Major

and
Minor

Blood Group
System

Major
Other Major
Blood
Blood Groups
Group
1. Lewis
5. Kell
s1.AB
O
2.Rh

2. MNSs 6. Duffy
3. P
7. Kidd
4. I
8. Lutheran

ABO
The most important of all blood

groups in transfusion practice

The only blood group system in
which individuals have antibodies in
their serum to antigens that are
absent from their RBCs
Due to presence of antibodies,
transfusion of an incompatible ABO
type may result in Lysis of donors
RBC

ABO Antibodies

Individuals normally

roduce antibodies
directed against the
Aand/or B antigen(s)
absent from their RBCs
They are naturally
loccuring because they
are produced w/out any
exposure toor colder
RBCs
ABO are predominantly
IgM
Activate complement
React at room
temperature

Formation
of
A,

Results from the

and
H RedofCgenes
ell at
interaction
Antigens
three separate loci

( ABO, Hh, and Se)

A,B and H antigens are
formed from the same
basic precursor material
called paragloboside or
glycam- to which sugars
are attached in response
to specific enzyme
transferases elicited by
an inherited gene
H antigen is actually the
precusoror strucure on
which A and B antigens
are made

The H antigen must be inherited to

form the ABO antigens on the RBCs

Se gene must be inherited as well to
form ABO secretions
ABH antigens develop early in fetal life
but do not increase much in strength
during gestational period
Fully developed by 2 to 4 years and
remains throughout life
Also expression of Antigens vary with
race, genetic, and interaction, and
disease states

Rh
The term Rh refers to a specific red blood cell

(RBC) antigen and to a complex blood group

system currently composed of over 50 different
antigen specificities.
Rh is the 2nd most important blood group
system in terms of transfusion.
Once present they can produce significant HDFN
as well as HTR.
The terms RH positive or positive and RH
negative or negative are routinely used when
referring to blood typing.
Rh positive- indicates that individual RBCs

Other Major
Blood Groups

The Abo and Rh blood groups are the

most significant in transfusion

practice. However, there are over 300
RBC antigens that are formally
recognized internationally.
Blood group antigens are defined by

carbohydrates (sugars) attached to

glycoprotein or glycolipid structures
or by amino acids on protein.

All blood group system is one or

more antigens produced by alleles at

a single gene locus or at loci so
closely linked that crossing over does
not occur or is very rare.
With a few notable exceptions, most

blood group genes are located on the

autosomal chomosomes and
demonstrate straightforward
Mondelian inheritance.

Lewis (007)
Lewis gene (Le) codes for the

production of fucosyltransferase
enzyme
Le phenotype are acquired by
Erythrocytes by adsorbing Lewis
substances from the plasma, rather
than being membrane-bound
antigens
Are not considered as red cell Ag

Lewis Antigens

Lewis Antibodies

Cord blood and red

Considered naturally
cells from newborn
infants phenotype as
occuring
Le (a-b-)
IgM in nature
Decrease in
Activate the
expression of Lewis
complement & can
antigens on red cells
cause in vivo and in
of pregnant women
vitro hemolysis

MNSs

the M & N Ag are found on a well characterized

glycophorin(GA)

Located on Glycophorin

A
MN Ag
MN antigens differ in
their amino acid residue
at position 1 (M) and
has a Serine and
Glycine while at position
5 (N) and has Leucine
and Glutamic acid

Ss Ag

Located on Glycophorin
B
Both are positioned at
29 of the amino acid
S has Methionine and s
has Threonine
Well developed at birth
Less degraded by

Anti-M
Most are naturally

occuring
Either IgG or IgM
antibody
Usually do not bind
complement
Do not react with
enzyme-treated ells
Are pH dependent,
reacting best at 6.5 and
Glucose dependent
Rarely cause HTR and
HDN

Cold reactive
IgG or
IgM Antibody
Anti-N
Do not bind

Anti-S & Anti-s

complement
Implicated only with
rare cases of HDN
Most are IgG
Seen in renal
Reactive at 37c
patients, who are
Implicated with
dialyzed on
severe HTR with
equipment sterilized Hemoglobinuria and
with formaldehyde
HDN

P
The P blood groups comprised the P, P1, & Pk Ag, &

later ,Luke (LKE)

P is assigned to the Globoside blood group system
(028,symbol GLOB).

P1 Antigen

Fou nd on fetal cells as

arly as 12 weeks but it

weakens with gestational
age
Deteriorates rapidly on
storage
P1

Kell
Immunogenic, K is rate4d second only to D in

terms of immunogenicity
Well developed at birth
Expression very weakon McLeod phenotype cells

Duffy

Fy Antigens
Identified on fetal

red cells as early as

6 weeks gestational
age and are well
developed at birth
Destroyed by
common proteolytic
enzymes (MNSs, Fy)

Fy Antibodies

Usually IgG and react

best at the
antiglobulin phase
Activity is enhanced
in a low ionoc
strength medium
Do not react with
enzyme-treated red
cells
Associated with HTR,
although hemolysis is
not often severe

Kidd

Jk Antigens
Detected on fetal

red cells as early as

11 weeks for Jk and
7 weeks for Jk
Well developed at
birth
Not altered by
enzymes

Have notorious

Jk
Antibodies
reputation
in the

blood bank
Immune antibodies,
made in rtesponse to
pregnancy or
transfusion
Detected in the
antiglobulin test
Common cause of
HTR,
Associated with
infrequent and mild
cases of HDN

Lutheran (005)

Lua and Lu
b
Antigens

Most are
naturally
Poorly
developed
at

occurring
saline
birth and do
not reach
agglutinins
thatage
react
adult levels until
15
a
Anti-Lu
better at room
temperature than
37C
Few react at 37 C
by indirect
antiglobulin test
May be IgA, IgM or
IgG

Anti-Lu

Most are IgG (often

IgG4) although IgM
and IgA antibodies
have been noted
Reactive at 37C
and the antiglobulin
phase
Made in response to
pregnancy or
transfusion
Implicated with
shortened survival of
transfused cells and

Minor Blood
Groups
1. Diego
6. Colton
2. Cartwright
7.

Chido/Rodgers
3. Xg
8. Gerbich
4. Scianna
9. Cromer
5. Dombrock
10. Knops
11. Indian

Diego (010)

a
Di antigen has
served as a useful tool in

anthropologic studies in Mongolian ancestry

Cartwright (011)
YT antigens have been located on

erythrocyte acetylcholinesterase, which is an

enzyme involved in neurotransmission

Xg (012)
Gene that encodes for the Xg allele is located on the

short arm of the X chromosome

Difference in the frequency of the Xg antigen is noted
between the sexes: approximately 89% of the female
population expresses Xg, whereas 66% for males

Scianna (013)

Dombrock (014)

Colton (015)
CO antigens have been located on the
transport protein known as channel-forming
integral protein (CHIP) which forms the
primary erythrocyte water channel and is
reponsible for water permeability

Chido/Rodgers
(017)
CH/RG antigens were associated with the
human leukocytes antigen (HLA) system:
alleles for RG and CH have been located two
closely linked genes known as C4A and C4B
on chromosome 6.

Gerbich (020)
GE antigens are inherited on chromosome 2
and are expressed on glycophorins C (GPC)
and/or D (GPD)

Cromer (021)
Antigens are carried by decay accelerating
factor (DAF), which is involved with the
regulation of complement activation by
accelerating the decay of c3 and c5
convertases

Knops (022)
Alleles for the Kn blood group have been

located on chromosome 1, with the antigens

residing on complement receptor one (CR1)

Indian (023)
IN Antigens are carried on the hematopoietic
isoform of the CD-44 marker, which is known
for its immune adhesion properties