Other Blood Group Systems

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Other Blood Group Systems

• By
• Dr. Christina Thompson
• Texas AM University-
• Corpus Christi

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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

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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
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Development of Antigens

• Newborns born Le a-b-
• If Le and Se
• 2 weeks to 6 months Le a
• then Le ab
• then Le a-b
• During pregnancy, antigens become weaker

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Phenotype Frequencies
Phenotype White
Black Le ab-
22 --- Le a-b
72
---- Le a-b- 6
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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

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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

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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

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Lewis Antibodies

• Anti-Lex
• Most react at room temperature or below -
• Reacts with both Lea and Leb as a single antibody

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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

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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

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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

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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

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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 37oC
• Can be found in almost all sera in low titers and
  titers increase during some diseases (viral
  infections - syphilis - atypical pneumonia)
• COLD AUTOAGGLUTIN

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I Blood Group

• Antibodies Anti-I anti-i
• Anti-i
• rare antibody occurs in patients with infectious
  mononucleosis, cirrhosis, myeloid leukemia,
  reticulosis

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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

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Autoabsorption
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P Blood Group

• Discovered in 1927 by Landsteiner
• Antigens P1 P p pk Luke
• Luke antigen and disease association -
  page 173

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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

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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

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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

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Duffy Blood Group

• Discovered in early 1950s
• Fy antigen locus on chromosome 1 with Rh locus
• Antigens
• codominant inheritance
• Fya Fyb Fyx
• Others Fy3 Fy 4 Fy5 Fy6 Fs -
  (page 185)

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Duffy Blood Group

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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

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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
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Kell Blood Group

• Most common gene complexes

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Kell Blood Group

• Mc Leod syndrome
• Reduced expression of Kell antigens
• association with hemolytic anemia and chronic
  granulomatous disease
• genetics and antigen page 181

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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

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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

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MNSs Blood Group

• Phenotypes

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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

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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

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MNSs Blood Group

• Antibodies
• Anti-S
• Usually igM and room temperature although some at
  AHG
• destroyed by enzymes
• Rare HTR and HDN

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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)

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Kidd Blood Group

• Discovered in the 1950s
• Two antigens Jka Jkb

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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

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Kidd Blood Group

• Antibodies
• Anti-Jk3
• found in some Jka-b- individuals
• reacts with Jka and Jkb

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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

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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)

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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

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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 -

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Other Blood Groups

• Xg
• sex-linked inheritance
• Xga positive Male - 66 Female - 89
• uncommon antibody - AHG reaction and destroyed by
  enzymes - HTR and HDN?

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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
• Sc1 - 100 Sc2 - 0.3 Sc3 - 100
• Antibodies are rare

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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

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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?

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Other Blood Groups

• IN
• Ina Inb
• Ina Iranian and Arabs
• Enzyme destroyed - Ina HTR
• Knops
• five antigens
• depressed in some diseases
• HTLA

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Other Antigens

• High incidence
• Vel, Lan, August, Jacobs, Sid, Wra
• Low incidence
• too numerous to mention
• Bg - HLA antigens that coat red cells

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Other Blood Group Systems

• By
• Dr. Christina Thompson
• Texas AM University-
• Corpus Christi