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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 4  |  Issue : 2  |  Page : 69-73

Prevalence of hemolytic antibodies among blood donors in owo, Southwest Nigeria


1 Department of Medical Laboratory Science, Edo University, Iyamho, Edo State, Nigeria
2 Department of Medical Laboratory Science, Achievers University, Owo, Ondo State, Nigeria
3 Department of Haematology and Blood Transfusion, Federal Teaching University, Ido Ekiti, Nigeria
4 Guinness Eye Center, Onitsha; Department of Medical Laboratory Science, Nnamdi Azikwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
5 Department of Health Information Management, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria
6 Department of Haematology and Blood Transfusion Science, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria
7 Department of Medical Laboratory Science, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria

Date of Submission09-Mar-2019
Date of Acceptance15-Mar-2019
Date of Web Publication30-Jul-2019

Correspondence Address:
Dr. Musa A Muhibi
Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, Edo University, Iyamho, Edo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijas.ijas_3_19

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  Abstract 


Background: One of the dangers of blood transfusion is the introduction of lethal substance like potent hemolysins into a blood unit's or product's recipient, in a heterologous transfusion practice. The prevalence of alpha (α-) and beta (β)-hemolysins among blood donors in Owo, was investigated.
Materials and Methods: A volume of 4 ml of blood samples was collected from 300 consenting Groups A, B, and O donors who had been screened and accepted as donors. About 400 μl of donor serum was added into three test tubes labeled A, B, and O. To each tube, 200 μl of 5% red cell suspension of Groups A, B, and O were added, respectively. The standard O cell suspension was used as negative control. The tubes were then incubated at 22°C–25°C for 1 h, after which all tubes were centrifuged. They were then held before a source of light, and with minimal disturbances and the supernatant was examined macroscopically for hemolysis.
Results: Of 300 donors recruited, frequencies of A, B, and O groups were 20%, 26.6%, and 53.3%, respectively. Among the donors, hemolysin was present in 32, translating to 10.67% prevalence. Among the 32 donors with hemolysins, the percentage obtained for the age groups 20–25, 26–30, 31–35, and 36–40 was 43.75%, 25.0%, 18.75%, and 12.5%, respectively. The distribution of α-hemolysin, β-hemolysin, and α+β-hemolysin was 14, 6, and 6 for male, whereas female recorded 2, 4, and 0, respectively.
Conclusion: The results obtained suggest that there is low prevalence of hemolysins among blood donors in Owo. Although hemolysin status is not a limiting factor in the donation of blood, it becomes one when it comes to blood units' and products' selection and transfusion into patients in the hospital. It is recommended that homologous transfusion is practiced as a priority, while hemolysin-positive units should never be considered for heterologous transfusion.

Keywords: Blood, hemolysis, homologous, transfusion


How to cite this article:
Muhibi MA, Dada OI, Fasakin KA, Onwurah OW, Muhibi MO, Tijani BA, Jeremiah ZA. Prevalence of hemolytic antibodies among blood donors in owo, Southwest Nigeria. Imam J Appl Sci 2019;4:69-73

How to cite this URL:
Muhibi MA, Dada OI, Fasakin KA, Onwurah OW, Muhibi MO, Tijani BA, Jeremiah ZA. Prevalence of hemolytic antibodies among blood donors in owo, Southwest Nigeria. Imam J Appl Sci [serial online] 2019 [cited 2019 Oct 18];4:69-73. Available from: http://www.e-ijas.org/text.asp?2019/4/2/69/263662




  Introduction Top


The importance of a blood group system in clinical blood transfusion practice lies in the frequency of its antibodies and in the possibility that such antibodies will destroy incompatible cells in vivo.[1] Almost every human being above the age of 6 months has clinically significant anti-A and anti-B in his/her serum if he/she lacks the corresponding antigens on his/her red cells, though not all these alloantibodies are hemolytic.[1] Immune hemolysin production may occur following ABO heterospecific pregnancy, mismatched blood transfusion, or sensitization with A or B substances.[2] Hemolysins are proteins, which, in this case, are antibodies that cause lysis of red blood cells by destroying their cell membrane.[3] Hemolysins are usually IgG or IgM type of immunoglobulin. Hemolysins that are of IgG type have the smallest molecular weight among all immunoglobulins, and this characteristic enables them to cross the placenta during pregnancy. They also have the ability to activate complement, together with which they bring about the lysis of red blood cell.[4]

Alpha (α)-hemolysin is detectable in ABO blood Group B and O individuals, whereas beta (β)-hemolysin is detectable in Group A and O individuals.[5] The way hemolysin lyses erythrocytes is by forming pores in phospholipid bilayers of erythrocytes.[6],[7] Previous reports indicate a high frequency of these hemolysins among Yoruba-dialect-speaking ethnic groups, in the southern part of Nigeria.[8],[9]

Globally, approximately 80 million units of blood are donated each year. Of this total, 2 million units are donated in sub-Saharan Africa, where the need for blood transfusions is on the high side (due to maternal morbidity, malnutrition, and a heavy burden of infectious diseases such as malaria and infestation with blood-sucking worms) but supply is limited.[10] In a bid to meet the increasing needs for transfusion of blood and blood products in developing countries, transfusion of red cell and plasma products against ABO blood group barrier is not uncommon. Donor units from Groups A, B, and O are potentially being transfused to Group AB recipients, as some still believe that AB individuals are universal recipients.[11],[12] Evidenced-based best practice in developed countries recommend that all Groups A and B fresh frozen plasma (FFP) units intended for use against ABO blood group barrier and all Groups A, B, and O platelet concentrates intended for use against ABO blood group barrier should be tested and found negative for α- and β-hemolysins.[13] Although a report indicates that there is no significant change in the hemoglobin concentration associated with the transfusion of plasma-incompatible apheresis platelets,[14] such a practice put blood transfusion recipients at avoidable risks.

The main consequence of hemolysin in a heterologous blood transfusion recipient is the induction of hemolysis, which may cause additional morbidity. Depending on its degree, hemolysis has potential to result in hemolytic anemia, a condition that involves the destruction of erythrocytes and their later removal from the bloodstream, earlier than expected in a normal situation. As a consequence, some symptoms may appear, such as fatigue, pain, arrhythmias, an enlarged heart or even heart failure, among others.[15]

In spite of the increasing reports and proliferation of literatures on α- and β-hemolysins in blood donors, the prevalence of these hemolysins among Groups A, B, and O donors in some parts of Nigeria is unknown. Assessment of all Groups A, B, and O donor units for high titer α- and β-hemolysins is not carried out routinely in most blood transfusion laboratory units. There is dare need of adequate information on the distribution and patterns of ABO hemolysins, to guide practitioners and research community. This work was carried out to determine the prevalence of α- and β-hemolysins among the blood donors in the Federal Medical Centre (FMC), Owo.


  Materials and Methods Top


Study area

The study was conducted on apparently healthy blood donors at FMC, Owo, Ondo State. Owo is situated in Southwestern Nigeria. It has an estimated population of 276,593.[16] It is located within the low rain forest zone of Nigeria and has two seasons – dry and wet. The dry season lasts from mid-October to March, whereas the raining season lasts from April to September.

Sample size

A total of 300 blood samples (24 samples as attrition inclusive) from Groups A, B, and O comprising of males and females were collected from FMC, Owo, Ondo State. The sample size was determined by the Wayne's formula where the prevalence of α- and β-hemolysins in Ilorin, Kwara state, from previous study was 23.2%.[17]

Specimen collection

Blood samples for the study were collected from Groups A, B, and O donors who had been screened, found fit, and accepted as donors. A volume of 4 ml of blood was collected into a plain bottle; it was spun at 2500 rpm for 5 min after clot retraction, and the serum was separated into another plain bottle and analyzed.

Methodology

About 400 μl of donor serum was added into three tubes labeled A, B, and O. To each tube, 200 μl of 5% suspensions of red cells of Groups A, B, and O were added, respectively. The O cells were used as negative controls because blood Group O individuals do not have ABO blood antigens on their red cells. The tubes were then incubated at room temperature for 1 h, after which all tubes were centrifuged. They were then held before a source of light, and with minimal disturbances the supernatant was examined macroscopically for hemolysis.

Statistical analysis

Statistical analyses were conducted using SPSS (version 19; SPSS Inc., Chicago, IL, USA) software. Continuous variables were described using means and standard deviations, whereas categorical variables were described using counts and percentages. P < 0.05 denoted a statistically significant difference in all statistical comparison.


  Results Top


[Table 1] shows the number of male and female participants to be 260 and 40 constituting 86.67% and 13.4%, respectively. The percentage of the age group distribution 20–25, 26–30, 31–35, and 36–40 of the participants was shown to be 47.3%, 27.3%, 20.1%, and 5.3%, respectively. [Table 2] shows the percentage distribution of ABO blood groups among the individuals. The percentage of A, B, and O among the donors was 20%, 26.6%, and 53.3%, respectively.
Table 1: The gender and age distribution of participants

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Table 2: The distribution of ABO blood groups among donors

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The prevalence of hemolysin among the participants is shown in [Figure 1]. Of 300 blood donors, hemolysin was present in 32 and absent in 268 donors giving a percentage prevalence of 10.67%. Thirty-two donors with the presence of hemolysins were set at 100%, and the percentage obtained for the age group of 20–25, 26–30, 31–35, and 36–40 years was 43.75%, 25.0%, 18.75%, and 12.5%, respectively [Figure 2]. The distribution of α-hemolysin, β-hemolysin, and α+β− hemolysin was 14, 6, and 6 for males and 2, 4, and 0 for female, respectively [Figure 3].
Figure 1: Hemolysin status of blood donors

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Figure 2: Age distribution pattern of hemolysin-positive donors

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Figure 3: Hemolysin type distribution among donors according to gender

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  Discussion Top


In this study, we investigated the prevalence of hemolysins among blood donors in Owo. The percentage distribution of A, B, and O among the 300 blood donors was 20%, 26.6%, and 53.3%, respectively. We observed an overall prevalence of hemolysin among 10.67% of the donors. Among 32 donors with the presence of hemolysins, the highest hemolysin prevalence of about 43.75% was obtained for the age group of 20–25 years. We observed a prevalence of 2.5% β-hemolysin among Group A donors, 5% of α-hemolysin among group B, and 18.3% α- and β-hemolysin among Group O donors. The overall prevalence (10.67%) and the prevalence among Group O donors (18.3%) obtained in this present study is lower than a prevalence of 55.4% observed by Kagu et al. in Northeastern Nigeria among Group O donors. A 23.2% prevalence of α- and β-hemolysin was obtained by Olawumi and Olatunji in Ilorin.[17] Okafor and Enebe investigated 509 volunteers from a Nigerian community and obtained a 53.6%, 62.7%, and 47.9% prevalence, respectively, for α-, β-, and α+β-hemolysins.[9] Similarly, Kulkarni et al. investigated 5380 blood Group O donors for the presence of anti-A and anti-B hemolysins and observed 32.3% prevalence.[8] Furthermore, Emeribe investigated 602 blood donors for α- and β-hemolysins and observed a 5%, 12.1%, and 21.4% prevalence of α-, β-, and α + β-hemolysins, respectively.[11]

The overall prevalence of anti-A and anti-B hemolysins obtained among Group O Thai donors in a previous report was 69%. Anti-A, anti-B, and anti-A + B hemolysins comprised 18.3%, 16.7%, and 34%, respectively.[18] Similarly, Adewuyi et al. studied sera from young, black, Group O Zimbabwean blood donors for anti-A and anti-B hemolysins. Nearly one-fifth of the sera were found to be strongly hemolytic for either A or B cells or both.[19] Prevalence obtained in our study was also lower than that obtained in a study carried out in Jos, Nigeria.[20] A possible reason for the lower prevalence obtained in our study compared to studies from other parts of Nigeria could be as a result of the difference in climates of varying geographical locations within the large country and genetic diversity.

We observed that the prevalence of hemolytic anti-A in blood Group B individuals (5.0%) was twice the prevalence of hemolytic anti-B in blood Group A individuals (2.5%). This finding is at variance with reports by Olawumi and Olatunji.[17] However, the reasons for this predisposition may either be genetic or environment-induced (sensitization due to exposure during previous transfusion or pregnancies).

We observed that there was no age- or gender-related differences in the prevalence of α- and β-hemolysins among the donors studied. This finding is in conformity with the finding from a previous study which observed that there was also no significant age difference in the prevalence of hemolysins.[1]

Although the risk of a hemolytic transfusion reaction is considered a rare complication in platelet transfusion, previous reports indicate that if minor ABO incompatibility exists between donor and recipient particularly when donor plasma contains high titer hemolysin directed against recipient's red cells, there is the risk of acute hemolysis. Similarly, acute hemolytic transfusion reactions have been reported after transfusion of group O single-donor apheresis platelets (SDPs) to Groups A, B, and AB recipients. Owing to low availability of type-specific SDP, transfusion services particularly in developing countries sometimes issue ABO-mismatched platelets.[13]

Best practices in the developed world frown against the transfusion of Group O SDP and FFP positive for high titer anti-A and B hemolysins to Group A, B, and AB recipients because of the potential risk for intravascular hemolysis and mortality and recommend that only Group O platelets and FFP tested and found negative for high titer anti-A and anti-B hemolysins should be used in such cases.[12]


  Conclusion Top


This study has shown that the prevalence of α- and β-hemolysins is high particularly among blood Group O donors in Owo, Southwestern Nigeria. We recommend that all Groups O, A, and B donors be screened routinely for high titer α- and β-hemolysins and that all blood Group O red cell intended for use as universal donor units must be screened and found negative for α- and β-hemolysins. Furthermore, all FFP and platelet concentrate intended for use against ABO blood group barriers must be tested and found negative for high titer anti-A and B hemolysin. At the point of screening, the documentation should include labeling every unit/product accordingly. In case the emergency transfusion request is being granted by a medical scientist who was not involved in the screening, the documentation and labeling will serve as a useful guide.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kagu MB, Ahmed SG, Mohammed AA, Moshood WK, Malah MB, Kehinde JM. Anti-A and anti-B haemolysins amongst group “O” voluntary blood donors in Northeastern Nigeria. J Transfus 2011;2011:1-3.  Back to cited text no. 1
    
2.
Worlledge S, Ogiemudia SE, Thomas CO, Ikoku BN, Luzzatto L. Blood group antigens and antibodies in Nigeria. Ann Trop Med Parasitol 1974;68:249-64.  Back to cited text no. 2
    
3.
Stipcevic T, Piljac T, Isseroff RR. Di-rhamnolipid from Pseudomonas aeruginosa displays differential effects on human keratinocyte and fibroblast cultures. J Dermatol Sci 2005;40:141-3.  Back to cited text no. 3
    
4.
Karmakar P, Chakrabarti MK. Thermostable direct hemolysin diminishes tyrosine phosphorylation of epidermal growth factor receptor through protein kinase C dependent mechanism. Biochim Biophys Acta 2012;1820:1073-80.  Back to cited text no. 4
    
5.
Klein HG, Anstee DJ. Blood grouping techniques. In: Mollison's Blood Transfusion in Clinical Medicine. 11th ed. Oxford, UK: Blackwell Scientific Publications; 2005. p. 302-10.  Back to cited text no. 5
    
6.
Chalmeau J, Monina N, Shin J, Vieu C, Noireaux V. A-hemolysin pore formation into a supported phospholipid bilayer using cell-free expression. Biochim Biophys Acta 2011;1808:271-8.  Back to cited text no. 6
    
7.
Thompson JR, Cronin B, Bayley H, Wallace MI. Rapid assembly of a multimeric membrane protein pore. Biophys J 2011;101:2679-83.  Back to cited text no. 7
    
8.
Kulkarni AG, Ibazebe R, Fleming AF. High frequency of anti-A and anti-B haemolysins in certain ethnic groups of Nigeria. Vox Sang 1985;48:39-41.  Back to cited text no. 8
    
9.
Okafor LA, Enebe S. Anti-A and anti-B haemolysins, dangerous universal blood donors and the risk of ABO antagonism in a Nigerian community. Trop Geogr Med 1985;37:270-2.  Back to cited text no. 9
    
10.
World Health Organization. Global Database on Blood Safety: Report 2001-2002. World Health Organization. Available from: http://www.who.int/bloodsafety/GDBS_Report_2001-2002.pdf. [Last accessed on 2018 Aug 03].  Back to cited text no. 10
    
11.
Emeribe AO. The status of alpha and beta haemolysins in Nigerian blood donors. East Afr Med J 1990;67:205-8.  Back to cited text no. 11
    
12.
Josephson CD, Mullis NC, Van Demark C, Hillyer CD. Significant numbers of apheresis-derived group O platelet units have “high-titer” anti-A/A, B: Implications for transfusion policy. Transfusion 2004;44:805-8.  Back to cited text no. 12
    
13.
Cooling LL, Downs TA, Butch SH, Davenport RD. Anti-A and anti-B titers in pooled group O platelets are comparable to apheresis platelets. Transfusion 2008;48:2106-13.  Back to cited text no. 13
    
14.
Mair B, Benson K. Evaluation of changes in hemoglobin levels associated with ABO-incompatible plasma in apheresis platelets. Transfusion 1998;38:51-5.   Back to cited text no. 14
    
15.
Kebaier C, Chamberland RR, Allen IC, Gao X, Broglie PM, Hall JD, et al. Staphylococcus aureus α-hemolysin mediates virulence in a murine model of severe pneumonia through activation of the NLRP3 inflammasome. J Infect Dis 2012;205:807-17.  Back to cited text no. 15
    
16.
National Population Commission. National Census Figures, Abuja, Nigeria. National Population Commission; 2007. Available from: http://www.population.gov.ng/. [Last accessed on 2019 Jan 01].  Back to cited text no. 16
    
17.
Olawumi HO, Olatunji PO. Prevalence and titre of alpha and beta haemolysins in blood group 'O' donors in Ilorin. Afr J Med Med Sci 2001;30:319-21.  Back to cited text no. 17
    
18.
Khampanon K, Chanprakop T, Sriwanitchrak P, Setthakarn M, Oota S, Nathalang O, et al. The characteristics of ABO antibodies in group O Thai blood donors. J Clin Lab Anal 2012;26:223-6.  Back to cited text no. 18
    
19.
Adewuyi JO, Gwanzura C, Mvere D. Characteristics of anti-A and anti-B in black Zimbabweans. Vox Sang 1994;67:307-9.  Back to cited text no. 19
    
20.
Onwukeme KE, Nanna OU. Frequency of anti-A and anti-B haemolysins in Nigerians living in Jos. Niger Med Pract 1990;20:29-35.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

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