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Lewis System

antigens are manufactured by tissue cells, secreted into the body fluids, and are absorbed (stuck) onto the RBC membrane.

To have Lewis antigens these genes must be present

Lewis genes AND the secretor (Se) gene

3 ways Lewis antigens differ

1. Lewis antigens are not intrinsic to the RBC membrane produced during the cell development.
Antigens are produced by tissue cells and are absorpted onto the RBCs.
2. A person's Lewis phenotype is NOT determined SOLELY by genes at the Lele locus.
Hh and Sese loci are involved with the Lele locus
3. The amount of Lewis antigen expression on the RBC varies according to the cell's ABO phenotype.

What Chromosome is the Le gene on?

Short arm of chromosome 19
(90% white population)

Genes needed to express Le-a

Just Le gene

Genes needed to express Le-b

Le and Se genes

Le-a %

22% of the population


72% of the population

Le-b secretes what antigens and what antigens are on the RBC

both Lea and Leb soluble antigens are present in the secretions and plasma but only Leb appears on the RBC surface.

LE (a-b-)

no Le antigens are present on the RBC or secretions...
(nonfunctional or partially active Lewis transferase)

A baby that is genetically Le(a-b+)

At birth:
2 months:
12-18 months:
Finally (6 - 7 years):

"The Scandal in the Lewis Family":

Lea (Lea), age 22, married a bum named Bob (Leb), who is 50 years her senior (72)

Anti Lewis andtibodies

Generally produced by Le(a-b-) persons
Generally IgM and can't cross the placenta

A cold LeMN PHI

Lewis, Lu-a, anti-M, anti-N, anti-S, anti-P, Anti-P1, Anti-Pk, Luke (LKE), Anti-H, Anti-I, anti-i

Lewis antibodies

Generally considered insignificant in blood transfusion (because they can fall off)

Helicobacter pylori

Expresses Lewis antigens.

Globoside antigens

All P but P1 (P, Pk, and LKE)

Rare P phenotypes

p, P1k, and P2k.

Most common P phenotypes

P1 and P2

Very Rare P Phenotype


The P1 antigen

is present on the RBCs of 80% of the population
Similar to the 80% A1 and 20% A2 in the ABO System

Approximately 20%

lack the P1 antigen and are designated as P2
Similar to the 80% A1 and 20% A2 in the ABO System

P1 Antigen

deteriorates rapidly on storage

Donath-Landsteiner antibody.

IgG auto-anti-P antibody
Biphasic Hemolysin

Paroxysmal Cold Hemoglobinuria (PCH)

diagnosed by the Donath-Landsteiner Test

P antigen serves as a receptor for what virus

parvovirus B19, which causes erytherma infectiosum (Fifth's Disease).
people who are little p are naturally resistant.

Anti-PP1Pk Antibody

Also known as the anti-Tja Antibody
Seen in very rare "p" people who lack ALL of the P blood group system's antigens (P, P1, & Pk)

Ii system

all babies are born with the i then as they age they can be converted to I (IF the person is I phenotype)

Auto Anti-I

Common autoantibody that is found in virtually all sera (Almost everybody has it!).
classified as an heterophil antibody

Pathogenic Anti-I

cold autoimmune hemolytic anemia or Cold Agglutinin Syndrome
An Anti-I that has a broad thermal range

Anti I & Anti IH

Nuisance antibodies that can be overlooked using prewarm techniques and monospecific AHG

bacteria related to autoanti I

Mycoplasm pneumoniae body develops a strong cold agglutinins as a cross-reactivity response


not well discribed, not normally found in healthy people.
involved in EBV, liver cirrosis, and Myeloid leukemias

Gene responsible for I antigen's branching enzyme


M antigen percentage


N antigen percentage


S antigen percentage


s antigen percentage


The M and N antigens are found on a glycoprotein called

glycophorin A (GPA)

Enzymes enhance

I really love a pink kangaroo (I, Rh, Lewis, ABO, P1, Kidd)

Enzymes destroy

X MD (Xga, MNS, Duffy)

Blood Groups that Exhibit Dosage

"Dr. Martin Luther King"
(Duffy, Rh (except D), MNS, Lutheran, Kidd)

S and s Antigens are located on

glycoprotein B (GPB)

S and s are differentiated by the amino acids at the 29 position:

29th position
S has methionine
s has threonine

Which antibody reacts better at a lower pH of 6.5

Anti-M Antibody

Formaldehyde alters the M and N antigens so that they are recognized as foreign. What antibody is this?

(It has been associated with the rejection of a chilled transplanted kidney.)

The U antigen is a high incidence antigen that is found on RBCs of all individuals except about

1% of Blacks

En(a-) Phenotype

produce anti-Ena, which is an umbrella term for reactivity against various portions of GPA unrelated to M or N, but not all antibodies detect the same portion.

Mk Phenotype

the null phenotype in the MNS system.

Escherichia coli may use

the GPA to gain entry to the urinary tract.

Plasmodium falciparum

use alternative receptors, GPA, GPB, and GPC for cell invasion.

k antigen percentage


K antigen percentage


is very immunogenic, second only to D

K, 10 % of people negative for K create an anti K antibody

The Kpa antigen is found only in



only in whites, 2%

Js^a & Js^b antigen percentages

20% of blacks and <0.1% of whites.

The Ko Phenotype

Lacks all Kell antigens (can produce anti-Ku)

Where is The Kx Antigen found?

Only trace amounts of Kx are found on RBCs of normal Kell phenotypes but elevated levels of Kx are present on Ko cells.
(Not found in Mcleod phenotype)

The McLeod Phenotype & Syndrome

Seen only in males
Transferred through carrier mother
severe mutations and deletions at the XK locus.
RBCs lack Kx and Km antigens and have marked depression of all other Kell antigens

The McLeod Phenotype & Syndrome Hematological picture

Acanthocytic RBCs with decreased deformability and reduced in-vivo survival.
Chronic hemolytic anemia (compensated)
X-linked chronic granulomatous disease.

Chronic Granulomatous Disease (CGD)

Granulocytes exhibit normal phagocytosis of microorganisms but inability to kill ingested pathogens.

The McLeod Phenotype & Syndrome: clinical manifestations

Muscle and nerve disorders
Slow, progressive form of muscular dystrophy

Passively Acquired Antibodies

Antibodies passed to baby by mother through placenta

Unexpected Antibodies

Antibodies discovered through panel testing

Monospecific AHG misses what important antibody?


Gel Technique uses

dextran acrylamide gel (gel contains anti-IgG)

Solid Phase Technique

RBC antigens coat microtiter wells instead of being present on intact RBCs.
(The patient's serum is added to each well along with LISS.)

Mixed field agglutination in antibody panel is due to which antibodies?

associated with anti-Sda and Lutheran antibodies.

Hemolysis in antibody panel is due to which antibodies?

anti-Lea, anti-Leb, anti-PP1Pk, and anti-Vel antibodies.

Factors Affecting the Antibody Screen

temp, cell to serum ratio, length of incubation and pH

Examples of enzymes

Ficin, papain, trypsin, and bromelin

What is adsorption?

The antigen:antibody complex is removed

The serum is then tested in a panel.

Clerical error is

#1 cause of transfusion associated fatalities.

blood to give a weak D

Rh negative

Percentage of people who are Rh negative that when exposed to Rh positive RBCs create an Anti-D

80% of these patients may be expected to make the anti-D antibody.

purpose of FFP

Contains coagulation factors and is used to treat coagulation deficiencies from DIC, liver failure, vitamin K deficiency, Warfarin overdose, or massive transfusion.

what type should be transfused when considering platelets?

Only specific to Rh when involving women in younger years

These antigens are known as "The Travelers"

Fya and Fyb (DUFFY)

Fya antigen percentage


Fyb antigen percentage


Fya and Fyb Antigens are found on what cells/organs

RBCs, brain, colon, spleen, thymus but not found on any other blood cell

Duffy is located on what chromosome?

Chromosome 1

What is the major Duffy antigen in blacks?


what is strange about Fyx?

it types as Fy(b-) but will absorb and elute anti Fyb
(weak expression of Fyb)

Fy3 stands out in the Duffy system because...

It is not destroyed by enzymes

Anti-Fy3 antibody reacts with what antigens

Fya, and Fyb
(at one time it was thought this was a compound antibody)

Receptors that the organism plasmodium use to enter cells

Fya and Fyb

This system is known as the gamblers


Jka antigen percentage


Jkb antigen percentage


Most African Americans are this Kidd phenotype


Most Caucasians are this Kidd phenotype


What antibody system must use fresh serum?

(complement levels are too low in stored serum for these antibodies to react)

The phenotype Jk(a-b-) is found most commonly in what group of peoples?

(Filipinos, Indonesians, Chinese, and Japanese)

The 2 molar urea test is used as a screen for what phenotype?


Lua antigen percentage


Lub antigen percentage


Causes Of The Lu(a-b-) Phenotype

Amorphic gene, Lu
Inhibitor gene, In(Lu), which prevents the normal expression of the Lutheran antigens

Lutheran antibodies have...

...a characteristic loose, mixed-field reactivity in a test tube.

Unique in the blood group systems in that inheritance is on a sex linked basis

Xg antigens
Women: 89%
Men: 66%

where is the Xga chomosome?

short arm of the X chromosome

What antigen is Useful marker in the anthropologic studies of Mongolian ancestry

Diego system Dia
(Also seen in 54% of South American Indians)

Yta antigen percentage


Ytb antigen percentage


Sc1 antigen percentage


Sc2 antigen percentage


Sc3 antigen percentage


Name the five antigens in The Dombrock (ISBT 014) Blood Group System

Gya: Gregory
Jy (Holley)
Joa: Joseph

Name the three antigens in the Colton (ISBT 015) Blood Group System

Coa (99.9% of population)
Cob (10% of population)
Co3: high incidence antigen

Name five of the nine Chido/Rodgers (ISBT 017) Blood Group System

CH1, CH2, CH3, RG1, and RG2 as high incidence antigens.
(Plasma inhibition tests are used to confirm the identity of suspected anti-Ch or anti-Rg antibodies.)

Name three high incidence antigens in the Gerbich (ISBT 020) Blood Group System

Ge2, Ge3, Ge4

name four low incidence antigens in the Gerbich (ISBT 020) Blood Group System

Wb, Lsa, Ana, Dha

Name eight high incidence antigens in the Cromer (ISBT 021) Blood Group System

Cra, Tca, Dra, Esa, IFC, UMC, WESb, GUTI

Name three low incidence antigens in the Cromer (ISBT 021) Blood Group System

Tcb, Tcc, WESa

The Knops (ISBT 022) Blood Group System

Composed of eight antigens:
Kna (Knops)
McCa (McCoy)
S11 (Swain-Langley)
Yka (York)
S12 (vil)

Indian (ISBT 023) Blood GroupSystem is composed of which two antithetical antigens?

Ina (low incidence)
Inb (high incidence)

John Milton Hagen is known as what antigen

JMH (High incidence)

The absence of the JMH antigen:

A. Elderly
B. Paroxysmal nocturnal hemoglobinuria

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