Important Additional Notes: Minor Blood Groups and Antigens

 The Diego system antigens are located on a major RBC protein, Band 3, also known as the RBC anion exchange
(AE1).

 Anti-Dia, anti-Dib, and anti-Wra are generally considered to be clinically significant; all have caused severe HTRs
and HDFN. Anti-Wra is a relatively common antibody.

 Wrb expression requires the presence of a normal GPA (MNS system); alloanti-Wr b is extremely rare.

 Anti-Yta is a fairly common antibody to a high-prevalence antigen that is sometimes clinically significant and
sometime insignificant.

 The Xga antigen is found on the short arm of the X chromosome and is of higher prevalence in females (89%)
than in males (66%). Although it is usually IgG, anti-Xg a has not been implicated in HDFN or is a cause of HTRs.

 Antibodies to Scianna system antigens are rare and little is known about their clinical significance. The rare null
phenotype, Sc: -1, -2, -3, has been observed in the Marshall Islands and New Guinea.

 In addition to the Doa and Dob antigens, the Gya, Hy, Joa antigens are assigned to the Dombrock system. Anti-Do a
and anti-Dob have caused HTRs but no clinical HDFN; these antibodies are usually weak and difficult to identify.

 The Colton system is composed of the antithetical Co a and Cob antigens as well as the high-prevalence Co3
antigen; the antigens are carried on aquaporin 1, a red cell water channel. The Colton antibodies have caused
HTRs and HDFN.

 LW has a phenotypic relationship with the D antigen; Rh null RBCs type LW (a-b-).

 Anti-LW reacts strongly with D+ RBCs and can look like anti-D. DTT treatment of test RBCs will distinguish
between these two antibodies because the LW antigen is denatured by DTT, but the D antigen is not. In other
words, anti-LW does not react with DTT-treated D+ RBCs but anti-D does.

 The antigens in the Chido/Rodgers system are located on the complement fragments C4b and C4a, respectively,
that are adsorbed onto RBCs from plasma.

 The clinically insignificant anti-Ch and anti-Rg react weakly, often to moderate or high-titer endpoints in the
antiglobulin test and may be tentatively identified by plasma inhibition methods.

 Gerbich-negative phenotypes are very rare outside of Papua New Guinea.

 Gerbich antibodies are sometimes clinically significant for transfusion and sometimes insignificant. Only 3 cases
of serious HDFN due to anti-Ge3 have been reported.

 The Cromer antigens are carried on the decay accelerating factor and are distributed in body fluids and on RBCs,
WBCs, platelets, and placental tissue.

 The rare anti-Cra and anti-Tca have been found only in black individuals; some examples have caused HTRs.

 The Knops antigens are located on complement receptor 1 (CR1). Knops antibodies are clinically insignificant
and have weak and “nebulous” reactivity at the antiglobulin phase; they are not inhibited by plasma.

 The Ina antigen is more prevalent in Arab and Iranian populations, with In a and Inb antigen expression being
depressed on the dominant type Lu(a-b-) RBCs.

 JMH antibodies most often occur in individuals with acquired JMH-status. Anti-JMH in these individuals is not
clinically significant.

 Anti-Vel is most often IgG but can be IgM, and has caused severe immediate HTRs and HDFN. When serum is
tested, anti-Vel characteristically causes in vitro hemolysis.

 Anti-Ata has been found only in blacks; the antibody is usually IgG and has caused severe HTRs.
 Anti-Jra is found more commonly in Japanese, but clinical significance is not well established, since it is a rare
antibody; it has caused HTRs and a fatal case of HDFN.

 Anti-Sda has characteristic shiny and refractile agglutinates under the microscope and is inhibited with urine
from Sd(a+) individuals.