2. Facts
Over 200 blood antigens exist!
Unfortunately, we only get to review the
most relevant antigens
We will discuss each of these major
antigens, their antibodies, and the clinical
significance of each
4. Basic terms to remember
Clinical significance: antibodies that are
associated with decreased RBC survival
Transfusion reactions
HDN
Not clinically significant: antibodies that do
not cause red cell destruction
Cold reacting antibodies: agglutination best
observed at or below room temp.
Warm reacting antibodies: agglutination best
observed at 37°C
6. Lewis Antigens
Soluble antigens produced by tissues and
found in body fluids (plasma)
Adsorbed on the RBC
Lewis substance
adheres to RBC
becoming an antigen
RBC
Le substance
in plasma
Le
genes
7. Lewis inheritance
Lewis system depends on Hh, Se, and Le
genes
le, h, and se do not produce products
If the Le gene is inherited, Lea substance is
produced
Le, H, and Se genes must ALL be inherited
to convert Lea to Leb. Examples:
Le se H Le(a+b-)
Le Se H Le(a-b+)
le H se Le(a-b-)
le hh se Le(a-b-)
8. Lewis Antibodies
Usually occur naturally in those who are Le(a-b-)
Other phenotypes RARELY produce the antibody
IgM (may fix complement, becoming hemolytic)
Enzymes enhance activity
May be detected soon after pregnancy because
pregnant women may temporarily become Le(a-b-)
No clinical significance…Why?
Le antibodies in a patient can be neutralized by the Lewis
antigens in the donor’s plasma (cancel each other out)
do not cause HDN because they do not cross placenta
(antigens not developed well in cord blood)
Le(a-b-)
9. I antigens
These antigens may be I or i
They form on the precursor chain of RBC
Newborns have i antigen
Adults have I antigen
i antigen (linear) converts to I (branched)
as the child matures (precursor chain is
more linear at birth) at about 18 months
10. I antibodies
Most people have autoanti-I (RT or 4°C)
Alloanti-I is very rare
Cold-reacting (RT or below) IgM antibody
Clinically insignificant
Can attach complement (no hemolysis unless it
reacts at 37°)
Prewarming the tests can eliminate reactivity
Enzymes can enhance detection
11. I antibodies
Anti-I often occurs as anti-IH
This means it will react at different
strengths with reagent cells (depending on
the amount of H antigen on the RBC)
O cells would have a strong reaction
A cells would have a weaker reaction
12. Anti-I antibodies
Anti-I:
Associated as a cause of Cold Agglutinin
Disease (similar to PCH)
May be secondary to Mycoplasma
pneumoniae infections
Anti-i:
rare and is sometimes associated with
infectious mononucleosis
13. P Antigen
Similar to the ABO system
The most common phenotypes are P1 and
P2
P1 – consists of P1 and P antigens
P2 – consists of only P antigens
Like the A2 subgroup, P2 groups can
produce anti-P1
75% of adults have P1
14. P1 Antigen
Strength of the antigen decreases upon
storage
Found in secretions like plasma and
hydatid cyst fluid
Cyst of a dog tapeworm
15. P antibodies
Anti-P1
Naturally occurring IgM
Not clinically significant
Can be neutralized by hydatid cyst fluid to reveal more
clinically significant antibodies
Anti-P
Produced in individuals with paroxysmal cold
hemoglobinuria (PCH)
PCH – IgG auto-anti-P attaches complement when cold
(fingers, toes). As the red cells circulate, they begin to
lyse (releasing Hgb)
This PCH antibody is also called the Donath-
Landsteiner antibody
16. MNSs Blood System
4 important antigens (more exist):
M
N
S
s
U (ALWAYS present when S & s are inherited)
M & N located on Glycophorin A
S & s and U located on Glycophorin B
Remember: Glycophorin is a protein that
carries many RBC antigens
17. MNSs Antigens
M & N only differ in
M their amino acid
Glycophorin A N sequence at positions
1 and 5
RBC
S S & s only differ in
U
Glycophorin B s their amino acid
sequence at position
29
COOH end ….. ….5, 4, 3, 2, 1 (NH2 end)
18. MNSs antigens
all show dosage
M & N give a stronger reaction when
homozygous, (M+N-) or (M-N+)
Weaker reactions occur when in the
heterozygous state (M+N+)
Antigens are destroyed by enzymes (i.e.
ficin, papain)
19. U (Su) antigen
The U antigen is ALWAYS present when S
& s are inherited
About 85% of S-s- individuals are U-
negative (RARE)
U-negative cells are only found in the
Black population
21. Thought…..
Can a person have NO MNSs antigens?
Yes, the Mk allele produces no M, N, S, or s
antigens
Frequency of 0.00064 or .064%
22. Anti-M and anti-N antibodies
Demonstrate dosage
Anti-M and anti-N
IgM (rarely IgG)
Clinically insignificant
If IgG, could be implicated in HDN (RARE)
Will not react with enzyme treated cells
23. Anti-S, Anti-s, and Anti-U
Clinically significant
IgG
Can cause RBC destruction and HDN
Anti-U
will react with S+ or s+ red cells
Usually occurs in S-s- cells
Can only give U-negative blood units found in
<1% of Black population
Contact rare donor registry
24. MNSs Antibody Characteristics
Antibody Ig Class Clinically
significant
Anti-M IgM (rare IgG) No
Anti-N IgM No
Anti-S IgG Yes
Anti-s IgG Yes
Anti-U IgG Yes
26. Kell System
Similar to the Rh system
2 major antigens (over 20 exist)
K (Kell), <9% of population
k (cellano), >90% of population
The K and k genes are codominant alleles
on chromosome 7 that code for the
antigens
Well developed at birth
The K antigen is very immunogenic (2nd to
the D antigen) in stimulating antibody
production
27. Other Kell antigens
Other sets of alleles also exist in the Kell
system:
Analogous to the Rh system: C/c and E/e
Kp antigens
Kpa is a low frequency antigen (only 2%)
Kpb is a high frequency antigen (99.9%)
Js antigens
Jsa (20% in Blacks, 0.1% in Whites)
Jsb is high frequency (80-100%)
28. Kell antigens
Kell antigens have disulfide-bonded
regions on the glycoproteins
This makes them sensitive to sulfhydryl
reagents:
2-mercaptoethanol (2-ME)
Dithiothreitol (DTT)
2-aminoethylisothiouronium bromide (AET)
29. Kellnull or K0
No expression of Kell antigens except a
related antigen called Kx
As a result of transfusion, K0 individuals
can develop anti-Ku (Ku is on RBCs that
have Kell antigens)
Rare Kell negative units should be given
30. Kell antibodies
IgG (react well at AHG)
Produced as a result of immune stimulation
(transfusion, pregnancy)
Clinically significant
Anti-K is most common because the K antigen
is extremely immunogenic
k, Kpb, and Jsb antibodies are rare (many
individuals have these antigens and won’t
develop an antibody)
The other antibodies are also rare since few
donors have the antigen
31. Kx antigen
Not a part of the Kell system, but is
related
Kx antigens are present in small amounts in
individuals with normal Kell antigens
Kx antigens are increased in those who are K0
32. McLeod Syndrome
The XK1 gene (on the X chromosome) codes for
the Kx antigen
When the gene is not inherited, Kx is absent
(almost exclusive in White males)
Causes abnormal red cell morphologies and
decreased red cell survival:
Acanthocytes – spur cells (defected cell membrane)
Reticulocytes – immature red cells
Associated with chronic granulomatous
disease
WBCs engulf microorganisms, but cannot kill (normal
flora)
34. Kidd Antigens
Well developed at birth
Enhanced by enzymes
Not very acessible on the RBC membrane
35. Kidd antibodies
Anti-Jka and Anti-Jkb
IgG
Clinically significant
Implicated in HTR and HDN
Common cause of delayed HTR
Usually appears with other antibodies when
detected
36. Kidd antibodies
Anti-Jk3
Found in some individuals who are Jk(a-b-)
Far East and Pacific Islanders (RARE)
37. Duffy Blood Group
Predominant genes (codominant alleles):
Fya and Fyb code for antigens that are well
developed at birth
Antigens are destroyed by enzymes
Show dosage
Phenotypes Blacks Whites
Fy(a+b-) 9 17
Fy(a+b+) 1 49
Fy(a-b+) 22 34
Fy(a-b-) 68 RARE
38. Duffy antibodies
IgG
Do not bind complement
Clinically significant
Stimulated by transfusion or pregnancy
(but not a common cause of HDN)
Do not react with enzyme treated RBCs
39. The Duffy and Malaria Connection
Most African-Americans are Fy(a-b-)
Interestingly, certain malarial parasites
(Plasmodium knowlesi and P. vivax) will
not invade Fya and Fyb negative cells
It seems either Fya or Fyb are needed for
the merozoite to attach to the red cell
The Fy(a-b-) phenotype is found
frequently in West and Central Africans,
supporting the theory of selective
evolution
41. Lutheran Blood Group System
2 codominant alleles: Lua and Lub
Weakly expressed on cord blood cells
Most individuals (92%) have the Lub
antigen, Lu(a-b+)
The Lu(a-b-) phenotype is RARE
42. Lutheran antibodies
Anti-Lua
IgM and IgG
Not clinically significant
Reacts at room temperature
Mild HDN
Naturally occurring or immune stimulated
Anti-Lub
Rare because Lub is high incidence antigen
IgG
Associated with transfusion reactions (rare HDN)
43. Bg Antigens
Three (Bennett-Goodspeed) Bg antigens:
Bga
Bgb
Bgc
Related to human leukocyte antigens
(HLA) on RBCs
Antibodies are not clinically significant
44. Sda Antigens
High incidence antigens found in tissues
and body fluids
Antibodies are not clinically significant
Antibodies characteristically cause mixed
field agglutination with reagent cells
45. Xg Blood Group
Only one exists (Xga)
Inheritance occurs only on the X chromosome
89% Xga in women
66% in males (carry only one X)
Men could be genotype Xga or Xg
Women could be XgaXga, XgaXg, or XgXg
Example: Xg(a+) male with Xg(a-) woman would only
pass Xg(a+) to daughters, but not sons
The antigen is not a strong immunogen (not attributed to
transfusion reactions); but antibodies may be of IgG class
46. HTLA Antigens
High Titer Low Avidity (HTLA)
Occur with high frequency
Antibodies are VERY weak and are not
clinically significant
Do not cause HDN or HTR
50. Remember enzyme activity:
Papain, bromelin, Enhanced by Destroyed
ficin, and trypsin enzymes by enzymes
Kidd Fya and Fyb
Rh M, N
Lewis S, s
I
P
51. Remembering Dosage:
Kidds and Duffy the Monkey (Rh) eat
lots of M&Ns
M&Ns
M&Ns
Jka, Jkb, Fya, Fyb, C, c, E, e (no D), M, N, S, s
MNSs
Kidd Duffy Rh
Notes de l'éditeur
May become hemolytic in vitro (in the tube) If pregnant women have Le antibodies detected, they need to first be neutralized so that HDN antibodies may be detected