BLOOD TYPING SYSTEMS OTHER THAN ABO
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BLOOD TYPES AND LISTS OF 'OTHER' VALUABLE BLOOD TYPING SYSTEMS USED FOR BLOOD TYPES AND BLOOD TYPING REFERENCE AND BLOOD TEST TYPE RESEARCH - DIFFERENCES IN BLOOD TYPES.
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First A Word About ABO Incompatibility.
Transfusing a patient with the incorrect ABO group Blood may have fatal consequences. Donor red cells may be destroyed by an antibody in the recipient's plasma. The rapid intravascular hemolysis which occurs in ABO incompatible transfusions can precipitate severe disseminated coagulation (DIC), prolonged hypotension, acute uraemia and even death. It has also been recognized that a potent anti-A or anti-B in donor Blood of group O may destroy the A or B red cells of a non-O recipient. This, together with the discovery of other red cell group systems, has completely altered the significance of the term 'universal donor' which is often applied to Blood of group O.
Group O Blood has neither A nor B Antigens. In the past, type O Blood was given to anyone. Donors of Blood group O were, in years past, referred to as 'universal donors.' Today, because of a better understanding of the complex issues regarding immune reaction related to incompatible donor Blood cells, type O Blood is no longer automatically seen as being suitable in most every case. Group AB Blood has neither anti A nor anti B antibodies, so any Blood can be transfused into it. Hence, persons with Blood group AB have often been seen as 'universal recipients.' [view full text HERE]
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In 1901 Karl Landsteiner discovered that when the Blood of one human being was transfused with that of another human being, differences in their Blood might well be the cause of shock, jaundice, and the Blood disorder hemoglobinuria that had resulted through earlier Blood transfusions.
Landsteiner classified human Blood into A, B, and O groups and demonstrated that transfusions between humans of group A or B did not result in the destruction of new Blood cells and that this catastrophe occurred only when a person was transfused with the Blood of a person belonging to a different group. A fourth main Blood type, AB was found in 1902 by A. Decastrello and A. Sturli.
From that time, differing Blood typing systems have been devised. Historically the naming of Blood grouping systems has been disorganized. The common conventions stipulating that dominant traits be given capital letters and recessive traits be designated with lower case letters have not been followed. Also by tradition, red cell antigens were given alphabetical designations or were named after the family of the antibody producer.
The International Society of Blood Transfusion (ISBT) has instituted a numerical system of nomenclature to help standardize red cell Blood group terminology. This convention mandates that each system and collection has been given a number and letter designation, and each antigen within the system is numbered sequentially in order of discovery. As of this writing, over 20 Blood group systems and seven antigen collections have been defined. High-prevalence or "public" antigens and low-prevalence or "private" antigens that are not associated with known systems or collections also are delineated in numbered series.
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Some systems (i. e. H, Ii, Lewis) delineate naturally occurring antibodies, but most of the other systems give rise to iso-antibodies, which result from incompatible transfusions and pregnancy. Following here is an ISBT Type/Class Chart.
CONVENTIONAL NAME ISBT SYMBOL ISBT NUMBER ANTIGENS
BLOOD GROUP SYSTEMS
ABO ABO 001 4
MNSs MNS 002 37
P P1 003 1
Rh RH 004 47
Lutheran LU 005 18
Kell KEL 006 21
Lewis LE 007 3
Duffy FY 008 6
Kidd JK 009 3
Diego DI 010 2
Cartwright YT 011 2
Xg XG 012 1
Scianna SC 013 3
Dombrock DO 014 5
Colton CO 015 3
Landsteiner-Wiener LW 016 3
Chido/Rogers CH/RG 017 9
Hh H 018 1
Kx XK 019 1
Gerbich GE 020 7
Cromer CROMER 021 10
Knops KN 022 5
Indian IN 023 2
Ok OK 024 - -
Raph RAPH 025 - -
JMH JMH 026 - -
ANTIGEN COLLECTIONS
Cost COST 205 2
Ii I 207 2
Er ER 208 2
P, P1, LKE GLOBO 209 3
Lewis-like: Le-c, Le-d - -
210 2
Wright WR 211 2
Low Prevalence
Low Prevalence - -
700 36
High Prevalence
High Prevalence - -
911 11
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The MNSs System
This system was discovered by injecting animals with human red cells. There are two loci: M/N and S/s. The antigens are M, N, S, and s. There are naturally occurring (IgM) antibodies to all these antigens. Anti-S and anti-s commonly develop immune characteristics (IgG class) as a result of pregnancy or transfusion.
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The P System
This system was also discovered by injecting animals with human red cells. P1 is the most common antigen which has variable strength of expression. Anti-P1 may be naturally occurring. It is most often an IgM antibody.
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The Lutheran (Lu) System
This system is a single locus system, with antigens Lua and Lub. The Lu(a) negative phenotype is very rare. Antibodies to Lutheran antigens are IgG. The genes of the Lutheran group are linked to the genes responsible for the secretion of ABH substances.
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The Kell System
In this system there are four antigens at two loci: K (Kell) and k (cellano), and Kpa and Kpb. The Kp(a+) phenotype and the Kp(a-b-) phenotype are both rare. The Knull phenotype K- k- Kp(a-b-) is associated with chronic granulomatus disease (CGD), an inherited defect in the bacterial capacity of neutrophils. Antibodies to Kell system antigens are IgG. Named for the family of the antibody producer Mrs. Kellacher.
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The Lewis System
This system was focuses on a single locus with two antigens, Le a and Le b. These antigens do not form an integral part of the red cell membrane, but are soluble antigens which may be present in body fluids and secretions. They are adsorbed on to the surface of red cells if they are present in the plasma in sufficient amounts. There are only three phenotypes: Le(a-b-); Le(a+b-); and Le(a-b+). Lewis phenotypes may change during pregnancy. Examples of Le(a+b+) are only transient. Lewis antibodies are only found in Le(a-b-) individuals, and are almost entirely IgM. They are the only Blood group antibodies which have never been implicated in HDN (hemolytic disease of the newborn.)
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The Duffy System
The Duffy system is also a single locus with two antigens, Fy a and Fy b. The only rare phenotype is Fy(a-b-), which has a higher frequency in countries where there is a high incidence of Plasmodium falciparium malaria. This phenotype gives a degree of immunity to the disease because the malarial parasite requires Duffy antigens to enter the red cells. Duffy antibodies are almost exclusively IgG. This system is named after the family of the antibody producer, Duffy.
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The Kidd (Jk) System
Another single locus system, two antigen system (Jka and Jkb). There are four possible phenotypes: Jk(a-b-); Jk(a+b-); Jk(a-b+); Jk(a+b+). Jk(a-b-) is a rare phenotype. Antibodies to the Kidd antigens are almost exclusively IgG.
Incompatible transfusion or pregnancy can lead to the formation of antibodies to all these Blood groups, if the recipient/mother lacks the relevant antigen. It is possible to detect all red cell antibodies using an antibody detection panel and different detection techniques. (Some antibodies, usually IgM class, react best at room temperature or cooler, and some work best at 37 degrees entigrade). If an antibody is detected in a serum the red cells from that patient are tested for the presence of the antigen. Antigen detection techniques also vary according to the nature of the antibody-antigen interaction. The presence of a particular antibody specifically excludes the patient from carrying that antigen.
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The Rhesus (Rh) System
The Rhesus system is the most important of the other commonly utilized Blood grouping systems. It was discovered by Landsteiner and Weiner in 1940. Their experiment was to produce an antibody to the red cells of the Rhesus monkey in rabbits and guinea pigs, but they discovered that not only did the antibody in the rodents' serum agglutinate the Rhesus monkey red cells, it also agglutinated the red cells of 85% of the human population. If an individual's red cells were clumped together by this antiserum, they were said to have the Rhesus factor on their red cells (i. e. Rh positive). If an individual's cells were not agglutinated by the antiserum, they were said to lack the Rhesus factor (i. e. Rh negative).
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The Fisher System
It is now known that the Rh system is very complex, and our present understanding is based on the Fisher system. There are three genes making up Rhesus antigens: C, D, and E, found on chromosome 1. There are two possible alleles at each locus: c or C; d or D; and e or E. One haplotype consisting of c/C, d/D, e/E is inherited from each parent, and the resulting Rhesus type of the individual depends on their inherited genotype. The haplotypes are given a code as follows in the table below.
Haplotype Fisher System
CDe R1
cDE R2
CDE Rz
cDe Ro
Cde r'
cdE r"
CdE Ry
cde r
If an individual's Rh genotype contains at least one of the C, D, E antigens, they are Rhesus positive. Only individuals with the genotype cde/cde (rr) are Rhesus negative. For Blood transfusion purposes, donors possessing C or E, even in Rh types r'r and r''r are classed as Rh positive. Recipients of Blood transfusions with Rh types r' and r'' should receive Rh negative (rr) Blood. This is to prevent sensitization to Rh antigens and subsequent Rh antibody formation. The most common Rh antibody is anti-D, but it is possible to form antibodies to c, C, e, and E as well, and to form combinations of antibodies. There is no anti-d
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