OTHER BLOOD GROUPS MNSs BLOOD GROUP SYSTEM

ISBT No. 002

BLOOD GROUPS are divided to two
• Discovered in 1927 by Levine and Karl
Cold Antibody Warm Antibody Landsteiner
Producers Producers • Second blood group system to be identified
Blood Groups: Blood Groups: • Important in disputed parentage examination
P, I, L, M, N Kell, Kidd, Duffy • Antigens are encoded by genes on
chromosome no. 4
ABO is considered • (q28- q31)
• Well developed at birth
IgM Antibodies IgG Antibodies
• Chemically are glycoproteins primarily seen on
(Largest Antibody (Smallest Antibody
red cell membrane
Molecule) molecule)
• True antigens by the Red Blood Cells
• M and N antigens - reside in Glycophorin A
• S,s and U antigens – reside in Glycophorin B
Not capable of crossing Capable of crossing the
RBC Membrane
the placenta placenta

Not implicated in Implicated in Hemolytic Glycophorin A

Hemolytic Disease of the Disease of the Newborn M, N Antigens
Newborn (HDN) (HDN)
S – Methionine
s – Threonine
U - Universal

Reacts best at Low Reacts best at 37°C

Glycophorin B
temperature (4°C or RT)
S, s, U Antigens

• M and N Antigens – differ only in 2 Amino acids

Not implicated in Implicated in Hemolytic
at position 1 and 5 at the polypeptide chain
Hemolytic Tranfusion Transfusion Reaction
• M gene
Reaction (HTR)
• codes for SERINE at position 1
• codes for GLYCINE at position 5
• N gene
• codes for LEUCINE at position 1
Reacts best at Saline Does not react with
• codes for GLUTAMIC ACID at position 5
medium Saline Medium
• Phenotypes – can be observed using anti-sera
available in the market
• Genotypes – genes inherited by parents
Does not react in Reactive with Albumin
Albumin and AHG
Not reactive in AHG Anti - M Anti - N Phenotype Genotype
+ + M +N + MN
• IgG Antibody – a COATING ANTIBODY, + - M N
+ - MM
meaning the antibody will attach to the red - + M -N + NN
cell (sensitized Red Cell) but there will be no • Follow the positive reaction in determining the
agglutination or VISIBLE REACTION. The AHG Genotype
must be added to see the reaction. • Positive reaction can be seen by using anti-sera
• Only the Rh Antibodies does not bind (Anti-M and Anti-N)
complement
• ABO, Lewis and Kidd Antibodies do bind • Phenotypes defined by the S and s genes:
complement S +s - S -s +
S +s + S -s -U -

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 Anti - S Anti - s Phenotype Genotype KIDD BLOOD GROUP SYSTEM
+ + S +s + Ss ISBT No. 009
+ - S +s - SS
- + S -s + ss • Simplest and most straight forward blood group
- - S -s - S us u system
• Blood group gene is located at chromosome 18
• SIMILARITIES BETWEEN ANTI –M AND ANTI- N : • q11-q12
• Naturally occurring antibodies
• IgM • KIDD ANTIGENS: True antigens of the RBC
• Don’t bind complement 1. Jka 2. Jkb 3. Jk3
• Demonstrate dosage effect • Kidd antigens are detected on fetal red cells as
• Usually are cold reactive and are detected as early as 11 weeks
RT saline agglutinins • 7 weeks for Jkb
• Not implicated in HTR and HDN • They are well developed at birth
• Not clinically significant unless it reacts at 370 C • Antigens not altered by enzymes or reagents
• Not potent immunogens
• REMEMBER! • Jka and Jkb are weakly immunogenic but can
• There are some antibodies in the different cause a fatal delayed transfusion reaction
blood groups that if treated with ENZYMES, it
can either: • KIDD ANTIBODIES:
• Enhance the reactivity • Mainly IgG
• No reaction at all • Frequently difficult to detect or identify
• Reaction is destroyed • Anti-Jka – recognized in 1951 and found in
serum of a woman who gave birth to a child
• DIFFERENCES OF ANTI – M and ANTI - N with HDN
ANTI – M ANTI - N • Anti-Jkb – found in a serum of a patient
Antibody reactivity More specific at alkaline suffered a transfusion reaction
enchanced by pH • Detected only by AHG test
acidification of serum • Capable of binding complement
• Antibody reactivity can be enhanced with
Observed in multiparous Seen in renal patient’s enzyme treated red cells and by the use of
women where the dialysis LISS and PEG
machine has been • Can cause delayed hemolytic transfusion
sterilized with reaction
formaldehyde • Also associated with mild cases of HDN

• ANTI – S and ANTI – s • KIDD PHENOTYPES AND GENOTYPES

• IgG 1. Jk (a +b-)
• Reactive on the indirect antiglobulin test 2. Jk (a-b-) – Mostly found in Orientals
• May or may not react with enzymes treated particularly Filipinos
cells 3. Jk (a-b+)
• Can bind complement 4. Jk (a+b+)
• Can cause severe transfusion reaction and
severe HDN Anti - Jka Anti - Jkb Phenotype Genotype
• Anti – U – a rare antibody but can cause HDN + - Jk (a+b-) Jka / Jka
or HTR; reacts with AHG - - Jk (a-b-) Jk / Jk
• Anti-S, Anti – s and Anti – U - enzymes can - + Jk (a-b+) Jkb /J kb
enhance reactivity + + Jk (a+b+) Jka / Jkb

PLANT LECTINS that can exhibit

Anti – M Specificity Anti – N Specificity
• Iberis amara • Vicia graminea
• Iberis semperivens • Bauhinia variegata
• Iberis umbellata • Bauhinia bometiana
• Japanese turnip • Bauhinia pupurea
• Maclura aurantiaca • Bauhinia candicans

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 DUFFY BLOOD GROUP SYSTEM • P ANTIBODIES
ISBT No. 008 • Anti- P- autoantibody which is found in
patient with PCH
• An autoantibody
• First reported in 1950 by Cutbush and associates.
• Biphasic – Donath Landsteiner Antibody
• The FY gene is located at chromosome 1
seen in patients with PCH
• q22- q23
• Duffy antigens reside on DARC (Duffy Antigen • Biphasic
Receptor for Chemokines) • 4°C – Fix complement
• The antigen can be identified on fetal red cells as • 37°C – Lysis of Red Blood cell
early as 6 weeks of gestational age and • Landsteiner Test – Test to detect PCH
developed at birth • Anti- P1- found in hydatid cyst fluid
• Fya and Fyb are destroyed by proteolytic enzymes • Anti- PP1pk – originally called anti- Tja –
such as: Ficin, papain, bromelin and chymotrypsin associated with spontaneous abortion in early
pregnancy
and IgG cleaving reagent (ZZAP)
• Produced by p – individuals
• The antibody is a mixture of IgG and IgM
• DUFFY PHENOTYPES AND GENOTYPES
• Can bind complement
1. Fy (a +b-) – found among Caucasians –
• Causes HDN and HTR
Suceptible to malaria
2. Fy (a-b+)
3. Fy (a+b+)
4. Fy (a-b-) - found among Black people, I BLOOD GROUP SYSTEM
resistant to malaria (P. vivax/P. knowlesi) ISBT Collection 207

Anti - Fya Anti - Fyb Phenotype Genotype • “I” means “INDIVIDUALITY”

+ - Fy (a+b-) Fya / Fy a • Like ABH, Lewis and P blood group antigens, are
- + Fy (a-b+) Fyb / Fyb complex carbohydrates, on glycoproteins,
+ + Fy (a+b+) Fya / Fyb polylactosaminyl ceramide, and
- - Fy (a-b-) Fy / Fy glycosphingolipids.
• They are not blood group system but are classified
as a blood group collection.
• DUFFY ANTIGENS
• I Antibodies
1. Fya 2. Fyb
Fya is more immunogenic than Fyb • Anti- I - seen in patients with Mycoplasma
pneumoniae infection.
• DUFFY ANTIBODIES • Anti- i – seen in patients with infectious
• Anti-Fya mononucleosis, myeloid leukemia and
• Anti-Fyb alcoholic cirrhosis.
• Both antibodies are IgG • Anti – I is increased in adults while Anti – i is
• Implicated in HDN and delayed HTR increased in newborns
• Detected in the AHG phase • “i to I” – rare adult
• There are some individuals who haven’t
changed from i to I. (“I” must increase
habang tumatanda)
P BLOOD GROUP SYSTEM • There is a increased frequency of “i”
ISBT No. 003 • Related to HEMPAS (Hereditary
erythroblastic multinuclearity with positive
• Biochemically related to the ABO, Lewis and I acidified serum test)
blood group systems.
• All of the antigens of these systems share a
common precursor substance, ceramide dihexose
also called lactosyl ceramide.
• Individuals who lack P1 are termed P2.
• Individuals who lack P, P1, or Pk antigens are
termed p.

• P ANTIGENS
1. P1 2. P 3. Pk
• P-Antigens – a receptor for Parvovirus B19

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 KELL BLOOD GROUP SYSTEM • LEWIS PHENOTYPES and GENOTYPES
ISBT No. 006 1. Le (a+ b-) – Non-secretor (No Se gene) that
inherited the Le gene; ABH Non-secretor but
with Lea in secretion. Only Lea is expressed
• Consists of 5 sets of high incidence and low
2. Le (a - b+) – A secretor that inherited the Le
incidence antigens:
gene. ABH secretors
1. K (Kell) and k (Cellano)
2. Kpa (Penney), Kpb (Rautenberg) , 3. Le (a- b-) – Can’t recognized if secretor or
Kpc (Levay) non-secretor; Secretor if Se gene is inherited,
3. Jsa (Sutter) , Jsb (Matthews) but non-secretor if did not inherit the Se gene;
4. K11 (Cote) and K17 (Wka) did not inherit the Le gene. Lea and Leb is not
5. K14 (Santini) and K24 (Callois) expressed in the secretion
4. Le (a+ b+) – a PARTIAL SECRETOR; have a
• K and k antigens are inactivated when red cells reduced amount of ABH substances.
• Sew – weak variant of secretory gene. The
are treated with reducing agents such as
person must have this secretory gene so
dithiothreitol and 2- aminoisothiuronium bromide
that the phenotype can be expressed
• Not destroyed by enzymes (ficin, papain)
• They are destroyed by a combination of trypsin
and chymotrypsin Anti - Lea Anti - Leb Phenotype Genotype
+ - Le (a b )
+ - Lea / Lea
• Kx – Kell antigens are produced from precursor - + Le (a b )
- + Leb / Leb
substance called Kx - - Le (a b )
- - Le / Le
• Present in both RBC and WBC + + Le (a+b+) Lea / Leb
• If absent in RBC: • LEWIS ANTIBODIES
• In vivo survival is affected (reduced) • Characteristics of Lewis antibodies:
• Shape of RBC is affected 1. Generally IgM
• Increased Acanthocytes (observed in 2. Capable of binding complement
patients with Mcleod Phenotype) 3. Are enhanced by enzymes
• If absent in WBC: 4. Not implicated in HDN
• Observed in patients with Chronic 5. Not considered significant ln transfusion
Granulomatous disease (patients have medicine
recurrent bacterial infection) 6. Readily neutralized by Lewis blood group
substances
LEWIS BLOOD GROUP SYSTEM
ISBT No. 007 LUTHERAN BLOOD GROUP SYSTEM
• The only blood group system that is not ISBT No. 005
manufactured by the red cell membrane. • Discovered in 1945
• Lewis antigens are not synthesized by the red cells • Major Antigens: Lua and Lub
and incorporated into the red blood cell • Lua – high frequency
membrane. • Lub – low frequency
• Referred as a system rather than a blood group • Antibodies
because the antigens are found primarily in • Anti – Lua
secretion and plasma. • Naturally occuring saline agglutinin
• IgM
• LEWIS ANTIGENS • Reacts at Room Temperature
1. Lea 2. Leb • Rare IgM antibody not implicated in HTR
and HDN
• Lewis antigens are not true antigens of the RBC • Anti – Lub
but antigens of the body fluids • IgG
• Synthesized by the intestinal epithelial cells and • Reactive in AHG at 37°C
circulate in the plasma, either pre or bound
glycoprotein and adsorbed by the RBC • LUTHERAN PHENOTYPES and GENOTYPES
membrane 1. Lu (a+b-)
• In the formation of Le antigen, Le Gene is 2. Lu (a+b+)
needed 3. Lu (a-b-) rarest
• Lea – appear in secretions regardless of the 4. Lu (a-b+) most common
secretor (non-secretor)
• Leb – appear in secretions if you are a secretor.
A receptor for H. pylori

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 Anti - Lua Anti - Lub Phenotype Genotype Phenotype Genotype
+ - Lu (a+b-) Lua / Lua Xg (a+) Xga / Xga
+ + Lu (a+b+) Lua / Lub Xg (a-) Xga / Xg
- - Lu (a-b-) Lu / Lu Xg / Xg
- + Lu (a-b+) Lub / Lub
• Anti-Xga react at RT or at 37°C – Clinically
• Strength of antigen is known to increase until significant
about the age of 15.
• Lu gene is located on chromosome 19 along with SCIANNA BLOOD GROUP SYSTEM
H gene, Se gene, Le gene, Lw gene and C3 Antigen Symbol SC
ISBT No. 013
MISCELLANEOUS BLOOD GROUPS Antigens Sc:1, Sc:2, Sc:3

• Sc1
DIEGO BLOOD GROUP SYSTEM
• High incidence or high frequency Antigen
Antigen Symbol Di, Wr
• Orginally known as “Sm”
ISBT No. 010
• Sc2
Antigens Dia. Dib, Wra, Wrb
• Low incidence antigen
Characteristics • Dia more common in South • Referred as BUa
American Indians. • Sc3
• Useful anthropologic marker • High incidence Antigen
for Mongolian Ancestry • Present on RBC and carries Sc1 and Sc2
• Inherited as codominant alleles in Chromosome antigen
17
• Anti-Sc1 – Binds complement; implicated in HTR
CARTWRIGHT BLOOD GROUP SYSTEM • Anti Sc2 – Don’t bind complement; Implicated in
Antigen Symbol Yt HTR and can cause mild HDN
ISBT No. 011
Antigens Yta, Ytb
Characteristics • Yt antigens are located on DOMBROCK BLOOD GROUP SYSTEM
erythrocyte
acetylcholinesterase, an
enzyme involved in Antigen Symbol Do
neurotransmission ISBT No. 014
• Variably sensitive to enzyme Antigens Doa, Dob, Gya (Gregory),
• Sensitive to DTT Hy (Holley), Joa (Joseph)
• Yta – not well developed, strongly immunogenic Characteristics • Hy phenotype is found only in
• Ytb – Strongly developed, poorly immunogenic Blacks
• Antibodies are of IgG type • Anti-Doa and Anti-Dob found
• Reactive in IAT as a single specificity
• Implicated in Hemolytic Transfusion Reaction • Dombrock Antibodies are reactive at AHG also
• Not implicated in Hemolytic Disease of the in enzymes and LISS.
newborn • Anti – Doa – associated with HTR

XG BLOOD GROUP SYSTEM COLTON BLOOD GROUP SYSTEM

Antigen Symbol Co
Antigen Symbol Xg
ISBT No. 015
ISBT No. 012
Antigens Coa, Cob, Co3
Antigens Xga
Characteristics • Anti-Cob is rarely found as a
Characteristics • Inherited on X chromosome
single specificity
• Sensitive to enzymes but not
• Co3 is formerly known Coab
in Dithiothreitol
• Antibodies are rare causing mild HTR and HDN;
• One of the most unique blood groups
can be detected in AHG
• Discovered in 1962
• X-linked
• Only 1 antigen - Xga
• Xga is more common in females than in males

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 CHIDO/RODGERS BLOOD GROUP SYSTEM CROMER BLOOD GROUP SYSTEM
Antigen Symbol Ch/Rg Antigen Symbol Cr
ISBT No. 017 ISBT No. 021
Antigens Ch, Rg Antigens Cra, Tca, Dra, Esa, IFC, UMC,
Characteristics • Antigens are sensitive to Westa, Westb, Tcb, Tcc
enzymes and found in plasma Characteristics • Antigens are carried on
• Antibodies have HTLA decay accelerating factor
characteristics • Sensitive to pronase
• Located on Complement Fragments C4a and treatment and chymotrypsin
C4b
• Antigens are distributed in body fluids, red cells,
• Clinically insignificant with weak reactivity at
white cells, platelets and placental tissue
AHG
• The Anti-Cromer Antibodies are rare and
• Identified with plasma inhibition and adsorption
associated with mild HTR and more common in
with C4 coated cells
black people
• HTLA – High Titer Low Avidity
• Antibodies exhibit reactivity at high dilution of
serum but take note of the reaction KNOPS BLOOD GROUP SYSTEM
• Agglutination is weak at any dilution Antigen Symbol Kn
ISBT No. 022
• Antibodies categorized as HTLA Antigens Kna, Knb, McC, SIa, Yka
• Anti-Ch (Chido) Characteristics • Antigen depression in SLE,
• Anti-Rg (Rodgers) PNH and AIDS
• Anti-Kn (Knops) • Antigens are weakend by
• Anti-McC (MacCoy) ficin treatment
• Anti-Yka (York) • Antibodies have HTLA
• Anti-Csa (Cost) characteristics
• Anti-JMH (John Milton Hagen) • Disease associated:
• Systemic Lupus Erythematosus
• Chido/Rodgers – Clinically insignificant • Paroxysmal Nocturnal Hemoglobinuria
• Can be identified by: • Acquired Immunodeficiency Syndrome
• Plasma Inhibition Method • Knops antigen is located in complement receptor
• Adsorption with C4 coated cells 1 (CR1) with expression being depressed by Indian
Lutheran Gene [In(Lu)] of the autoimmune
diseases (SLE, PNH and AIDS)
GERBICH BLOOD GROUP SYSTEM
Antigen Symbol Ge
ISBT No. 020
Antigens Ge2, Ge3, Ge4, COST BLOOD GROUP SYSTEM
Wb, Lsa, Ana, Dah Antigen Symbol Cs
Characteristics All antigens are sensitive to ISBT No. 205
enzymes Antigens Csa, Csb
• The antigens are carried by Glycophorin C and Characteristics • Part of a blood group
Glycophorin D collection rather than a
• Glycophorin C – carries the Ge3 and Ge4 system
• Glycophorin D – carries the Ge2 and Ge3
• The Anti-Gerbich are IgG but may have IgM
component
VEL BLOOD GROUP SYSTEM
• Clinical significance of Antibody is variable
Antigen Symbol Vel
• Antibody to the low antigens may be a rare
ISBT No. 901.001
cause of HDN
Antigens Vel
Characteristics • React best with enzyme–
treated red cells
• Both IgG and IgM associated
with HTR
• Causes HDN too.

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 JMH (John Milton Hagen)
BLOOD GROUP SYSTEM
Antigen Symbol JMH
ISBT No. 026
Antigens JMH
Characteristics • Autoanti-JMH - found in
elderly patients
• Antibodies have HTLA
characteristics
• Antigens are sensitive to
enzyme

Sda BLOOD GROUP SYSTEM

Antigen Symbol Sda
ISBT No. 901.012
Antigens Sda
Characteristics • Anti-Sda appears shiny and
refractile under the
microscope
• Seen in urine and body fluids

BG
• Formerly known as Bennett Goodspeed
• White Cell antigen
• There are 3 antigens
• Bga
• BGb
• BGc
• Each antigen correspond to a class in Human
Leukocyte Antigen
• Bga – Corresponds to B7
• BGb – Corresponds to B17
• BGc – Corresponds to A28
• Antibodies are IgG
• Reacts with Indirect Antiglobulin Test
• Destroyed by treatment of Chloroquine or
Glycine-HCl-EDTA solution

INDIAN BLOOD GROUP SYSTEM

ISBT No. 023
• Antigens
• Indian A – more prevalent to Arabs and
Iranians
• Indian B

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