Authors
Dhargam Muhamed Aljebouri, Mohammed Aljadiri, Bassam Alshaikhli, Rawa Alattabi, Arwa Alkhamess, Sajjad Aldoori, Yousif Suleiman
Published in
Transfusion. Sep 07, 2026. Epub Sep 07, 2026.
Abstract
H-deficient states are important in ABO-related transfusion practice. Patients may be misclassified as group O if testing stops at forward ABO typing. Anti-IH may render group O units incompatible and increase hemolysis risk.
A 70-year-old Iraqi man was referred for failure to obtain compatible blood before knee arthroplasty. ABO testing, crossmatching, antibody screening, anti-H lectin testing, saliva inhibition and molecular analysis of fucosyltransferase 1 (FUT1) and fucosyltransferase 2 (FUT2) were performed.
Forward grouping showed anti-A/anti-B 0 (apparent O), with reverse grouping 4+ with A and B cells. Multiple group O units showed immediate 4+ incompatibilities at room temperature (RT). Antibody screening was pan-reactive at RT, 37°C, and the antihuman globulin phase; the direct antiglobulin test and auto-control were negative. Patient red blood cells were nonreactive with anti-H lectin (Ulex europaeus), while control O cells reacted 4+. Cord O cells were nonreactive. Saliva inhibition demonstrated soluble H and B substances. Exome testing identified a homozygous FUT1 frameshift with wild-type FUT2; the variant is deposited in ClinVar (Variation ID 4526453).
Based on Iraqi National Blood Transfusion Center records, this is the first documented molecularly characterized Para-Bombay phenotype in Iraq. Apparent group O with O-unit incompatibility should trigger anti-H lectin testing, secretor evaluation, and molecular confirmation/referral, underscoring the need for rare-donor pathways.
PMID:
42703786
Bibliographic data and abstract were imported from PubMed on 07 Sep 2026.
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