title: Genotyping Applications for Transplantation and Transfusion Management: The Emory Experience.
abstract: Current genotyping methodologies for transplantation and transfusion management employ multiplex systems that allow for simultaneous detection of multiple HLA antigens, human platelet antigens, and red blood cell (RBC) antigens. The development of high-resolution, molecular HLA typing has led to improved outcomes in unrelated hematopoietic stem cell transplants by better identifying compatible alleles of the HLA-A, B, C, DRB1, and DQB1 antigens. In solid organ transplantation, the combination of high-resolution HLA typing with solid-phase antibody identification has proven of value for highly sensitized patients and has significantly reduced incompatible crossmatches at the time of organ allocation. This database-driven, combined HLA antigen/antibody testing has enabled routine implementation of "virtual crossmatching" and may even obviate the need for physical crossmatching. In addition, DNA-based testing for RBC antigens provides an alternative typing method that mitigates many of the limitations of hemagglutination-based phenotyping. Although RBC genotyping has utility in various transfusion settings, it has arguably been most useful for minimizing alloimmunization in the management of transfusion-dependent patients with sickle cell disease or thalassemia. The availability of high-throughput RBC genotyping for both individuals and large populations of donors, along with coordinated informatics systems to compare patients' antigen profiles with available antigen-negative and/or rare blood-typed donors, holds promise for improving the efficiency, reliability, and extent of RBC matching for this population.
authors.forename: Ross M
authors.initials: RM
authors.lastname: Fasano
authors.forename: Harold Cliff
authors.initials: HC
authors.lastname: Sullivan
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bray
authors.forename: Howard M
authors.initials: HM
authors.lastname: Gebel
authors.forename: Erin K
authors.initials: EK
authors.lastname: Meyer
authors.forename: Annie M
authors.initials: AM
authors.lastname: Winkler
authors.forename: Cassandra D
authors.initials: CD
authors.lastname: Josephson
authors.forename: Sean R
authors.initials: SR
authors.lastname: Stowell
authors.forename: Alexander
authors.initials: A
authors.lastname: Sandy Duncan
authors.affiliation: From the Center for Transfusion and Cellular Therapies (Drs Fasano, Sullivan, Meyer, Winkler, Josephson, Stowell, Duncan, and Roback) and the Department of Pathology and Laboratory Medicine (Drs Fasano, Sullivan, Bray, Gebel, Meyer, Winkler, Josephson, Stowell, Duncan, and Roback), Emory University School of Medicine, Atlanta, Georgia; and the Department of Transfusion, Tissue, and Apheresis, Children's Healthcare of Atlanta, Atlanta (Drs Fasano, Meyer, and Josephson). Dr Meyer is now with the Department of Pathology, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus.
authors.forename: John D
authors.initials: JD
authors.lastname: Roback
mesh_terms: D001788:Blood Grouping and Crossmatching / Q000379:methods*; D001803:Blood Transfusion / Q000379:methods; D060005:Genotyping Techniques / Q000379:methods*; D006801:Humans; D016377:Organ Transplantation / Q000379:methods; D017713:Platelet Transfusion / Q000379:methods