The Study Of HPA1?18 And RHD Genes Polymorphism And The Evaluation Of The Efficacy Of Platelet Transfusions In The Northern Of Henan Province

BackgroundWith the development of component transfusion,platelet transfusion was a clinically effective way to prevent and treat bleeding disorders.However,human platelet antigen(HPA)had genetic polymorphisms,it was easily to result in platelet transfusion refractoriness(PTR)and neonatal alloimmune thrombocytopenic purpura(NAITP)and post-transfusion purpura(PTP)and other alloimmune thrombocytopenic purpura for repeated blood transfusions or multiple pregnancy patients.However,HPA had genetic polymorphisms,it was easily to result in alloimmune thrombocytopenias such as platelet transfusion refractoriness(PTR),neonatal alloimmune thrombocytopenic purpura(NAITP),post-transfusion purpura(PTP)for repeated blood transfusions or multiple pregnancy patients.At present,although it has not been found that RHD antigens were expressed on the platelet surface,it could lead to fetal or neonatal hemolytic disease when Rh(D)negative pregnant women with normal immunity generated antibodies against Rh(D)antigen transfused apheresis platelets containing a small amount of red blood cells.HPA polymorphisms existed ethnic and regional differences,and RHD gene existed variants.Objective1.HPA genotyping,HPA gene polymorphism analysis and establishment of Platelet genotyping database were performed on the voluntary blood donors without platelet antibody in the Northern of Henan.The research of RHD gene polymorphism was performed on the Han nationality of Rh(D)negative in Xinxiang prefecture in Henan.2.They infused the same type of ABO and HPA apheresis platelets to patients with antibody screened positive and then evaluated its efficacy.Method1.Solid state agglutination was performed to screen platelet antibodies in thevoluntary blood donors and patients.2.ABO and Rh blood group phenotype on red blood cell surface were measured by Olympus PK7200 blood analyzer.3.PCR-SSP were used to perform HPA1~18 system genotyping of 500 Han blood donors in the Northern of Henan Province,and RHD genotyping of Rh(D)negative platelet donors.4.Serum groups reactive antibodies were detected by means of HLA-specific antibodies test kit for PTR patients.For HLA antibodies negative patients,platelet antibody was identified using the standard spectrum platelet of known HPA genotypes,and then HPA genotyping was performed on HPA antibodies positive patients.5.They carried out infusion platelets of the same type of ABO and HPA to PTR patients and evaluated its efficacy through the CCI and PPR.Result1.The platelet antibody screening results of patients and voluntary blood donors showed that compared with blood transfusion history less than three times,male patients with transfusion history more than three times had a higher probability to produce antibodies;compared with blood transfusion history three more than times and no pregnancy history,women patients with pregnancy history more than three times and no blood transfusion history had similar rates to produce antibody;male voluntary blood donors were not detected platelet antibody;compared with pregnancy history less than three times,female voluntary blood donors pregnancy history more than three times had a higher probability to produce antibody.2.The results of HPA1~18 genotyping showed that 500 volunteer blood donors were only detected a allele and aa genotype of HPA-4~14,16~18 in Northern of Henan Province;HPA-1,2 mostly aa type,a small amount of ab-type,non-bb-type;HPA-3,15 mostly polymorphic,they were expressed aa,ab,bb genotype;Allele frequencies of HPA-1a,2a,3a,15 a were 0.985,0.924,0.469,0.532 respectively.3.The results of RHD genotyping showed that the RHD gene variant of 48 cases Rh(D)negative were mainly RHD gene whole deletion in 30 cases,accounting for62.5%,DEL RHD1227 A heterozygous in 12 cases(25%),the type of RHD-CE(2-9)-D variation 4 cases(8.33%),we were unable to determine the type of mutation in 2 cases;among 48 Rh D negative individuals,there was four Rh phenotypes: 29 cases of ccdee(60.4%),14 cases of Ccdee(29.2%),3 cases of CCdee(6.25%),2 cases of ccd Ee(4.2%).4.Among 52 cases PTR patients,there were platelet antibody screening positive in23 cases(44.2%),including HPA alloantibody positive in 5 cases(2 cases anti-HPA-3a,3 cases anti-HPA-15b),another 18 cases were HLA antibody positive(78.3 %).5.It was transfuse platelet of ABO and HPA of the same type to the patients containing HPA antibodies,and the efficacy of platelet transfusion evaluation(CCI and PPR)was significantly better than random platelet transfusion.Conclusion1.HPA1,2,3,15 have polymorphism and RHD gene variants includes RHD gene whole deletion,DEL RHD1227 A heterozygous and RHD-CE(2-9)-D of Rh(D)negative individual in Northern of Henan Province.2.It can improve platelet transfusion that HPA antibody-positive patients transfusion HPA and ABO of the same type platelet.