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Other Blood Group Systems

Other Blood Group Systems

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Other Blood Group Systems

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  1. Other Blood Group Systems By Dr. Christina Thompson Texas A&M University- Corpus Christi

  2. 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

  3. 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+

  4. 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

  5. Phenotype Frequencies Phenotype White Black Le a+b- 22% --- Le a-b+ 72% ---- Le a-b- 6% 20%

  6. 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

  7. 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

  8. 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

  9. Lewis Antibodies • Anti-Lex • Most react at room temperature or below - • Reacts with both Lea and Leb as a single antibody

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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) • COLD AUTOAGGLUTIN

  15. I Blood Group • Antibodies Anti-I anti-i • Anti-i • rare antibody occurs in patients with infectious mononucleosis, cirrhosis, myeloid leukemia, reticulosis

  16. I Blood Group • Antibodies • Other combination antibodies have been found (IA, IH, IP1, etc.) pp. 176 - 177 • ENZYMES ENHANCE ACTIVITY • ABSORBTION IS USED TO TEST FOR OTHER MORE IMPORTANT ANTIBODIES

  17. Autoabsorption

  18. P Blood Group • Discovered in 1927 by Landsteiner • Antigens P1 P p pk Luke • Luke antigen and disease association - page 173

  19. 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

  20. 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

  21. 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

  22. 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)

  23. Duffy Blood Group

  24. 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

  25. 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

  26. Kell Blood Group • Most common gene complexes

  27. Kell Blood Group • Mc Leod syndrome • Reduced expression of Kell antigens • association with hemolytic anemia and chronic granulomatous disease • genetics and antigen page 181

  28. 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

  29. 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 MS Ms NS Ns • Other alleles Mg, Mk, Mc, Mr, Mz, Mv, Na, T1m, Sj, S2, some quantitative differences

  30. MNSs Blood Group • Phenotypes

  31. 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

  32. 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

  33. MNSs Blood Group • Antibodies • Anti-S • Usually igM and room temperature although some at AHG • destroyed by enzymes • Rare HTR and HDN

  34. 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)

  35. Kidd Blood Group • Discovered in the 1950s • Two antigens Jka Jkb

  36. 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

  37. Kidd Blood Group • Antibodies • Anti-Jk3 • found in some Jka-b- individuals • reacts with Jka and Jkb

  38. 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

  39. 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)

  40. 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

  41. 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 -

  42. Other Blood Groups • Xg • sex-linked inheritance • Xga positive Male - 66% Female - 89% • uncommon antibody - AHG reaction and destroyed by enzymes - HTR and HDN?

  43. 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

  44. 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

  45. 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?

  46. Other Blood Groups • IN • Ina Inb • Ina Iranian and Arabs • Enzyme destroyed - Ina HTR • Knops • five antigens • depressed in some diseases • HTLA

  47. Other Antigens • High incidence • Vel, Lan, August, Jacobs, Sid, Wra • Low incidence • too numerous to mention • Bg - HLA antigens that coat red cells

  48. Other Blood Group Systems By Dr. Christina Thompson Texas A&M University- Corpus Christi