Other Blood Group Systems

By
Dr. Christina Thompson
Texas A&M UniversityCorpus Christi

LEWIS SYSTEM
A serum antigen secondarily absorbed to
the red cells
Le gene produces Le a
Secretors change the Le a 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
Le a+b-

White
22%

Le a-b+

72%

Le a-b-

6%

Black
-----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-Le a
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
doesnt cause hemolysis unless it reacts at 37 oC
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

Autoabsorption

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 P substance
1

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 DonathLandsteiner 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 1950s
Fy antigen locus on chromosome 1 with Rh
locus
Antigens
codominant inheritance

Fya
Fyb
Others Fy3

Fyx
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

KEL 1 K
Kell
KEL 2
k
Cellano
KEL 3 Kpa
Penny
KEL 4 Kpb Rautenberg
KEL 6 Jsa
Sutter
KEL 7 Jsb Matthews

Incidence
10%
99.8%
2%
99.9
Rare (19% Blacks)
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-sOther 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 Thompson
Texas A&M UniversityCorpus Christi