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Other Blood Group Systems. By Dr. Christina Thompson Texas A&M University- Corpus Christi. LEWIS SYSTEM. A serum antigen secondarily absorbed to the red cells Le gene produces Le a Secretors change the Le a to Le b

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other blood group systems

Other Blood Group Systems


Dr. Christina Thompson

Texas A&M University-

Corpus 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
Lewis Red Cell Phenotypes

Genes Lewis Red Cell Phenotype

Le Se Lea- Leb+

Le se Lea+ Leb-

lele Lea- Leb-

le se Lea- Leb- Lec+

le Se Lea- Leb- Lec- Led+

development of antigens
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 Frequencies

Phenotype White Black

Le a+b- 22% ---

Le a-b+ 72% ----

Le a-b- 6% 20%

lewis antibodies
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 antibodies1
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 antibodies2
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 antibodies3
Lewis Antibodies
  • Anti-Lex
  • Most react at room temperature or below -
  • Reacts with both Lea and Leb as a single antibody
lewis antibodies4
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
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 group1
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 group2
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 group3
I Blood Group
  • Antibodies Anti-I anti-i
    • Anti-I
      • usually reacts at room temperature, saline or below
      • often attaches complement
      • doesn’t 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)
i blood group4
I Blood Group
  • Antibodies Anti-I anti-i
    • Anti-i
      • rare antibody occurs in patients with infectious mononucleosis, cirrhosis, myeloid leukemia, reticulosis
i blood group5
I Blood Group
  • Antibodies
    • Other combination antibodies have been found (IA, IH, IP1, etc.) pp. 176 - 177
p blood group
P Blood Group
  • Discovered in 1927 by Landsteiner
  • Antigens P1 P p pk Luke
    • Luke antigen and disease association - page 173
p blood group1
P Blood Group
  • Antibodies Anti-P1 Anti-P Anti-pk Anti- P + P1 + pk
    • Anti-P1
      • Usually IgM reacts at room temperature and saline
      • May attach complement
      • rarely a problem with transfusion
      • easily inhibited with P1 substance
p blood group2
P Blood Group
  • Antibodies Anti-P1 Anti-P Anti-pk Anti- P + P1 + pk
    • Anti-P
      • 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 Donath-Landsteiner antibody
p blood group3
P Blood Group
  • Antibodies Anti-P1 Anti-P Anti-pk Anti- P + P1 + 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
Duffy Blood Group
  • Discovered in early 1950’s
  • Fy antigen locus on chromosome 1 with Rh locus
  • Antigens

codominant inheritance

    • Fya Fyb Fyx
    • Others Fy3 Fy 4 Fy5 Fy6 Fs - (page 185)
duffy blood group2
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
Kell Blood Group
  • Many antigens in this system and has been given a numerical nomenclature Refer to table 8-8
  • Six most important

Numeric Alpha Name Incidence

KEL 1 K Kell 10%

KEL 2 k Cellano 99.8%

KEL 3 Kpa Penny 2%

KEL 4 Kpb Rautenberg 99.9

KEL 6 Jsa Sutter Rare (19% Blacks)

KEL 7 Jsb Matthews 99.9%(99.8% Blacks

kell blood group1
Kell Blood Group
  • Most common gene complexes
kell blood group2
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 group3
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
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


  • Other alleles Mg, Mk, Mc, Mr, Mz, Mv, Na, T1m, Sj, S2, some quantitative differences
mnss blood group2
MNSs Blood Group
  • U antigen is absent or reduced on S-s-
  • Other antigens - page 165
  • Mi - abnormal forms of Ss glycoprotein
  • En(a-) absence of MN glycoprotein
  • Disease association Page 170
mnss blood group3
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 group4
MNSs Blood Group
  • Antibodies
  • Anti-S
    • Usually igM and room temperature although some at AHG
    • destroyed by enzymes
    • Rare HTR and HDN
mnss blood group5
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
Kidd Blood Group
  • Discovered in the 1950s
  • Two antigens Jka Jkb
kidd blood group1
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 group2
Kidd Blood Group
  • Antibodies
  • Anti-Jk3
    • found in some Jka-b- individuals
    • reacts with Jka and Jkb
lutheran blood group
Lutheran Blood Group
  • Two antigens Lua (8%) Lub (99%)
    • Other antigens Table 8-12
  • 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 group1
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
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 groups1
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 groups2
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 groups3
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 groups4
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 groups5
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 groups6
Other Blood Groups
  • IN
    • Ina Inb
    • Ina Iranian and Arabs
    • Enzyme destroyed - Ina HTR
  • Knops
    • five antigens
    • depressed in some diseases
    • HTLA
other antigens
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 systems1

Other Blood Group Systems


Dr. Christina Thompson

Texas A&M University-

Corpus Christi