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Baldota R, Kakkar B, Ketkar S, Patil M. Hidden in plain sight: Detecting rare naturally occurring anti-K antibody in a blood donor. Transfus Apher Sci 2025; 64:104109. [PMID: 40081193 DOI: 10.1016/j.transci.2025.104109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 02/26/2025] [Accepted: 03/07/2025] [Indexed: 03/15/2025]
Abstract
Red cell alloimmunisation is commonly reported among pregnant, transplant and multitransfused patients, whereas it is a fairly rare occurrence in the healthy general population. We report a rare case where we detected naturally occurring anti-K antibody in a healthy male whole blood donor during routine antibody screening.
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Affiliation(s)
- Rutuja Baldota
- Department of Transfusion Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra 411004, India
| | - Brinda Kakkar
- Department of Transfusion Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra 411004, India.
| | - Sanjiv Ketkar
- Department of Transfusion Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra 411004, India
| | - Manaswi Patil
- Department of Transfusion Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra 411004, India
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Al-Allawi N, Al-Mousawi MM, Al Allawi S, Ibrahim KJ. Alloimmunization in β-Thalassemia and Sickle Cell Disease in Middle Eastern Countries: A Systemic Review. Hemoglobin 2025; 49:126-140. [PMID: 40069098 DOI: 10.1080/03630269.2025.2471923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 02/11/2025] [Accepted: 02/13/2025] [Indexed: 04/22/2025]
Abstract
Sickle cell disease and β-thalassemia are important health problems in Middle Eastern countries. Transfusion is the cornerstone of the management in these disorders, and red blood cell alloimmunization is among the well-recognized adverse effects associated with it. We reviewed the literature on published studies on alloimmunization prevalence, its associated risk factors, and transfusion policies employed in these countries. Our review included 39 studies on thalassemia (including 9005 patients), and 19 on sickle cell disease (including 3867 patients). The mean alloimmunization prevalence rate in thalassemia was 13.0% (95% CI: 10.0-15.0%), while that in sickle cell disease was 14.0% (95% CI: 10.0 - 19.0%). The distribution of the prevalence rates showed considerable heterogeneity in both diseases. The most frequent alloantibodies detected were anti-K (25.9%), Anti-E (21.8%), and Anti-D (9.2%), with Rhesus and K antibodies comprising 74.2% of all antibodies detected. Some risk factors were significant in several studies, including older age, female sex, older age at first transfusion, number of transfused units, and splenectomy. The prevalence of alloimmunization was significantly higher in retrospective studies compared to cross-sectional ones, in both thalassemia and sickle cell disease (P = 0.04 in each). This review reaffirmed the need to provide ABO+Rhesus + K matched blood to hemoglobinopathy patients in the Middle East, and the need for more research on Rhesus variants in this part of the world.
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Affiliation(s)
- Nasir Al-Allawi
- Department of Pathology, College of Medicine, University of Duhok, Duhok, Iraq
| | | | - Sarah Al Allawi
- Department of Medicine, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA, USA
| | - Kevi J Ibrahim
- Department of Hematology, Maternity Hospital, Duhok, Iraq
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Yovera-Ancajima CDP, Calderon Cumpa LY, Lezama-Cotrina ID, Walttuoni-Picón E, Cárdenas-Mendoza WW, Culqui-García JE, Retuerto-Salazar WR, Céspedes Poma RC. Phenotypic Identification of Blood Groups in Blood Donors: A Peruvian Multicenter Analysis. J Blood Med 2025; 16:41-49. [PMID: 39902094 PMCID: PMC11789512 DOI: 10.2147/jbm.s475336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 12/02/2024] [Indexed: 02/05/2025] Open
Abstract
Background Red blood cell alloimmunization currently continues to be a significant problem during the blood transfusion process, where phenotypic identification plays a clinically relevant role in its prevention. The objective of the study was to carry out the phenotypic identification of blood groups in blood donors from three hospitals in Lima. Methods A cross-sectional study was conducted, including 20,141 blood donors in three hospitals in Lima, Perú during the period from January to June 2023. Red blood cell phenotyping was performed by the gel agglutination method using gel cards with the IH-500 automated system. Results A predominance of donors within the age group of 29 to 38 years (30.9%) was observed, with the majority being men (69.5%). Most donors were Peruvian (97.9%), and among foreign donors (2.1%), Venezuelans predominated (1.5%). In the distribution of the ABO and RhD blood groups, the O Rh+ phenotype predominated in 79% of the donors. In the phenotypic distribution of the Rh system, the presence of the D antigen was observed in 98.1% of the donors, with the c phenotype being the most frequent (76.4%). For the Kidd system, 70.7% of the donors presented the Jka antigen and 81.9% the Jkb antigen. In the Duffy system, 77.7% of the donors presented the Fya antigen and 50% the Fyb antigen. For the MNS system, 93.7% of donors had the S antigen and 76.1% had the s antigen. It was also found that 1.5% of donors are carriers of the Kell antigen, all of which are clinically important. Conclusion The phenotypic identification of blood groups in blood donors from three hospitals in Lima highlighted the clinical relevance of identifying less common antigens in the Kell, Kidd, Duffy, and MNS systems to prevent alloimmunization during blood transfusions.
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Affiliation(s)
- Cleofe del Pilar Yovera-Ancajima
- Comunidad de conocimiento: Enfermedades infecciosas y no infecciosas tropicales, Universidad Nacional Federico Villarreal, Lima, Perú
- Centro de Hemoterapia y Banco de Sangre tipo II Hospital Nacional Cayetano Heredia, Lima, Perú
| | - Luis Yuri Calderon Cumpa
- Comunidad de conocimiento: Enfermedades infecciosas y no infecciosas tropicales, Universidad Nacional Federico Villarreal, Lima, Perú
- Centro de Hemoterapia y Banco de Sangre tipo II Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | - Irene Doraliza Lezama-Cotrina
- Comunidad de conocimiento: Enfermedades infecciosas y no infecciosas tropicales, Universidad Nacional Federico Villarreal, Lima, Perú
- Centro de Hemoterapia y Banco de Sangre tipo II Hospital María Auxiliadora, Lima, Perú
| | - Eder Walttuoni-Picón
- Comunidad de conocimiento: Enfermedades infecciosas y no infecciosas tropicales, Universidad Nacional Federico Villarreal, Lima, Perú
| | - Wilmer William Cárdenas-Mendoza
- Comunidad de conocimiento: Enfermedades infecciosas y no infecciosas tropicales, Universidad Nacional Federico Villarreal, Lima, Perú
- Servicio de Emergencia. Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | - Jennie Evelyn Culqui-García
- Comunidad de conocimiento: Enfermedades infecciosas y no infecciosas tropicales, Universidad Nacional Federico Villarreal, Lima, Perú
| | - Wilmer Raul Retuerto-Salazar
- Comunidad de conocimiento: Enfermedades infecciosas y no infecciosas tropicales, Universidad Nacional Federico Villarreal, Lima, Perú
| | - Roberto Carlos Céspedes Poma
- Comunidad de conocimiento: Enfermedades infecciosas y no infecciosas tropicales, Universidad Nacional Federico Villarreal, Lima, Perú
- Instituto de Estandarización En Laboratorio Clínico Del Perú, Lima, Perú
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Yamada C, Ono T, Ino K, Nemoto N, Shinba T, Furumaki H, Shibata H, Ishizuka K, Yamada N, Matsuura H, Izuhara Y, Fujihara H, Minamiguchi H. The development and evanescence of red blood cell antibodies after transfusion: A multi-institutional prospective study in Japan. Transfusion 2024; 64:1980-1992. [PMID: 39288000 DOI: 10.1111/trf.18009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Despite several reports on red blood cell (RBC) alloimmunization, the actual prevalence and factors contributing to RBC alloimmunization in transfused patients remain poorly investigated. We examined the association between clinical factors and the development and evanescence of RBC antibodies after transfusion. STUDY DESIGN AND METHODS Each participating institution performed antibody screens before and after RBC transfusion. A survey including patient characteristics, results of antibody screen and identification, antibody screen methods, total amount of RBC transfused, and adverse reactions, was conducted. RESULTS Between October 2018 and March 2023, 1194 patients were registered at five institutions. Overall, 958 patients underwent at least one follow-up RBC antibody screen after transfusion, revealing new antibody development in 44 (4.6%). Anti-E was identified in 25 patients, anti-Jka in 5, and anti-c in 4. The number of RBC units transfused was significantly associated with antibody development after transfusion (p < .001). Among 55 patients in whom antibodies were identified after transfusion, including historical antibodies, antibodies evanesced in 18 (33%); anti-E in 7, anti-Jka in 4, and anti-Lea in 2. Evanescent antibodies were identified more frequently by saline and/or enzyme methods than persistent antibodies (p = .012). DISCUSSION The number of RBC units transfused can impact antibody development, and antibodies identified only by saline and/or enzyme methods, deemed clinically insignificant, are likely to have a high evanescence rate. Antibody screen should be carefully performed, especially in those receiving a large number of RBC units. Confirming previous antibody screen results should be performed to prevent omitting evanesced antibodies regardless of clinical relevance.
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Affiliation(s)
- Chiaki Yamada
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takaaki Ono
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kaede Ino
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Nemoto
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takahito Shinba
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroaki Furumaki
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroki Shibata
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keiko Ishizuka
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naotomo Yamada
- Department of Transfusion Medicine, Saga University, Saga, Japan
| | - Hideaki Matsuura
- Department of Blood Transfusion, Fujita Health University, Toyoake, Japan
| | - Yumiko Izuhara
- Division of Transfusion Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Harumi Fujihara
- Transfusion Medicine & Cell Therapy, Kochi University, Kochi, Japan
| | - Hitoshi Minamiguchi
- Blood Transfusion and Cell Therapy Center, Shiga University of Medical Science, Otsu, Japan
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Datta SS, Sinha A. Current challenges of blood transfusions in patients with thalassemia in India and future perspectives. Transfus Clin Biol 2024; 31:162-166. [PMID: 38513824 DOI: 10.1016/j.tracli.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/15/2024] [Indexed: 03/23/2024]
Abstract
The introduction of regular red blood cell transfusions transformed thalassemia major from a fatal childhood disease into a chronic disorder. Thalassemia is highly prevalent in South Asia, including the Indian subcontinent, and blood transfusion remains the cornerstone of management for these patients. But safe blood transfusions still remain a major problem in India. Difficulties in maintaining adequate blood inventory, a lack of a national blood act, and fragmented blood transfusion services are some of the major contributing factors for the delay in blood supply. In most of the blood centers, alloantibody detection facilities and extended red cell antigen typing are unavailable. Awareness is the key to reducing alloimmunization, which limits the effectiveness of transfusions and the potential availability of blood. Patients with thalassemia are also at high risk of transfusion-transmitted infections unless appropriate blood screening is in place. Hence, many patients remain under-transfused, resulting in decreased health and quality-of-life outcomes. Facilities such as leucoreduction and immunohematological monitoring following a blood transfusion are often lacking in India, especially at the sub-district level. Continuous efforts to raise community awareness, regular training of health-care workers, and proper utilization of available resources are essential to ensuring safe blood transfusions for patients with thalassemia. Access to the new treatments at an affordable cost may reduce the blood transfusion burden for thalassemia patients in India.
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Affiliation(s)
- Suvro Sankha Datta
- Department of Transfusion Medicine, Tata Medical Center, Kolkata, India.
| | - Ayesha Sinha
- Department of Transfusion Medicine, Tata Medical Center, Kolkata, India
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'Adani SN, Mohd Ashari NS, Johan MF, Edinur HA, Mohd Noor NH, Hassan MN. Red Blood Cell Alloimmunization in Pregnancy: A Review of the Pathophysiology, Prevalence, and Risk Factors. Cureus 2024; 16:e60158. [PMID: 38868295 PMCID: PMC11167514 DOI: 10.7759/cureus.60158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/14/2024] Open
Abstract
This review paper provides an overview of the risk factors and laboratory testing for red blood cell (RBC) alloimmunization in pregnancy. RBC alloimmunization is a significant medical issue that can cause haemolytic disease of the fetus and newborn (HDFN), leading to neonatal morbidity and mortality. Current HDFN prophylaxis targets only Rhesus D (RhD) alloimmunization, with no effective measures to prevent alloimmunization to other RBC antigen groups. Several factors can increase the risk of developing RBC alloimmunization during pregnancy, including fetomaternal haemorrhage, RBC and maternal genetic status, and previous transfusions. Identifying these risk factors is essential to execute the appropriate management strategies to minimize the risk of HDFN. The review also discusses the laboratory methods and overview of pregnancy management. The paper highlights the importance of identifying and managing the risk factors for RBC alloimmunization in pregnancy to minimize the risk of HDFN and improve neonatal outcomes.
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Affiliation(s)
- Sanusi Nurul 'Adani
- Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | | | - Muhammad Farid Johan
- Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Hisham Atan Edinur
- Forensic Programme, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | | | - Mohd Nazri Hassan
- Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
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Chenna D, Polavarapu I, Shastry S. Prevalence of blood group antigens among regular blood donors: A single center study from South India with a review of national literature. Transfus Apher Sci 2023; 62:103747. [PMID: 37316433 DOI: 10.1016/j.transci.2023.103747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVES The antigen frequencies vary across different regions and ethnic groups. Hence, we aimed to study the prevalence of blood group antigens in our population and to systemize the zone-wise prevalence of the same across India. MATERIALS AND METHODS Regular voluntary O group blood donors were screened for 21 blood group antigens; C, c, E, e, K, k, Kpa, Kpb, Jka, Jkb, Fya, Fyb, Lea, Leb, Lua, Lub, P1, M, N, S, s, using commercially available monoclonal antisera by column agglutination technology. A literature search was performed to identify all the studies that reported blood group antigens prevalence to estimate the zone-wise prevalence of these antigens in the country. RESULTS A total of 521 participants of 9248 O group donors meeting all the inclusion criteria were included. Among the study group, the male-to-female ratio was 9:1 with a mean age of 32.6 years (±10.01) ranging from 18-60 years. The majority of the donors 446 (85.6%) were D positive. The most common phenotypes among Rh, Lewis, Kell, Duffy, Kidd, Lutheran and MNSs were CcDee (34.93%), Le(a-b+) (61.80%), K-k+(98.27%), Fy(a+b-) 43.19%, Jk(a+b+) 42.61%, Lu(a-b+) ( 99.61%), M+N+ (48.17%), S-s+ (45.29%) respectively. The prevalence of D and E antigens was significantly lower in the South zone compared to other zones of India. CONCLUSION Significant difference in the prevalence of blood group antigens is observed between the South and other zones of India. Zone-wise prevalence of blood group phenotypes is essential in the timely management of alloimmunized patients.
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Affiliation(s)
- Deepika Chenna
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
| | - Isha Polavarapu
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India; Department of Transfusion Medicine, Yashoda Hospitals, Hitech City, Hyderabad
| | - Shamee Shastry
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
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He XH, Yan H, Wang CY, Duan XY, Qiao JJ, Guo XJ, Zhao HB, Ren D, Li JS, Zhang Q. Comparison of the conventional tube and erythrocyte-magnetized technology in titration of red blood cell alloantibodies. World J Biol Chem 2023; 14:62-71. [PMID: 37273684 PMCID: PMC10236968 DOI: 10.4331/wjbc.v14.i3.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/16/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Erythrocyte alloantibodies are mainly produced after immune stimulation, such as blood transfusion, pregnancy, and transplantation, and are the leading causes of severe hemolytic transfusion reactions and difficulty in blood grouping and matching. Therefore, antibody screening is critical to prevent and improve red cell alloantibodies. Routine tube assay is the primary detection method of antibody screening. Recently, erythrocyte-magnetized technology (EMT) has been increasingly used in clinical practice. This study intends to probe the application and efficacy of the conventional tube and EMT in red blood cell alloantibody titration to provide a reference for clinical blood transfusion.
AIM To investigate the application value of conventional tube and EMT in red blood cell alloantibody titration and enhance the safety of blood transfusion practice.
METHODS A total of 1298 blood samples were harvested from blood donors at the Department of Blood Transfusion of our hospital from March 2021 to December 2022. A 5 mL blood sample was collected in tubing, which was then cut, and the whole blood was put into a test tube for centrifugation to separate the serum. Different red blood cell blood group antibody titers were simultaneously detected using the tube polybrene test, tube antiglobulin test (AGT), and EMT screening irregular antibody methods to determine the best test method.
RESULTS Simultaneous detection was performed through the tube polybrene test, tube AGT and EMT screening irregular antibodies. It was discovered that the EMT screening irregular antibody method could detect all immunoglobulin G (IgG) and immunoglobulin M (IgM) irregular antibodies, and the results of manual tube AGT were satisfactory, but the operation time was lengthy, and the equipment had a large footprint. The EMT screening irregular antibody assay was also conducted to determine its activity against type O Rh (D) red blood cells, and the outcomes were satisfactory. Furthermore, compared to the conventional tube method, the EMT screening irregular antibody method was more cost-effective and had significantly higher detection efficiency.
CONCLUSION With a higher detection rate, the EMT screening irregular antibody method can detect both IgG and IgM irregular antibodies faster and more effectively than the conventional tube method.
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Affiliation(s)
- Xue-Hua He
- Department of Blood Transfusion, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Hong Yan
- Department of Blood Transfusion, The Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Chun-Yan Wang
- Department of Blood Transfusion, Shanxi Cancer Hospital, Taiyuan 030013, Shanxi Province, China
| | - Xue-Yun Duan
- Department of Blood Transfusion, Shanxi Cardiovascular Hospital, Taiyuan 030024, Shanxi Province, China
| | - Jia-Jia Qiao
- Department of Blood Transfusion, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Xiao-Jun Guo
- Department of Blood Transfusion, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Hong-Bin Zhao
- Department of Blood Transfusion, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Dong Ren
- Department of Blood Transfusion, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Jian-She Li
- Department of Blood Transfusion, The Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Qiang Zhang
- Department of Clinical Laboratory, Taiyuan Blood Center, Institute of Blood Transfusion Technology, Taiyuan 030024, Shanxi Province, China
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