Lifeblood identifies partial D variant in the Australian Indigenous population

Published in the journal Vox Sanguinis is a report by Lifeblood investigators describing a novel RHD variant with risk of RhD alloimmunization, recurrent within the Australian Indigenous population. Dr. Emma Palfreyman, lead investigator says, “The RCR team had observed over some years a pattern of changes suggesting a previously undefined RHD variant. The cases were collated and with some additional testing, we were able to confirm a newly defined RHD variant observed in Indigenous Australian peoples.  This variant RHD can form anti-D, which is important to identify as there are implications for transfusion and pregnancy management.” 

Previous publications, including one case of severe haemolytic disease of the fetus and newborn (HDFN) identified a novel RHD variant with the pattern of single nucleotide variation c.186G>T, c.410C>T, c.455A>C, c.602C>G, c.604G>A, c.733G>C, and a deletion or rearrangement with RHCE exon 9. In this case, severe HDFN had occurred when the child inherited the variant allele from their father, stimulating anti-D antibodies in the D-negative mother.  

Retrospective data containing the variant combination was extracted and collated for review. A total of 12 cases were identified with consistent loss of detection of exon 9 where BeadChip™ and massively parallel sequencing (MPS) were performed. All cases except one were phenotypically D-positive. Nine of the 12 cases presented with anti-D and were associated with a previous or concurrent pregnancy. Three cases had no recorded ethnicity whilst the remaining cases were reported to be of Australian Indigenous ethnicity.  

Given the majority of these cases were referred to investigate detected anti-D, it would be beneficial to be able to identify this D variant prior to the development of antibodies. We note that all the individuals had the D+C−E−c+e+ (Ro) phenotype. This may be a possible way to identify those in the Australian Indigenous population who might benefit from genotyping. As this RHD variant is capable of anti-D development, it is important to define and identify it and to look for ways to prevent anti-D formation within this ethnic group. 

NICE updates UK guidance on tranexamic acid

The UK National Institute for Health and Care Excellence (NICE) has updated their guidance on tranexamic acid to reduce the requirements for blood transfusion for people having surgery. Click here to access the updated section of guideline, which includes a short explanation of why the committee made the 2026 recommendations and how they might affect practice. 

The evidence underpinning these recommendations can be found here: 

• Evidence review for tranexamic acid for reducing anticipated minor blood loss due to surgery

• Evidence review for safety of tranexamic acid during surgery

Transforming transfusion safety: Insights from implementing bedside electronic checks at a large UK NHS Trust

Use of bedside electronic transfusion checks (BETC) can reduce error and improve transfusion safety. Despite national recommendations in the UK supporting introduction of these systems, uptake has been limited.    

A recent study by Oyekan and colleagues reported on the implementation of BETC at a large UK National Health Service (NHS) trust with 4 hospitals, investigating successes and challenges encountered across stakeholder engagement, technical (digital and organisational) and staff training. These insights aim to guide future adopters in navigating the complexities and maximising the patient safety benefits. 

Resuscitation in traumatic major haemorrhage – Fixed ratio blood components versus targeted VHA‑guided therapy 

In a pro-con debate that discusses a formulaic approach using fixed ratios of blood components versus a targeted therapy approach guided by viscoelastic haemostatic assays, the authors state that, “The aim of a major hemorrhage protocol is to guide a multidisciplinary multiple strategy approach to identify the source and cause of bleeding and control it expeditiously, correct coagulopathy, and normalize physiological derangement”.

Episode 2: From lab to life: Solid organ transplant case studies - precision matching

We’d love you to join us for episode 2 in our 3-part series highlighting the life-saving work of Lifeblood’s Transplantation and Immunogenetics Services (TIS).

Speaker:  Lou Goddard, Transplantation and Immunogenetic Scientist (NSW)

Tuesday 28 April

2.00-3.00pm 

Australian Red Cross Lifeblood
100-154 Batman Street West Melbourne VIC 3003

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