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Case Reports
. 2022 Sep;62(9):1917-1922.
doi: 10.1111/trf.17001. Epub 2022 Jul 29.

YTGT: A new high-prevalence antigen in the Yt blood group system in two unrelated Native Americans and transfusion management

Nancy L Van Buren  1   2 , Barbara Gillen  1 , Christine Lomas-Francis  3 , Anna Burgos  3 , Daniel Pease  4 , Maria Beaver  5 , Adam Imbryk  1 , Julia Dugger  1 , Alexandra Fugate  1 , Eric Hebel  1 , Michelle Lodermeier  1 , Sunitha Vege  3 , Connie M Westhoff  3
Affiliations
Case Reports

YTGT: A new high-prevalence antigen in the Yt blood group system in two unrelated Native Americans and transfusion management

Nancy L Van Buren et al. Transfusion. 2022 Sep.

Abstract

Background: The Yt system consists of five antigens: antithetical Yta /Ytb 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.

Keywords: Yt antigen; hemolytic transfusion reaction; transfusion management.

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References

REFERENCES

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