Kell Blood Group System

Muhammad Asif Zeb

Lecturer hematology
IPMS-KMU
Peshawar
 The Kell blood group system consists of 28 high-
incidence and low-incidence antigens; it was the first
blood group system discovered after the introduction
of antiglobulin testing.

 Anti-K (originally called Kell) was identified in 1946 in

the serum of Mrs. Kellaher.
 The antibody reacted with the RBCs of her newborn

infant, her older daughter, her husband

 In 1949 Levine described anti-k (Cellano), the high-

incidence antithetical partner to K.
Basic concept
 For many years it was believed that Kell blood
group antigens are found only on RBCs.

 They have not been found on platelets or on

lymphocytes, granulocytes, or monocytes by
means of using immunofluorescent flow
cytometry.

 There is recent evidence, however, that Kell

glycoprotein is abundantly present in testes and,
to a lesser extent, in other tissues
K and k Antigens
 Excluding ABO, K is rated second only to D in
immunogenicity.
 When K– people are transfused with a unit of K
blood, the probability of their developing anti-K
may be as high as 10 percent.

 Fortunately, the incidence of K antigen is low,

and the chance of receiving a K unit is small.

 If anti-K develops, compatible units are easy to

find.
Advanced Concepts
 Biochemistry
 The Kell antigens are located on a 93-kD RBC membrane

glycoprotein that consists of 731 amino acids and spans the

membrane once.

 The N-terminal domain is intracellular, and the large external

C-terminal domain is highly folded by disulfide linkages.

 The Kell glycoprotein is covalently linked with another

protein, called Kx, by a single disulfide bond.

 The Kx protein (440 amino acids and 37 kD) is predicted to

span the RBC membrane ten times
Genetics

 The KEL gene, located on chromosome 7 (at

7q33).

 Single base mutations encoding amino acid

substitutions are responsible for the different Kell
antigens.

 A rare silent allele at the KEL locus has been

designated Ko.
Antibodies
 Kell antibodies are usually IgG and
predominantly IgG1.

 They should be considered potentially

clinically significant, both from the point of
view of causing severe HDFN and HTRs.

 Patients with Kell antibodies should be

 transfused with antigen-negative blood

whenever possible.
 Anti-K is the most common immune red cell antibody
outside the ABO and Rh systems;
 one third of all non-Rh-red-cell immune antibodies are
anti-K.

 An antiglobulin test is usually the method of choice for

detection, although occasional examples may agglutinate
red cells directly.

 Anti-K, -k, -Kpa, -Kpb, -Jsa, -Jsb, -Ku, -Ula, -K11, -K19,
and -K22 are all reported to have caused severe HDFN and
anti-K, -k, -Kpb, -Jsa, -Jsb, -Ku, and -K19 have all been
implicated in acute or delayed HTRs.