YTGT: A new high‐prevalence antigen in the Yt blood group system in two unrelated Native Americans and transfusion management. Issue 9 (29th July 2022)

• Record Type: Journal Article
• Authors: Van Buren, Nancy L.; Gillen, Barbara; Lomas‐Francis, Christine; Burgos, Anna; Pease, Daniel; Beaver, Maria; Imbryk, Adam; Dugger, Julia; Fugate, Alexandra; Hebel, Eric; Lodermeier, Michelle; Vege, Sunitha; Westhoff, Connie M.
• Is Part Of: Transfusion. Volume 62:Issue 9(2022)
• Page Start: 1917
• Page End: 1922
• Publication Date: 2022-07-29
• Subjects: hemolytic transfusion reaction -- transfusion management -- Yt antigen; Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; Blood Group Antigens -- Periodicals; Blood Preservation -- Periodicals; Blood Transfusion -- Periodicals; 615
• DOI: 10.1111/trf.17001
• Languages: English
• ISSNs: 0041-1132

Abstract

Abstract: Background: The Yt system consists of five antigens: antithetical Yt a /Yt b and the high‐prevalence antigens YTEG, YTLI, and YTOT. We investigated a sample from a Native American (NA) female with post‐operative anemia and an unidentified antibody who developed rigors, tachycardia, and hypotension on transfusion of incompatible RBCs. Methods and Materials: Serologic testing methods included LISS, PEG, and IgG gel. Test RBCs were treated with papain, trypsin, alpha‐chymotrypsin, 2‐amino‐ethylisothiouronium, and dithiothreitol. Rare RBCs were tested, and inhibition studies were performed. DNA extracted from WBCs was used for Sanger sequencing. Results: Initial testing showed strong 3–4+ plasma reactivity with all panel cells at LISS IAT; auto control was negative. Positive reactions were observed with numerous rare RBCs except for PNH‐III, which lack GPI‐linked DO, Yt, CROM, JMH, and Emm. Enzyme sensitivity patterns suggest Yt specificity, and soluble recombinant srYt neutralized reactivity. ACHE sequencing revealed YT*A/A genotype but with a homozygous change in exon 2, c.290A>G (p.Gln97Arg). Antibody reactivity was reminiscent of that seen in an unrelated NA male investigated previously. His RBCs were nonreactive with her plasma. ACHE carried the same c.290G/G change. Conclusion: Two unrelated NA patients were found to have an antibody to a new high‐prevalence Yt antigen, designated YTGT (YT6), associated with a clinically significant transfusion reaction. Identification of the specificity relied on enzyme sensitivity, use of PNH‐III RBCs, neutralization using soluble recombinant Yt, and the finding of a novel change in ACHE, c.290A>G (p.Gln97Arg), designated YT*01.‐06 . IVIG and steroids were used to mitigate further reactions to transfusion.