You are on page 1of 48

Other Blood Group Systems

By Dr. Christina Thompson Texas A&M UniversityCorpus Christi

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

Lewis Red Cell Phenotypes


Genes
Le Se

Lewis Red Cell Phenotype


Lea- Leb+

Le
lele le le

se

Lea+ LebLea- Leb-

se Se

Lea- Leb- Lec+ Lea- Leb- Lec- Led+

Development of Antigens
Newborns born Le a-b If Le and Se

2 weeks to 6 months Le a+ then Le a+b+ then Le a-b+

During pregnancy, antigens become weaker

Phenotype Frequencies
Phenotype White Black

Le a+bLe a-b+ Le a-b-

22%
72% 6%

-----20%

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

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

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

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

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

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

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

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

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

I Blood Group

Antibodies
Anti-i

Anti-I

anti-i

rare antibody occurs in patients with infectious mononucleosis, cirrhosis, myeloid leukemia, reticulosis

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

Autoabsorption

P Blood Group
Discovered in 1927 by Landsteiner Antigens P1 P p pk Luke

Luke antigen and disease association - page 173

P Blood Group

Antibodies Anti-P1 Anti- P + P1 + pk


Anti-P1

Anti-P Anti-pk

Usually IgM reacts at room temperature and saline May attach complement rarely a problem with transfusion easily inhibited with P1 substance

P Blood Group

Antibodies Anti-P1 Anti- P + P1 + pk


Anti-P

Anti-P Anti-pk

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 DonathLandsteiner antibody

P Blood Group

Antibodies Anti-P1 Anti- P + P1 + pk

Anti-P Anti-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

Duffy Blood Group


Discovered in early 1950s Fy antigen locus on chromosome 1 with Rh locus Antigens codominant inheritance

Fya Fyb Others Fy3 (page 185)

Fyx Fy 4 Fy5

Fy6

Fs -

Duffy Blood Group

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

Kell Blood Group


Many antigens in this system and has been given a numerical nomenclature Refer to table 8-8 Six most important
Numeric KEL 1 KEL 2 KEL 3 KEL 4 KEL 6 KEL 7 Alpha K k Kpa Kpb Jsa Jsb Name Kell Cellano Penny Rautenberg Sutter Matthews Incidence 10% 99.8% 2% 99.9 Rare (19% Blacks) 99.9%(99.8% Blacks

Kell Blood Group

Most common gene complexes

Kell Blood Group

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

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

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

MNSs Blood Group

Phenotypes

MNSs Blood Group


U antigen is absent or reduced on S-sOther antigens - page 165 Mi - abnormal forms of Ss glycoprotein En(a-) absence of MN glycoprotein Disease association Page 170

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

MNSs Blood Group


Antibodies Anti-S

Usually igM and room temperature although some at AHG destroyed by enzymes Rare HTR and HDN

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)

Kidd Blood Group


Discovered in the 1950s Two antigens Jka Jkb

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

Kidd Blood Group


Antibodies Anti-Jk3

found in some Jka-b- individuals reacts with Jka and Jkb

Lutheran Blood Group


Two antigens Lua (8%)


Other antigens Table 8-12

Lub (99%)

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

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)

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

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 -

Other Blood Groups

Xg
sex-linked inheritance

Xga positive

Male - 66%

Female - 89%

uncommon antibody - AHG reaction and destroyed by enzymes - HTR and HDN?

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
Sc:1 - 100% Sc:2 - 0.3% Sc:3 - 100% Antibodies are rare

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

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?

Other Blood Groups

IN
Ina Inb Ina Iranian and Arabs Enzyme destroyed - Ina HTR

Knops
five antigens depressed in some diseases HTLA

Other Antigens

High incidence
Vel, Lan, August, Jacobs, Sid, Wra

Low incidence
too numerous to mention

Bg - HLA antigens that coat red cells

Other Blood Group Systems


By Dr. Christina Thompson Texas A&M UniversityCorpus Christi