combln8doaof E me ca aUeleIs IOffcrcnt in the pmel8C;eor Ibseace of the D SC- However. becaaIe chey were only UJalyzina I1OIII:OdInI rep.. tIane rall'" oaI) becween the M. l whcreal .1101thesampla ... wen~Iy Iyped . with C. bal ubo or E with C (!Iee the nn CDfJCDE. CdfJ CdE aad CDEICDe pkaotypa). All ~ tUt wae sera100icaUy IYpedu & or ce plOchK:cd!Wo b8ndI whea primer 'leta B lIIId C wcre !lied in Ihe ASPA: lite RIt c:-~ilk band ut 141 lip :andtlte conIn1I band. All ~mpla thaI wcre ~lop-aIly Iyped III ER only product:d the c:onbOl band rFiI 2). DtSCUSSIOH Until recenlly. il was onJypossible 10det~inc me Rh C/c.RhPJe.1II8d RhO phenotypes ~Iy: buabecau!ie .be ~!IC'" RNA sequenca or the Rit Cc& and Rh O lenes hevebeaJmeknow"," !lCYCnIJmcthodI hne beende. .dJow Ii.. RfLP al ilie RIt EIepbeaotyP8. Moreover. no DNA fmm cidler D-poIiciveor D-nepri\'e subjects with the CE alleIe WIIS Iyped. In the ASPA medlad. we Inled DNA o( !lix donan containina die cB hapIotype ud lIe"er mc:ountered a dllmpIUICY. Funllennore. we lI1to lälled !'IOtneDNA ..... piet en. 11ft phenoty... 1'hc!e remlb ~ ulM) i. full coaaxdlnce. For RfLP plitan analyJia. 18IltJc quaality of DNAil needed. wbaaafor miaPCR-baedmcthod.II small ~ 01 DNA is JUlfic:iaL Thil 5II11IIamountpuriJled from leM lhu O.~ mL of whole bIood or from lIJIIftiotic c:etll-makcs anotYptn, umplea from fetuJClalld fmm pItieof8 with S8veretnanII'usioa problcmareaible. A ldIoutfalbe mulll 01 <MIl'RIt EIe JCOOCYpin, w~ i IJ - I' AM IT Al. NU 00IICGI'CI8IC8 WlIIIIII8 l181li8 UJ"U8I - RIa IlA! 1pu1lo d8e BI. tbI El. pbcaotypia.. caaconIIac:e widalb8 rauJII of one rmJItbe awue of die f8ct dill cU8cap8IIdeI occur cIia8p8Dc" oc:c:ur jarW'8 c-. lUCb . ~ ja wbida lddId88 tb88il il~..... cr---i..v. wbidI of .iIea&liliiii . the RIaJocua. .IDla ~ C8I8 C88 (... <...die tb8 RJ8..8Dd!bl D- pI8Iaa&ype8),_lUt. lU1 Cd!8,..1I CcE8 ... ilpnI8III ...... withouc ., rarnnpmenII lDIIIIdoaI wtdda die rarnnpmenal1lioror 06 fI'IIIUIOIII widda tb8 codiq bal DOCJc or Ple cacabebldeI8d8d deIecr8d 011die erydIroc:ytea.l. o. f8II1I ,*JM froIn tbI8 poup of do8Jn COlIlInDtb8I'"~ 88IOCi8ll--Ibec:yUJIiaeor auni. poIYJ8DIIIbiIlD . po8idoa 676 of... RIaCcBe... and the Kb B or Kb e pbeootype.I ~ weIy.The8 ladInp Sb'DD8IJ th8t proIiDelIIId aJaiae areiDvoIvedin the 5peciJ1c epi8Dp8tb88.. recopDed by and-Kb B ud aadRh e 8IIIibodIea,rapecåvely. In c:oaduaåoa, we praeat . limpIe lIId reIi8III8 PCR-b8aI metbod to dItermi- the RIaPJepolymorpldllD OGpaomic DN A. 11åI C8I bl uefaI to cIe88nDi8Ibe Kb BIe pI8OIypI iD retulel iii ID euly pbue of pnp8DCJ and iD recady prachadby"""""""" BIDad.1074, 1992 lr8Ifa88d p8åeaII wiIb 8IDOUIIII of c:imII8d88 cIoaor 9. Ma8a I, c:I*tI-z CJ-P,lA V. Kl. C: ~ I.. b8IiI al 11- bIDad .,-. ,... cell.. - 0IaIdc8 al ~ 0nIIIp Serolog lIId Dr c.P. ~ tar REFERENCU I. LewII Mo.u.. DI, Bild Owo. B, C.uoa J.p, ea.u.. ... CIook88 MC. D8brw. D8Di8IIOM. CP, 00. CM, PI). - I, JtQI8II8d ... l..uI8IIIb A..... WL. ~ J, BPI.,ManI p, D, NIow...u.- If. Nof--- J .. Obbo Y.'~ RB. PH.1hohI ,. P. WQ, WdI So~ p, 11ppII8p, WIIbr RH,WoadWd (], YOll8l S: BIDad ~ 1990 ..~ 1990. Voa SI8I5I:IS2, 1. L8wII MoAIII888DI, Bild OWo. lInIIII8a B, en.. J-P, l:onIIw8 ... DMr W, DI88II aL. ~ CP,I.. lO, ,..... .. J. ltarDIIIdL. LuII8dr.oA. ~ J. Mcal P, Mo8IdIU, -- If. NI.. .,.. RoObbo Y. J. PlI,...... I". P, SIIaIe801, SeIdlSoS P, 11"" P, W'" JtH. - IV aocMIIId loIou H:I.58, a. y-. rar lid cell 1991 So ZeIIIIIId T: lS8T W CIItia8 ,." ..,.. II1II1181: Lo8A8piIII'IIpIn - - ~ -- -- S:6Z, 1993 IQ.... ACKHOWLEDGMENT W. dIa8It... rall alibi t' l rre. h8Ip ,... d8 bIaad CQI7 I .. !be~ I-r,--- I; - ...... -RH. .... VCIII SI8I Sodl -. CAN, BIeIIr8r W 1M, Golc'o""""".. ... YI8 dir ScIIaaICB, 0djpIn RI1IM, VG8 lon8 ABOItr. s.,- ,. fil c:DN A c:-. cIIrIwd e~ o_. ,~ mRNAa c:odI. rar .. pot,~ Voa ,.. ... 67:- II. ~ PR.La V-KIm C. CoII8Y. WlrWIckaM, PIlla PRe.~ .. PIK NU, c UJ: ............ al RIIDtyp8 .., DNA~ N'" J Med329:d07. 1993 - -. A "'u_-- ~-~-- t2. ÅI'CI MA. 11IaaIpIaa ss. w S. ea,.. KB.PwIb8 BA, LII1IIt8 DM: MoIIcIIIIr cIaaI88 01I0Il) cDNA dldftld lra8 ... ~ la ~ tJutnat lUll) ~ . 11- bill."'" BIaod 82:65 t , t99:1 t3. S"" S. 8IIIår PMM. ". .. ABOXr. ....... 01... DO typL N BII8I1 Mad 330:195, t9M 14. Hy"" CA. WoItIarLe, U- Y-W. SaIII A: A Sa8dIam lII8IJI8 olD bbId palp ..~~D8 tcda8 /'rapII8I poIy..,... pI8IInI... .. l8'OtJpII. BJood 13:jf6, t9M 15.CIuI8TA, SkIar .-- SI.: A far DNA lra8 plit, bIDad.A88IBIDcIII8174:415. tt6. CWdt-ZaI8"..,...V,c...IP,CaII8Y:o.. ' '... II1II 01die .. laaIala III ~ widI , D- - ... DC- ~ Jr J 17:t 19M(...,o , 4"- ~ \( ~ The presenceof anRHD pseudogene contJtining a 37 basepair duplicationand a nonsensemutation in Africanswith theRh D-negativebloodgroupphenotype B8IInd8 K. SIngI8an,CII'OI8A. ~. HIll D.Awrt, Pe8r ca.M8rtIn,EIDb8Ih Snwt. Abig8IID8Ic8,EdwInG. N8rt8r.ol8g8, Und8 M. II8wIt1am8,lIId GeaI D8nI8II . Ek . .'" MIc8nL RffDItI oanIIIIn8 Jr .,...... 4, ..., encod8d bf 2 tIMNIlala.. lI8ft88, b88 pIIr (lip. ln8IIt In . .. codan II 211. RHf2, ~ 2 r8d C8II 1ntraduc8 AntIg8n8fil the RIt bIoacI .. RHD ... rMmbnI18 notyp8 .. CGI"""" 1118 D-n8g8tM ,.. lo lImo8t The ~ lCI'OI8 .. . baundIry - --'lir oIlnnn l~lft 3.. 4..ltIQI conIIIn8 codan In Im""" hm homoQIMtIr far. ~ .. The, oIlIID8Iln bI8cII pt8II8d8I8IIonvi RHD.". vi .. SouIIIMIc8n8 .. lppI'OIdIn8tIIrU714.. PCR far ","". D ....... blick AMcInI, hId type hin DNAobI8Inedhin 8In.1IoaytiI8 Ofa Ek ". 1ft hId RIOa-D hrbrId or .. d.lIlI"" fil the ~ 108vi RHD." U88dIn ord8r lo .. aI r1IIIn the rt8II fil henIot;ItID dI.- ((8 lied vi the .. RHD ... .nn"'" wIIh vs+ ~..... typ8,.. onIr1ft compl"'"...... Rh ia . hlpIy compta red een blood poup l)'IIan wida 52 ad... ad ~ pbeDotypI8.l.2TbI Rh 8DIipaa ...1IIIXIded by 2 c_ly liIIDd bamoICJIOU8 e8da c:oaåI8iq of 10 ac8. RHCBeacocIeI ... CclIId Et 8DIipaI, lIId l1HD aDti... ThIIre an allo mall)' UDCOIIIDIOII lb8ioa p8It of RHCE lDd plit of RHD, wbidt may D ad CcEe lIId l or lDOI8Jow- - D-n8gIIIM III"'" .. RfID8i, ... 8IIIr rHUII 01 ~&"18d mRNA -. !Id88Ing PC~ .... -. c* tar ... dla1IrI8D pe.1Otype"" nae for DM ,. At'Itc-. . .......... "" 001""'" propoItIoII01 MIc8n ....... nr.ean ,. lI8W o we lh8I 4 01""".. - -- In 24,. fil We..,. Id8nII- RHO.""". le CRHOIIrtIn RIt f).negIItNMtcIn AnNrtcII... 1~ fil Introductlon D-n8gIIIM 8outh AfIto8n8 01mI8d r-. No RHD ini"" cauId b8 III ..,.,.. . IM 37 bp ln88t III (1Iood. 2IGI:.:1 ~11) lir T1I8 AII8tc8II 011- II aIa. pheDotypeia peaple of AfHC18 orIPL.D la 130 D-nepdw 36(28%)h8d- lppInIItlyiIact RHD,2 h8d.. lcu8 1 b8d RHD C'JUIII 3.11Delpitl of 1tHDis tbc1IIU8l moIecul8rb8cqround ror die D-neptiw pheaotype. tbe8I 10 of 1tHD, l 0( allo vma.. bIrMrYer, il is .-.DY lCCCI*ddI88/å 1beD isofcliaicalimpor1IDce -- i. .. C8p8bIe ofc8a118'WII8 lI8Wbam(HON).~ ati-D "i~ bImolydc di8eue of the ... II1II ia hydrupI&talU II1IIfeI8Ide8da. ra lbaIe .-ly iaUIIaDwbo.. bomaliw,j8UDdice may 1- tobmic8Inat21be JllWYIIeDce ofRbDHDN" be8 p8dy reducIdlila ilie l ~ by ilie iDInJcIDctiaa of IIId-D ib.b~ liD pnIIJIayIaiI. whicb prev.a D-aepdw modIIn &om ..... i.mIm8Izedby fet8ID-poIåtiw red coOl u . reIUIt of ~ bemonIIap IlpålritioL SameD-aepdw WOIDIII,boweYer,åiJl . IIIti-D ror VIriety of reI8OIII iDcludiat lIDde8ected t1.4 feeo..m8naIlIemonII8p 8Ddfail... to IIdmiaiIlf8r _-D, 8DdIIIY lUb8cqueII& D-poIitiw f'etu8 i. riIk &om HON. It il DOW COIIIIDIIII prKtice ror 8Idi-D immunoaJobuUa to be 8dmiaitprocb:e . , 1( \~~,' . tf0 . ! tered uy .. weR.. poIIn8t81ly iD - lIIempt to reduce ilie rilt of D I_MtiDiacovwy of the moIecuJao bIIia of ilie D poIymorpIJic:n8tId die pollilliJily of JII8dictiDItiIf8l D p/JIaoCype &om,., DNA _ved &om lIIIIIiocyteI obIaiDed by lnIIIioI.'eaIeIi. D p~ of ilie recu. 01 . D-neptive WOlD8ll with IIIIIi-D provicIeIvllalble inform8Iio8fiJr p:edic:tiu,the ri* of HON lIId -.,- ror lUb8equeat o( the pntpllDC)'. Tbe fint teIII to be - FramIle lIrtI8aIII'IIIIUI far 'TI'InIiIIIan ~ 1IriI8aI,EngIInct tII8 InIIrnIIIoIl8I 8IDodGnIup R8IIII88 L8bcnIary, 8riIIDI.EngInI; tII8 NIIII Ra8d,1Irt8I.10 5ND,1ngIInd:Hllll:1IIGI.dIIII1I8.III..nII8.uII. 8IDod 1'r8nIMIan lI8nIa8, PIn8IDwn,SoIMI Mta8; tII8 lIIoadTr8nIIuIIon The puIIIaIIIan CIII8I cIIhIwed In plit bJ Il8Ol cfI8'gI S8Ma8, Z!nIIIIM8; tII8 lIIoad,., lI8nIa8, Aan, ~ TIwIIaIe. Ilet, '*'lIr 0hIn8; 8ndtII8LauIIIIn8 8l1liUrMr8IIy C8nIIr. ~ lA rrwIIId 1iIMI8/11" In_dille» .11 U.a.c.--.1734- 01 .. ... ... ...IDlndIc8II .. SubmlllldJun83, 1_"""" "",ob.. Z.1_. SuppcII18d lir . .,.nI110m DIIMIdNJ,CI8IIIIHur-MInI.~... 12 ....." C 2OCIO111 n. Am8lc8l1IocIIItr al HImIIaIDsIr 8I.OCO. 1 JN«JM( . 2IlOO VOWMIII, lIU88R 1 IILCQD, 1 JNIAJNf'f 2000 .va..uue.. NUM8R1 RHO ... ~ INAHD-HEQATMI APfUCANI 13 devi- åaYoIved a polymerue chIiD reacdoa(PCll). The teIt8 tb8pnI8IIII8 or oi. cIItIIrmUIed q\IIIICI8 ja _oa 10 or GOD 7 or nICOpized 01/UI1Hpetcitc . Ibe.. cIifI'tnac8I betwe8iDIIuDI 4 of RHD ad RHCB,I).I'The8etec:baiqu8... t"oaIMt to be wnli8bIe.l' The 8bIeac8of cert8iaRHD rep. iD encodia8pIIti8I D IIIIIJ predIct a D-aepIiw pbIDotype,ad dia ..of lOIII8RHO rep. la .... eacocliatDO D -pli may pndIct a D-poIitivejJbeDotypL la onIIr 10avoidtbnI compIicaticllll,mcdIocI8 w'" man l rep. of RHDil cIet8cted iDa .. PCIl w.. iJdrocIuaIcL 6,11,17 hybrid AnIaioc:aaIiI ila hiply iDV"ve procedur8 8IId DDt witbout It 11181 allo lIIIhIaceIbe riK of lDII8InII imm-iw8tWt Metboda lave bele de8aibed rar precIic:tiIIJ D phcaotypI tum fet.8J DNA ia lDIIIIm8I plumL It ... bee8 propoIId tbIt tbnI tecIIDicp8 couId be lIIId rar taIia8 aU D-aeptive pre WomeD to wbetll8' tbcy requiI8 riIk ID lb8 fetul. admiaiItrldoaof _-D ~ wouIdl'lllllal'N8I8Ipoflbl8val... nIOUI'C8 11,1'Te1dn8 by avoidiq uti.D illll1l1llllJliolia 8dmiaiMrIåoD to WOIII8 wi8b . D-nep8ivefeta8. rar predIctina D pbeaotype hm DNA or mANA areb88ed oa tbe dopIa tb8t,willaoaly vrtty rue u.cepdca..Ibe D-aeptM pbIIIotyp8 reRIt8 hm tbe lIIIIace of aU or lIIOIt of Ibe RHD MoIt bowwver. have bola p*lbmled lID people of Europ8ID orip.. ad the molecul8r t.ia of D poIymorpIIiIm hM not be8 8decr-'Y iDveItip8ld iD otb8 r--. pIdicuIIrty iD people of AIiic8D urip W. have tn8ed rar the preMIICII of tbe RHD ... ja AtticIa8 .. AJiic:Ia Amå:8aa ad fouDd ... tbe ~urity of D-nepdve AIti~ 8Dd about a quuW of D-nepdve Aftica Anaaic8u have - ill8Ctive RHD ... willa . 37 b8Ie pair All ~ -. --- (bp) u-t RJlD.CB-O ... or. ~ mutItIoD;tbeJ'IID8indIr haveoi.. tbe deletiaaof dieRHD.... M8t8rI."8nd rnethoda -- ~ aaIIIawII au. . ~ blå ScIu*AIdc8 wI*... ~-...-- a- ltHD 37 bp ~ CPD~ \AJI~"" Im .,.u.e; SI.-AIti:II. PooJe. l!D8J8d). II1II GIlla-- ., -- (MI8I.MACI 1ba ... 2 CJ'I'Iaa till BIood ...... ((~~: .. rr-tpe"'" la MIJI8,I"'" cbIaridI.CUM+~ a-. EIIII8d) '" -r-' ilad 1..- wilillIIIIia)34 wIIoI8 bIoDdiD -- ... cuItInII il .....- 01 , ~ ...... - >.r« _iDIIII -(rH)81)"""" (JIoIII. o.aepdw biocid -- obIUI8d~ bI8drAJHc8bIaad..... (N.v.IIJCb8, rIJIIIr '... FråII8t, 0.-,), dl ~ coIo8y hD 9011* AtrIc8, ZImbIIIwe. ... o-.; ... SoIåAAie8 al oI!-~ lIc8ar (UD 9ya8aa, AIIiJIIda8, Bn8Jand), lIId rH ~ mis8dr-. ndIImd tD "CoJoInd" 18SoIå AAica; 111111taIIIAttc88 '" MaIiklit aLD A-'~ die al ~-. 1taIII SIIn._1, ...3 (IL-])~ Sy8a),. cIa8arib8d AIW II cI8J8, ceIIa-- l8n88IdlIId lir die ~ till LouiIiIM. 8Iood hD l)..pIIIiIM bilat SoIå AIto8aI ~ A (OPA) .. RhproIIiIL 11118 ICCG8lpllIIIed 1IIin8 dldwdha -IIUIIJ.. All biocid coIIed8II iDID . citn".t"jL~t . .h..d.-(aD)~BIood III8IIIbrcytI8IIIIJ widt - 1lio8ii lIIIIIodIII BRJC ~ lIId BRIC 69 (UKW. BrI8I. EaPad). BRIC ~ cII8IcI8. - ... ~ ~ -- dieby-pIoducI albIaad ... - .- -- - -- tD die approvedpnJIDIXII 01... lif8DIftI8aa coI1ectIII iJlftIIMIL ww. albIood, .. ~ ,. -- widI iDIxmaII---. - r ........ ,- . - CIIdIIDIIJDIIr"'" .. .... .. BRIC 69 --Jular lUaDpa/JIpIpfIdIL About 809601... c:IIII8 bodI Rh """'II1II aPA. WI iIoIaIId IIIRNA fnm 101ceIIa(1be PoIyA'nnct SY*D 1000!dl; PrcnIp). JIIna.8rIM cDNA !lir rea .""'111 .11118 widI ID till GPA. -...,.. . ... RHCcII8 lIId -- 01'" (4T..)."""'" m.""""""" vfn8 ~ tbr D. C.o,S. .. G,vs. 8Dd1Ul32........ till (PII88dI, MIIat lt.IJI8, Bap8d). D cDNA -1IIIpIHIId wtdI die vs+ aI8o tbr V II1II S8nJIoaicaI (III 457-476, pedIn8d by ... lIIIIbDd JIIO8t tD ... pardcuIarJ'IIIIIIII: dInICt fbIJoIriIIIpr-..: 5'.aGAOOATOOTCATCAGrAA-3' ,,---,1ItI88tIcII.willllI8Iheor~ cIIIJI, . All ... eeO ar iIIdINct laG(BPL.EJ--. liDada8wllIa C8II8 by . kDowIIlD I'118III wItIa l'1li IIIIIW (I!1Mit II, O- ... lIoIIcuIIr ,... o.- DNA DNA ltc:IIIoa ~ kJt .. .......... - l!II8J8d). All I).aepdw red witII 2 paI88 IIJoIaIi-Ddill -- .. - 01111pIId8I D pbenatyp8LAll lCiHIuIiG8 HauI8a8, TX)BioJoP:aIa, 3 till lHCIl ... 914-891, tbr -- 5'.QAGATCAOCCCAOCCAC-3' bp pI'CI8at ... (III ~ la addiIIa8, . l/lD.tp8aitc rea wiå . pm- il ... 3 (RHDEX3', 1'IbI8 I) ... . " -- 7 (5' -ACCCAOCAAOCTOAAO1TOTAOCC-J') . 645 bp prodDatwiIIIlHD cDNA. Al . CCIIIInII. . RNa""'" II1II wItIa 8111i-D. to on g8ftOftIIcDNA CAOCOOO-J') rea _-W .-- OIIIwiIiI. - pn..1a-- 3(5'-'J'COOTOC1'OA1'- ... ~ la . .. 7(5'~TCAT. to81" . 715bp wiIIIllIa aDNA. ........ 0CCATI'QCC01TCX-3') Mt'II " ~ RNA!hin. D-nIpIM bIaak SaadI AMc8 abIIoI pIUC8Ihn ...!'08wIIoI8bIoDII wiIIIl +.. -- 10mL01""'" buIJIncIw'". ull," , WI).reasm- .. la '" iIGIIdIIICD71 iIolIIId !'08 ("-P. RHl1) ... 6 tIllJHa ... nID). 1ba..,. c:eIIIby I