b bother blood group systems
TRANSCRIPT
Other Blood Group Systems
By Dr. Christina ThompsonTexas A&M University-
Corpus Christi
LEWIS SYSTEM
A serum antigen secondarily absorbed to the red cells
Le gene produces Lea
Secretors change the Lea to Leb
Le may also modify the A antigen review the relationship to ABO precursors
Lewis Red Cell Phenotypes
Genes Lewis Red Cell Phenotype
Le Se Lea- Leb+
Le se Lea+ Leb-
lele Lea- Leb-
le se Lea- Leb- Lec+
le Se Lea- Leb- Lec- Led+
Development of Antigens
Newborns born Le a-b-
If Le and Se – 2 weeks to 6 months Le a+
– then Le a+b+
– then Le a-b+
During pregnancy, antigens become weaker
Phenotype Frequencies
Phenotype White Black
Le a+b- 22% ---
Le a-b+ 72% ----
Le a-b- 6% 20%
Lewis Antibodies
Anti-Le a, Anti-Le b, Anti-Lex
Most react at room temperature or below -
Often fix complement Some in vitro hemolysis Le a may cause HTR
Lewis Antibodies
Anti-Le a
Found in Lea-b- secretors best room temperature or below - some
at ICT and enzymes Often fix complement Some in vitro hemolysis Le a may cause HTR
Lewis Antibodies
Anti-Le b
Often found with Anti-Lea
Most react at room temperature or below
Two types - Anti-LebH and Anti-LebL
Rare cause of HTR
Lewis Antibodies
Anti-Lex
Most react at room temperature or below -
Reacts with both Lea and Leb as a single antibody
Lewis Antibodies
Special Problems in the Blood Bank– Lewis antigens may be weaker during
pregnancy and women produce antibodies– Can neutralize Lewis antibodies with Lewis
plasma– Pregnant woman with room temperature
antibodies, neutralize with Lewis antigen when testing for HDN antibodies
I Blood Group
Two antigens I and i I antigen present on almost all healthy
adults Rare adults that are I negative -
spectrum on page 175 I antigen varies in strength on adult cells
I Blood Group
Newborns do not have much I antigen Newborns have i antigen At about 18 months the i is replaced
with I Some transitional antigens
I Blood Group
I substance can be found in saliva and human milk and on lymphocytes and platelets
During disease, the I antigens may alter
I Blood Group
Antibodies Anti-I anti-i– Anti-I
usually reacts at room temperature, saline or below
often attaches complement doesn’t cause hemolysis unless it reacts at 37oC Can be found in almost all sera in low titers and
titers increase during some diseases (viral infections - syphilis - atypical pneumonia)
COLD AUTOAGGLUTIN
I Blood Group
Antibodies Anti-I anti-i– Anti-i
rare antibody occurs in patients with infectious mononucleosis, cirrhosis, myeloid leukemia, reticulosis
I Blood Group Antibodies
– Other combination antibodies have been found (IA, IH, IP1, etc.) pp. 176 - 177
– ENZYMES ENHANCE ACTIVITY
– ABSORBTION IS USED TO TEST FOR OTHER MORE IMPORTANT ANTIBODIES
AutoabsorptionAutoabsorption
P Blood Group Discovered in 1927 by Landsteiner Antigens P1 P p pk Luke
– Luke antigen and disease association - page 173
P Blood Group
Antibodies Anti-P1 Anti-P Anti-pk Anti- P + P1 + pk
– Anti-P1 Usually IgM reacts at room temperature and
saline May attach complement rarely a problem with transfusion easily inhibited with P1 substance
P Blood Group
Antibodies Anti-P1 Anti-P Anti-pk Anti- P + P1 + pk
– Anti-P
found in sera from pk individuals - an IgM hemolytic antibody that is clinically significant
also found as an IgG biphasic antibody in parozysmal cold hemoglobinuria called Donath-Landsteiner antibody
P Blood Group
Antibodies Anti-P1 Anti-P Anti-pk Anti- P + P1 + pk
– Anti-pk and Anti P + P1 + pk
Anti-pk has only been found as part of other antibodies
Anti-P + P1 + pk found in p individuals - formerly called Anti-Tja and very hemolytic
Duffy Blood Group
Discovered in early 1950’s Fy antigen locus on chromosome 1 with Rh
locus Antigens
codominant inheritance– Fya Fyb Fyx
– Others Fy3 Fy 4 Fy5 Fy6 Fs - (page 185)
Duffy Blood Group
Duffy Blood Group Fya-b- appear to provide some protection
from P.vivax infection Antibodies Anti-Fya Anti-Fyb
– Usually AHG reaction - IgG– destroyed by enzymes– Rare examples of antibodies to other antigens
(Anti-Fy 3, Anti-Fy4, Anti-Fy5) and those reactions are not destroyed by enzymes
– Cause HTR and HDN
Kell Blood Group Many antigens in this system and has
been given a numerical nomenclature Refer to table 8-8
Six most important Numeric Alpha Name Incidence
KEL 1 K Kell 10% KEL 2 k Cellano 99.8% KEL 3 Kpa Penny 2%KEL 4 Kpb Rautenberg 99.9 KEL 6 Jsa Sutter Rare (19% Blacks)KEL 7 Jsb Matthews 99.9%(99.8% Blacks
Kell Blood Group
Most common gene complexes
Kell Blood Group
Mc Leod syndrome– Reduced expression of Kell antigens– association with hemolytic anemia and
chronic granulomatous disease – genetics and antigen page 181
Kell Blood Group
Antibodies
– Usually IgG and require AHG – rare reaction in saline– common antibodies– implicated in HTR and HDN– Anti-K is a very common antibody
MNSs Blood Group
Many antigens in this system and some are alleles to the four common antigens
M N S s Association with GPA and GPB Four gene complexes
MS Ms NS Ns Other alleles Mg, Mk, Mc, Mr, Mz, Mv, Na, T1m,
Sj, S2, some quantitative differences
MNSs Blood Group Phenotypes
MNSs Blood Group
U antigen is absent or reduced on S-s- Other antigens - page 165 Mi - abnormal forms of Ss glycoprotein En(a-) absence of MN glycoprotein Disease association Page 170
MNSs Blood Group Antibodies Anti-M and Anti-N
– Usually room temperature– IgM saline reaction– Dosage (antibodies react better with
homozygous cells)– Destroyed by enzymes – Possible HDN and HTR if reaction at AHG– Anti-Nf found in dialysis patients
MNSs Blood Group
Antibodies Anti-S
– Usually igM and room temperature although some at AHG
– destroyed by enzymes– Rare HTR and HDN
MNSs Blood Group Antibodies Anti-s and anti-U
– Usually IgG and AHG– Not destroyed by enzymes– HTR and HDN– Anti-U found as warm autoantibody and
does not react well with Rh null cells– Other antibodies rarely detected but not
uncommon (ex. anti-Mg common antibody)
Kidd Blood Group
Discovered in the 1950s Two antigens Jka Jkb
Kidd Blood Group
Antibodies - Anti-Jka and Anti-Jkb
– Usually IgG and require AHG– bind complement– enhanced by enzymes– implicated in HDN and HTR– Seldom potent and deteriorate rapidly– Classic delayed HTR
Kidd Blood Group
Antibodies Anti-Jk3
– found in some Jka-b- individuals– reacts with Jka and Jkb
Lutheran Blood Group
Two antigens Lua (8%) Lub (99%)– Other antigens Table 8-12
Important blood group that demonstrates multiple methods for inheritance of the null cell type
Lu a-b- inheritance– InLu dominate inhibitor gene– lulu recessive lack of Lu gene– sex linked inhibitor gene
Lutheran Blood Group Antibodies
– Anti-Lua - not common - reacts in saline but can be IgG and require AHG - gives a (mf) agglutination - unclear about HTR & HDN
– Anti-Lub - rare - mostly IgG and requires AHG - probable HTR and HDN
– Anti-Luab (Anti-Lu3 ) - reacts with all but
Lu a-b- of the recessive type – Other antibodies react with rare Lu phenotypes
found on Lua-b- (page 192/3)
Other Blood Groups Diego - Dia Dib Wra Wrb 3 others
– Dia found in Chippawah Native Americans and Japanese and Chinese
– uncommon antibodies - AHG reaction and important in HTR and HDN
– Wra is a low incidence antigen and Wrb is a high incidence antigen
– anti-Wra is a fairly common antibody - IgM or IgG
Other Blood Groups
Chido/Rogers– Nine antigens - all normal individuals are
either Rg + or Ch +– HTLA - use plasma inhibition– Determinants on C4 molecule and linked to
HLA -
Other Blood Groups
Xg– sex-linked inheritance
Xga positive Male - 66% Female - 89%
– uncommon antibody - AHG reaction and destroyed by enzymes - HTR and HDN?
Other Blood Groups
Gerbich– system with at least 3 high incidence
antigens and 4 low incidence antigens– Antibodies usually IgG which require AHG
and clinically significant Scianna
– Sc:1 - 100% Sc:2 - 0.3% Sc:3 - 100%– Antibodies are rare
Other Blood Groups Colton
– antigens: Coa -99.7% Cob -10.7% Co3 -100%– the null phenotype has been found and
associated with genetic abnormality and anemia
– antibodies IgG and clinically significant Cromer
– consists of 7 high incidence antigens and three low incidence antigens
– antibodies probably clinically significant
Other Blood Groups
Cartwright– antigens Yta - 99.8% Ytb - 0.2%– Usually IgG and AHG ?HDN and HTR?
Dombrock– antigens Doa - 57% Dob - 83%– additional antigens added Holly, Gregory,
and Joseph – Uncommon antibodies HTR and ?HDN?
Other Blood Groups
IN– Ina Inb
– Ina Iranian and Arabs– Enzyme destroyed - Ina HTR
Knops– five antigens– depressed in some diseases– HTLA
Other Antigens
High incidence– Vel, Lan, August, Jacobs, Sid, Wra
Low incidence– too numerous to mention
Bg - HLA antigens that coat red cells
Other Blood Group Systems
By Dr. Christina ThompsonTexas A&M University-
Corpus Christi