Blood Banking

• Other Major Blood Groups

  • Lewis Blood Group System (007)
  • MNs Blood Group System (002)
  • I Blood Group System (207)
  • Kell Blood Group System (006)
  • Duffy Blood Group System (008)
  • Kidd Blood Group System (009)
  • Lutheran Blood Group System (005)
• Minor Blood Groups


  • Diego Blood Group System
  • Cartwright Blood Group System
  • Xg Blood Group System
  • Scianna Blood Group System
  • Dombrock Blood Group System
  • Colton Blood Group System
  • Chido/Rodgers Blood Group System
  • Gerbich Blood Group System
  • Cromer Blood Group System
  • Knops Blood Group System
  • Indian Blood Group System

  
• Lewis gene (Le)


  Codes for the production of fucosyltransferase enzyme
• Lewis phenotype


  Erythrocytes acquire it by adsorbing Lewis substances from the plasma. Rather than being membrane-bound antigens

  
• Type 1 precursor chain

  LE antigen is produced by tissue cells, then secreted to plasma and adsorbed to red cell surface

  
• Cord blood and red cells from newborn infants phenotype as Le(a-b-)
• Decrease in expression of Lewis antigen has been demonstrated on red cells from many pregnant women

  
• Lewis genotype and phenotype

  • ABH, lele, sese - ABH Le(a-b-)
  • ABH, lele, SeSe or Sese - ABH Le (a-b-)
  • ABH, Lele or lele, sese - ABH Le (a+b-)
  • ABH, LeLe or Lele, SeSe or Sese - ABH Le (a-b+)
• Lewis phenotype frequencies


  • Le (a+b-) - 22% whites, 23% blacks
  • Le (a-b+) - 72% whites, 55% blacks
  • Le (a-b-) - 6% whites, 22% blacks
• Lewis antibodies


  Considered naturally occurring, IgM in nature, activate the complement and can cause in vivo and in vitro hemolysis

  
• MN antigen


  Found on glycophorin A of cell membrane, also known as MN-sialoglycoprotein
• M and N antigens

  Differ in their amino acid residue at positions 1 and 5 - M has serine and glycine, N has leucine and glutamic acid
• MN and Ss antigens are easily destroyed or removed by enzymes
• MN and Ss antigens are well developed at birth, important in paternity studies of infants and young children
• Ss antigens

  Located on Glycophorin B, also known as Ss-sialoglycoprotein (SGP)

  
• S and s antigens

  Amino acid at position 29 on GPB is critical to antigen expression - S has methionine, s has threonine
• Ss antigens are well developed at birth and less easily degraded by enzymes
• Anti-M


  Naturally occurring cold reactive IgM or IgG, pH dependent, react best at pH 6.5, usually do not bind complement, rarely causes hemolytic transfusion reactions or HDN
• Anti-N


  Naturally occurring cold reactive IgM or IgG, rare cause of HDN, anti-N like antibody found in renal patient dialyzed with formaldehyde sterilized equipment
• Anti-S and Anti-s


  Most examples are IgG, reactive at 37°C and the antiglobulin test phase, implicated with severe hemolytic transfusion reaction with hemoglobinuria, and HDN

  
• P system phenotypes, antigens, and antibodies

  • P1 - P, P1, no antibodies
  • P2 - P, anti-P1
  • P (a.k.a P null) - none, anti-PP1PK or anti-Tia
  • P1K - Pk, P1, anti-P
  • P2K - Pk, anti-P1, anti-P

  
• Frequency of P system phenotypes

  • P1 - 79% whites, 94% blacks
  • P2 - 21% whites, 6% blacks
  • p - rare
  • P1K - very rare
  • P2K - most rare
• P1 antigen


  Found on fetal rbc as early as 12 weeks, weakens with gestational age, deteriorates rapidly on storage, P1-like antigen found in plasma, droppings of pigeons and turtledoves, egg white of turtledoves

  
• Anti-P1


  Common, naturally occurring IgM antibody in the sera of P2 individuals, cold-reactive saline agglutinin, associated with hydatid disease, fascioliasis, Clonorchis sinensis, and Opisthorchis viverrini infections

  
• Anti-PP1Pk


  Originally called anti-Tja, predominantly IgM, sometimes IgG, reacts over a wide thermal range, associated with spontaneous abortions in early pregnancy
• Anti-P


  Naturally occurring alloantibody in the sera of all Pk individuals, very significant because it is hemolytic with a wide thermal range of reactivity, also found as an IgG autoantibody in patients with Paroxysmal Cold Hemoglobinuria

  
• Anti-P (biphasic)


  Cold temperature will cause the Biphasic Anti-P to attach to RBC, warm temperature will cause the Biphasic Anti-P to lyse the RBC
• Anti-Pk


  Isolated from some examples of anti-PP1Pk by selective adsorption with P1 cells, has been reported in the serum of P1 individuals with biliary cirrhosis and autoimmune hemolytic anemia
• Ii antigens


  At birth, infant red cells are rich in i; I is almost undetectable, during the first 18 months of life, the quantity of i slowly decreases as I increases, adult red cells are rich in I and have only trace amount of i antigen, increase i Antigen = HEMPAS (Hereditary Erythroblastic Multinuclearity with Positive Acidified Serum Test)

  
• Rare I adult or I negative phenotype - individuals who do not change their i status after birth
• Anti-I


  Common autoantibody that can be benign or pathologic, demonstrates strong reactions with adult cells and weak reactions with cord cells, not associated with HDN because the antigen is poorly expressed on infant red cells

  
• Benign anti-I


  Found in the serum of many normal healthy individuals, not associated with in vivo red cell destruction, weak, naturally occurring, saline-reactive IgM agglutinin, usually reacts only at 4°C
• Pathologic anti-I


  Potent IgM agglutinins with higher titers and broader thermal range of activity, reacting up to 30 to 32°C, attach in vivo and cause autoagglutination and vascular occlusion (Raynaud's phenomenon) or intravascular hemolysis, associated with CAD, CAS and PAP
• Autoanti-I


  Production of autoanti-I may be stimulated by microorganisms carrying I-like antigen on their surface (Mycoplasma pneumoniae, Listeria monocytogenes), most autoanti-i are IgM, reacts best with saline-suspended cells at 4°C, potent examples are associated with infectious mononucleosis, diseases of reticuloendothelial system (alcoholic cirrhosis, myeloid leukemia, reticulosis), IgG anti-i has also been described and has been associated with HDN

  
• Kell antigens


  Immunogenic, K is rated second only to D in terms of immunogenicity, well-developed at birth, expression very weak on McLeod phenotype cells
• Anti-K


  Common antibody encountered in bloodbank, usually an IgG antibody reactive in the antiglobulin phase, made in response to antigen exposure through pregnancy and transfusion, implicated in severe hemolytic transfusion reactions, associated with severe hemolytic disease of the newborn
• Antibodies to Kpa, Jsa, and other low-frequency Kell antigens

  Rare because so few people are exposed to the antigen, most often detected through unexpected incompatible crossmatches or cases of HDN

  
• Antibodies to k, Kpb, Jsb, and other high-frequency Kell antigens

  Rare because so few people lack the antigen
• McLeod phenotype


  Rare phenotype with decreased Kell system antigen expression and abnormal red cell morphology, associated with Chronic Granulomatous Disease

  
• Frequencies of common Kell phenotypes

  • K- k+ - 91.0% whites, 96.5% blacks
  • K+ k+ - 8.8% whites, 3.5% blacks
  • K+ k- - 0.2% whites, <0.1% blacks
  • Kp (a+ b-) - <0.1% whites, 0% blacks
  • Kp (a+ b+) - 2.3% whites, rare blacks
  • Kp (a- b+) - 97.7% whites, 100% blacks
  • Js (a+ b-) - 0% whites, 1% blacks
  • Js (a+ b+) - rare whites, 19% blacks
  • Js (a- b+) - 100% whites, 80% blacks