Majorand MinorBlood Group System

Other Major Blood Groups

1. Lewis 5. Kell2. MNSs 6. Duffy3. P 7. Kidd4. I 8. Lutheran

1.ABO

2.Rh

Major Blood Groups

ABO The most important of all blood

groups in transfusion practice The only blood group system in

which individuals have antibodies in their serum to antigens that are

absent from their RBCs Due to presence of antibodies,

transfusion of an incompatible ABO type may result in Lysis of donor’s

RBCLeading cause of HTR

ABO AntibodiesFormation of A, B and H Red C ell Antigens

Individuals normally roduce antibodies directed against the Aand/or B antigen(s) absent from their RBCs

They are naturally loccuring because they are produced w/out any exposure toor colder RBCs

ABO are predominantly IgM

Activate complementReact at room

temperature

Results from the interaction of genes at three separate loci ( ABO, Hh, and Se)

A,B and H antigens are formed from the same basic precursor material called paragloboside or glycam- to which sugars are attached in response to specific enzyme transferases elicited by an inherited gene

H antigen is actually the precusoror strucure on which A and B antigens are made

The H antigen must be inherited to form the ABO antigens on the RBCs

Se gene must be inherited as well to form ABO secretions

ABH antigens develop early in fetal life but do not increase much in strength during gestational period

Fully developed by 2 to 4 years and remains throughout life

Also expression of Antigens vary with race, genetic, and interaction, and disease states

Rh The term Rh refers to a specific red blood cell

(RBC) antigen and to a complex blood group system currently composed of over 50 different

antigen specificities. Rh is the 2nd most important blood group

system in terms of transfusion. Once present they can produce significant

HDFN as well as HTR. The terms RH positive or positive and RH

negative or negative are routinely used when referring to blood typing.

Rh positive- indicates that individual RBCs possess one particular Rh Ag, the D Ag

Rh negative – indicates that RBCs lack the D Ag.

Other Major Blood Groups

The Abo and Rh blood groups are the most significant in transfusion practice. However, there are over 300 RBC antigens that are formally recognized internationally.

Blood group antigens are defined by carbohydrates (sugars) attached to glycoprotein or glycolipid structures or by amino acids on protein.

All blood group system is one or more antigens produced by alleles at a single gene locus or at loci so closely linked that crossing over does not occur or is very rare.

With a few notable exceptions, most blood group genes are located on the autosomal chomosomes and demonstrate straightforward Mondelian inheritance.

Lewis (007) Lewis gene (Le) codes for the production of fucosyltransferase enzyme Le phenotype are acquired by Erythrocytes by adsorbing Lewis substances from the plasma, rather than being membrane-bound antigens Are not considered as red cell Ag Produced by tissue cell rather than RBC Not well-developed at birth

Lewis Antigens Lewis AntibodiesCord blood and red

cells from newborn infants phenotype as Le (a-b-)

Decrease in expression of Lewis antigens on red cells of pregnant women

Considered naturally occuring

IgM in natureActivate the

complement & can cause in vivo and in vitro hemolysis

MNSs the M & N Ag are found on a well characterized

glycophorin(GA)

MN AgLocated on

Glycophorin AMN antigens differ in

their amino acid residue at position 1 (M) and has a Serine and Glycine while at position 5 (N) and has Leucine and Glutamic acid

Most are naturally occuring

Either IgG or IgM antibody

Usually do not bind complement

Do not react with enzyme-treated ells

Are pH dependent, reacting best at 6.5 and Glucose dependent

Rarely cause HTR and HDN

Anti-M

Ss Ag• Located on Glycophorin B• Both are positioned at 29 of the amino acid• S has Methionine and s has Threonine• Well developed at birth• Less degraded by enzymes

Anti-N Anti-S & Anti-sCold reactive IgG or IgM

AntibodyDo not bind

complementImplicated only

with rare cases of HDN

Seen in renal patients, who are dialyzed on equipment sterilized with formaldehyde

Most are IgGReactive at 37˚cImplicated with

severe HTR with Hemoglobinuria and HDN

PThe P blood groups comprised the P, P1, & Pk Ag, &

later ,Luke (LKE)P is assigned to the Globoside blood group system

(028,symbol GLOB).

P1 AntigenFou nd on fetal cells as

arly as 12 weeks but it weakens with gestational age

Deteriorates rapidly on storage

P1

I

Kell Immunogenic, K is rate4d second only to D in

terms of immunogenicity Well developed at birth

Expression very weakon McLeod phenotype cells

Duffy

Fy Antigens Fy AntibodiesIdentified on fetal

red cells as early as 6 weeks gestational age and are well developed at birth

Destroyed by common proteolytic enzymes (MNSs, Fy)

Usually IgG and react best at the antiglobulin phase

Activity is enhanced in a low ionoc strength medium

Do not react with enzyme-treated red cells

Associated with HTR, although hemolysis is not often severe

Kidd

Jk Antigens Jk AntibodiesDetected on fetal

red cells as early as 11 weeks for Jk and 7 weeks for Jk

Well developed at birth

Not altered by enzymes

Have notorious reputation in the blood bank

Immune antibodies, made in rtesponse to pregnancy or transfusion

Detected in the antiglobulin test

Common cause of HTR,

Associated with infrequent and mild cases of HDN

Lutheran (005)

Lu and Lu Antigens

Anti-Lu

Poorly developed at birth and do not reach adult levels until age 15

Most are naturally occurring saline agglutinins that react better at room temperature than 37˚C

Few react at 37 ˚C by indirect antiglobulin test

May be IgA, IgM or IgG

a b

a

Anti-Lub

• Most are IgG (often IgG4) although IgM and IgA antibodies have been noted• Reactive at 37˚C and the antiglobulin phase• Made in response to pregnancy or transfusion• Implicated with shortened survival of transfused cells and post transfusion jaundice

Minor Blood Groups 1. Diego 6. Colton2. Cartwright 7.

Chido/Rodgers3. Xg 8. Gerbich4. Scianna 9. Cromer5. Dombrock 10. Knops

11. Indian

Diego (010) Di antigen has served as a useful tool in

anthropologic studies in Mongolian ancestry

a

Cartwright (011) YT antigens have been located on

erythrocyte acetylcholinesterase, which is an enzyme involved in neurotransmission

Xg (012) Gene that encodes for the Xg allele is located on the

short arm of the X chromosome Difference in the frequency of the Xg antigen is noted

between the sexes: approximately 89% of the female population expresses Xg, whereas 66% for males

Scianna (013)

Dombrock (014)

Colton (015)CO antigens have been located on the

transport protein known as channel-forming integral protein (CHIP) which forms the

primary erythrocyte water channel and is reponsible for water permeability

Chido/Rodgers (017)CH/RG antigens were associated with the human leukocytes antigen (HLA) system:

alleles for RG and CH have been located two closely linked genes known as C4A and C4B

on chromosome 6.

Gerbich (020)GE antigens are inherited on chromosome 2 and are expressed on glycophorins C (GPC)

and/or D (GPD)

Cromer (021)Antigens are carried by decay accelerating

factor (DAF), which is involved with the regulation of complement activation by

accelerating the decay of c3 and c5 convertases

Knops (022)Alleles for the Kn blood group have been

located on chromosome 1, with the antigens residing on complement receptor one (CR1)

Indian (023)IN Antigens are carried on the hematopoietic isoform of the CD-44 marker, which is known

for its immune adhesion properties