Optimal blood grouping and antibody screening for safe transfusion.

(Full text is available at http://www.manu.edu.mk/prilozi). Introduction. Blood group antigens as integrated parts of the red cell membrane have many essential functions for the cell as well as for the organism, but they are recognized as unique antigens for the purpose of safe blood transfusion. Especially in the case of those with great clinical importance because of their involvement in haemolytic transfusion reactions and hemolytic disease of the newborn, it is very important that they be correctly, and some of them routinely, typed in blood donors as well as in patients. Aim. Evaluation of Rh and Kell blood group antigen frequencies in blood donors as well as the incidence of alloimmunization in transfused patients in the Macedonian population. The need for routine typing of certain blood group antigens in addition to ABO and RhD was also evaluated. Material and method. We evaluated data from 1600 ABO/Rh and Kell typed blood donors (from January 2003 to May 2008), as well as the data from pretransfusion testing (ABO/RhD blood typing, irregular red blood cell antibody screening and compatibility testing) and antibody identification in the period from January 2005 to November 2008. All tests were performed by the DiaMed micro tube gel system. Results. The frequencies of ABO antigens were as follows: A (39.7%), O (38%), B (14.1%), AB (7.4%). The frequencies of Rh antigens were as follows: D pos. (84.2%), D neg. (15.8%), C (58.3%), c (82.4%), E (21.3%), e (97.1%). We found the following frequencies of Kell phenotypes: K+ k- (0.25%), K+ k+ (6.18%), and K- k+ (93.6%) with the total frequency of K antigen of 6.4%. Antibody screening and/or cross-match were positive in the sera from 150 transfused patients. In 75 (50%) sera the following 81 antibodies were identified: anti-K (26), -E (25), -e (1), -C (4), -c (6), -C(w) (2), -k (1), -Fy (a) (3), -Fy(b) (1), -Jk(a) (3), -Lu(b) (1), -Le(b) (2), -Le(a) (1), -M (4), -P1 (1). The most frequent alloantibody was anti-K with 32%, and anti-E with 30.8% of all identified antibodies. Conclusion. Alloimmunization to red cell antigens is still a current problem in our transfusion practice. It is obvious that the additional testing of blood donors for Rh and Kell antigens should be implemented as a routine to prevent as far as possible the incidence of alloimmunization. It would also be cost-effective, bearing in mind the additional laboratory testing necessary to provide compatible blood for alloimmunized patients. Extended blood typing should be implemented for some categories of polytransfused patients as well. This strategy is another step forward to improve the safety of blood transfusion with optimal blood grouping. Key words: Kell phenotypes frequency, alloimmunization, blood grouping, safe transfusion.

Comparative analysis of national regulations concerning blood safety across Europe.

In October 2001, representatives of 17 European countries (Albania, Bosnia-Herzegovina, Bulgaria, Croatia, Czech Republic, Federal Republic of Yugoslavia, Finland, France, Germany, Greece, Italy, Macedonia, Romania, Slovenia, Spain, Turkey and UK) met in Sarajevo at a course organized by the European School of Transfusion Medicine to discuss their countries' regulations concerning different aspects of the safety of blood transfusion. Results are summarized in tables to facilitate comparisons. Most countries (13/17) have specific transfusion laws and 9/17 have hospital-based systems as opposed to national organizations. Quality assurance is common among investigated countries (14/17). Voluntary associations are responsible for donor promotion in the majority of countries (13/17). Exclusively, voluntary non-remunerated donors are found in 5/17 countries, whereas in the remaining ones, incentives, family replacement and remuneration are mechanisms stimulating blood donation. Medical doctors using official selection criteria are checking donor suitability in virtually all countries, which also perform main microbiological testing. Regulations on good clinical use of blood and derivatives are present in most countries but applied only in some. Although the data presented need to be interpreted with some caution, this preliminary analysis shows that, although some significant differences still exist, the majority of countries studied are moving in the same direction to ensure safety of their blood supply.

HLA genes in Macedonians and the sub-Saharan origin of the Greeks.

HLA alleles have been determined in individuals from the Republic of Macedonia by DNA typing and sequencing. HLA-A, -B, -DR, -DQ allele frequencies and extended haplotypes have been for the first time determined and the results compared to those of other Mediterraneans, particularly with their neighbouring Greeks. Genetic distances, neighbor-joining dendrograms and correspondence analysis have been performed. The following conclusions have been reached: 1) Macedonians belong to the "older" Mediterranean substratum, like Iberians (including Basques), North Africans, Italians, French, Cretans, Jews, Lebanese, Turks (Anatolians), Armenians and Iranians, 2) Macedonians are not related with geographically close Greeks, who do not belong to the "older" Mediterranenan substratum, 3) Greeks are found to have a substantial relatedness to sub-Saharan (Ethiopian) people, which separate them from other Mediterranean groups. Both Greeks and Ethiopians share quasi-specific DRB1 alleles, such as *0305, *0307, *0411, *0413, *0416, *0417, *0420, *1110, *1112, *1304 and *1310. Genetic distances are closer between Greeks and Ethiopian/sub-Saharan groups than to any other Mediterranean group and finally Greeks cluster with Ethiopians/sub-Saharans in both neighbour joining dendrograms and correspondence analyses. The time period when these relationships might have occurred was ancient but uncertain and might be related to the displacement of Egyptian-Ethiopian people living in pharaonic Egypt.