Porcine Blood Group and Hemocompatibility

There are 16 recognized porcine blood groups and the S gene that affects blood group A-O
expression are reviewed below:

• AO blood group system (A, Ss, H system). The A blood group antigen is synthesized by the
stepwise addition of fucose and N-acetyl galactosamine to type I or type II chain glycolipids.
The SS allele encodes for fucosyl-transferase 2 (FUT2) that add fucose to type I glycolipids to
create H substance. The recessive Ss allele codes for a non-functional enzyme. The EAH
alleles encodes for fucosyl-transferase 1 (FUT1) that add fucose to type II glycolipids to create
H substance. The EEAA allele encodes for UDP-GalNAc transferase that add terminal sugar to
H substance to create A substance. The recessive EEAO alleles has a major deletion within the
gene and no functional enzyme is produced. An A antigen in pigs is found primarily in the
plasma and is secondarily adsorbed to erythrocytes. Because type I chain glycolipid is the
predominant substrate found in plasma secretions and endodermally derived tissues, a pig that
is homozygous for the recessive SS allele will not express A or H substance on erythrocytes
and produces the ‘‘–’’ (blank) phenotype. Pigs do not have allele that can encode B substance
like in human. Pigs maybe one of the four phenotype A, AW (weak A), O, or ‘‘–’’ (blank).
While EAAOO, Sss genotype always produces ‘‘–’’ (blank) phenotype, EAAOO, Sss and EAAOO,
Sss genotypes maybe typed as AW (weak A) depending on the methods of detection. A
phenotyping can be done using monoclonal A-antibody while monoclonal anti-H antibody
does not distinguish between the O and ‘‘–’’ (blank) phenotypes. Anti-A monoclonal antibody
reagent is preferred over microtyping card that use human Ab which contain anti-ɑ-gal Ab
(especially in blood group A and O) that react with ɑ-gal Ag on the porcine RBCs and cause a
false positive on agglutination test [3].
• E blood group system. The E blood group antigen are highly immunogenic. Pazdera et al.
showed that SLA matched skin grafts from littermates survived longer if they were also
matched for the E antigen. Saison and Ingram showed that pigs that received skin grafts from
donors that were mismatched for the Ea antigen, frequently made anti-Ea antibodies. Thus, the
E antigens appear to act as a minor histocompatibility antigen as well as a blood group antigen
[2].
• B and F blood group systems. These blood group antigens are highly immunogenic and have
been responsible for hemolytic disease of the newborn [2].
• G, L, and N blood group systems. Skin grafts from donors that were mismated for these
blood group produces antibody to that specific blood group antigen [2].
• C, D, I, J, K, M, O, and P blood group systems are identified but there is no study
demonstrating affect of incompatibility in these blood group systems.
• Rh antigen. No polymorphism in the coding region of the gene has been identified; therefore,
it does not appear to represent a blood group antigen in pigs [2].

Although hemolytic transfusion reactions in previously untransfused pigs do not seem to occur,
Studies conduced by Hunfeld et al. and Sheil et al. showed pigs receiving A-O incompatible
blood transfusion developed symptoms similar to human receiving ABO incompatible blood
transfusion (such as disseminated intravascular coagulation (DIC), bleeding, hypotension, etc.).
It is possible that the observed outcomes may be the result of the reaction between anti-A
antibodies in the recipient plasma and A substance in the donor plasma, rather than A antigens on
the erythrocytes [2]. In this study, porcine blood is collected and PRBC are separated by blood
fractionation process and stored at 4 °C until perfusion circuit is prepared. The storied blood is
then mixed with preservation solution and gradually warmed up to 37 °C.