Few countries in sub-Saharan Africa make systematic searches for antigens C, c, E, and e of the Rh and Kell system antigens in the donor and recipient, thereby exposing transfused patients.
In Cote d’Ivoire and in other African countries [
Unfortunately, in sub-Saharan countries, few practice this systematic search for antigens C, c, e, E, and K in the donor and recipient, thereby exposing the transfused patient to high risk of alloimmunization [
Very few studies are available, reporting antigens frequencies of Rh and Kell blood groups in sub-Saharan countries.
This study is the first report on the frequency of blood groups system Rh and Kell in blood donors in Cote d’Ivoire. This work will perform Rh and Kell red cell typing among blood donors by traditional techniques to implement this into the routine for blood donors and recipients. It also allows us to determine the frequency of the major Rh and Kell blood group antigens and phenotypes commonly found among blood donors from Cote d’Ivoire to improve transfusion practices.
It was a retrospective study conducted at the Laboratory of Immunohaematology of the National Blood Transfusion Center of Abidjan, the capital of Cote d’Ivoire.
We analyzed grouping data in Rh and Kell blood group systems from 651 volunteer regular blood donors coming to the national blood on one year. The blood donors have an age range from 18 to 60 years.
Those excluded from donating blood fell within the following categories: taking drugs for high blood pressure or heart failure; having Hb below 11 g/dL (for females) or 12 g/dL (for males); testing positive for HBsAg, HCV, and HIV antibodies and syphilis; having had jaundice, liver disease, epilepsy, diabetes, duodenal or gastric ulcer, asthma, tuberculosis, or other pathology; taking self-injected drugs; having sickle cell disease; being a prostitute and/or homosexual; having severe weight loss within the last six months.
For optimal results, the determination was performed using a tube freshly drawn into ethylenediaminetetraacetate according to manufacturer’s instructions. The techniques are direct agglutination of the antigens with slide technique for Rh system antigens and indirect antiglobulin technique by tube technique for Kell system antigens. Rh phenotyping was done using five monoclonal monospecific antisera: anti-D, anti-E, anti-C, anti-c, and anti-e while Kell phenotyping was performed with anti-K according to manufacturer’s instructions. All reagents were supplied by Orgenics PBS, Eurobio.
Positive and negative control red cells and Coombs’ control cells were also performed as controls. Data were entered and analyzed with Epi Info version 6.1.
We determined blood group antigens in 651 donors with sex ratio 3.6 in favor of men.
605 blood donors representing 92.93% of the blood donors were found to be RhD positive while 46 blood donors representing 7.07 were found to be RhD negative (Figure
Prevalence of RhD antigen in blood donors.
The c and e antigens have the highest frequency with 99.83%. C and E antigen were less frequent with 21.97% and 13.82%, respectively (Table
Rh and Kell antigens frequency among 651 Ivorian blood donors.
Antigens | RhD negative donors | RhD positive donors | Total | |||
---|---|---|---|---|---|---|
|
% |
|
% |
|
% | |
c+ | 46 | 100 | 604 | 99,83 | 650 | 99,85 |
e+ | 46 | 100 | 604 | 99,83 | 650 | 99,85 |
C+ | 9 | 19,57 | 134 | 22,15 | 143 | 21,97 |
E+ | 0 | 0 | 90 | 14,88 | 90 | 13,82 |
|
||||||
k | 650 | 99,84 | ||||
K | 5 | 0,77 | ||||
Kpa | 4 | 0,61 | ||||
Kpb | 539 | 82,80 |
Seven phenotypes were detected among the blood donors (Table
Rh and Kell phenotypes frequencies in Cote d'Ivoire blood donors (
Antigens | Phenotypes | Genotypes | Number | Frequency % | |
---|---|---|---|---|---|
Wiener | Fischer race | ||||
Rh positive donors | 605 | ||||
D+C−E−c+e+ | R0r | R0r |
Dce/dce |
394 | 65,12 |
D+C+E−c+e+ | R1r | R1r |
DCe/Dce |
121 | 20,00 |
D+C−E+c+e+ | R2r | R2r |
DcE/dce |
77 | 12,73 |
D+C+E+c+e+ | R1R2 | R1R2 |
DCe/DcE |
12 | 7,00 |
D+C+E+c−e− | RzRz | RzRz |
DCE/DCE |
1 | 0,17 |
Rh negative donors | 46 | ||||
D−C−E−c+e+ | rr | rr | dce/dce | 37 | 80,43 |
D−C+E−c+e+ | r′r | r′r | dCe/dce | 9 | 19,57 |
|
|||||
Kell | |||||
K−k+ | 645 | 99.08 | |||
K+k+ | 5 | 0.77 | |||
K−k−(k0) | 1 | 0,15 |
In the Kell blood group system, 5 blood donors (0.77%) were typed as K antigen positive and 645 (98.08%) as k antigen positive antigens. Accordingly, the K−k+ phenotype was the most common in these donors (98.92%).
Our study focused on 651 regular and volunteer blood donors who have made donations at the National Blood Transfusion Center. The techniques used were the traditional techniques of agglutination on slide or in tube (indirect antiglobulin). Although recent years have been marked by the appearance of microtechnology, we wanted to show that, even with traditional techniques, such typing can be performed in a department with limited resources. The findings in our study will introduce plan for better care of the patients.
After ABO blood group, the Rh system is the most important in transfusion medicine. In Cote d’Ivoire, the blood transfusions are done only regarding ABO and RhD antigens exposing patients to high alloimmunization. Akre [
In our study, the frequency of D antigen was 92.93%. This is comparable with the findings in the north of Cote d’Ivoire [
Antigens frequencies of Rh blood group compared with published results.
Antigen | Our study ( |
Our study (%) | North Cote d’Ivoire [ |
Mauritania [ |
Guinea [ |
Cameroun [ |
Nigeria [ |
Antananarivo [ |
Morocco [ |
India [ |
Iran [ |
USA [ |
---|---|---|---|---|---|---|---|---|---|---|---|---|
D+ | 605 | 92,93 | 92.5 | 94,2 | 95,9 | 95 | 81,5 | 98,9 | 90,5 | 94,4 | 90,2 | 85.4 |
D− | 46 | 7,70 | 7.5 | 5,77 | 4,06 | 6 | 18,5 | 1,1 | 9,5 | 5,64 | 9,8 | 14.6 |
c+ | 650 | 99,85 | 97,5 | 73,9 | ||||||||
e+ | 650 | 99,85 | 97,5 | 97,9 | ||||||||
C+ | 143 | 21,97 | 95 | 75,9 | ||||||||
E+ | 90 | 13,82 | 92,5 | 29,5 |
The prevalence of the RhD negative is 7.7%. These results agree with the work of Seka [
The frequencies of c and e antigens in our study are high (99, 85%) (Table
In the Rh system, seven phenotypes on eighteen known [
The importance of this system is due to the K antigen, which has strong immunogenicity. It is among the most immunogenic system after the Rh system.
In the Kell system, k antigen was found in 98.92% of blood donors which is comparable with frequency in whites.
The prevalence of K antigen was found to be 0.92% of donors enrolled in the study, contrary to France where 9% of individuals are K+ [
The most common phenotype was K−k+ which is also common in white people. The antigens
Immunohematology data on blood donors are very few in West Africa. The ABO and D antigens are the main examination; other investigations are not performed.
Furthermore, Africa is full of its own specificities that are important to note for better care of patients by improving routine tests like phenotyping red cells, screening, and identifying red cells antibodies.
Research in that field should benefit from common work from West Africa national blood transfusion centers to enhance safety in transfusion medicine.
The authors declare that there is no conflict of interests regarding the publication of this paper.