Human blood group systems

The term human blood group systems is defined by the International Society of Blood Transfusion (ISBT) as systems in the human species where cell-surface antigens—in particular, those on blood cells—are "controlled at a single gene locus or by two or more very closely linked homologous genes with little or no observable recombination between them", and include the common ABO and Rh (Rhesus) antigen systems, as well as many others; 48 human systems are identified .

Table of systems and classifications Source: ISBT No. System name System symbol Structure / function ChromosomeAntigensNotes 001 ABO ABOCarbohydrate (N-Acetylgalactosamine, galactose) 9q34.2A, B, HMainly elicit IgM antibody reactions, although anti-H is very rare, see the Hh antigen system (Bombay phenotype, ISBT #18). 002 MNS MNSGPA / GPB (glycophorins A and B) 4q31.21M, N, S, s 003 P1PK P1PKGlycolipid 22q13.2P1, P, and Pk 004 Rh RHProtein and glucose 1p36.11C, c, D, E, eThere is no "d" antigen; lowercase "d" indicates the absence of D. 005 Lutheran LUProtein (member of the immunoglobulin superfamily) 19q13.3221 antigens 006 Kell KELGlycoprotein 7q34 K, k, Kpa, Kpb, Jsa and Jsb 007 Lewis LE Carbohydrate (fucose residue) 19p13.3Mainly Lea and LebAssociated with tissue ABH antigen secretion. 008 Duffy FYProtein (chemokine receptor) 1q23.2Mainly Fya and FybIndividuals lacking Duffy antigens altogether are immune to malaria caused by Plasmodium vivax and Plasmodium knowlesi. 009 Kidd JKProtein (urea transporter) 18q12.3Jka and Jkb 010 Diego DIGlycoprotein (band 3, AE 1, or anion exchange) 17q21.31Positive blood is found only among East Asians and Native Americans. 011 Yt YTProtein (AChE, acetylcholinesterase) 7q22.1 012 Xg XGGlycoprotein Xp22.33 013 Scianna SCGlycoprotein 1p34.2 014 Dombrock DOGlycoprotein (fixed to cell membrane by GPI, or glycosyl-phosphatidyl-inositol) 12p12.3 015 Colton COAquaporin 1 7p14.3Mainly Co(a) and Co(b) 016 Landsteiner-Wiener LWProtein (member of the immunoglobulin superfamily) 19p13.2 017 Chido/Rodgers CHC4A C4B (complement fractions) 6p21.3 018 Hh H Carbohydrate (fucose residue) 19q13.33 019 Kx XKGlycoprotein Xp21.1 020 Gerbich GEGPC / GPD (Glycophorins C and D) 2q14.3 021 Cromer CROMGlycoprotein (DAF or CD55, regulates complement fractions C3 and C5, attached to the membrane by GPI) 1q32.2 022 Knops KNGlycoprotein (CR1 or CD35, immune complex receptor) 1q32.2 023 Indian INGlycoprotein (CD44 adhesion function?) 11p13 024 Ok OKGlycoprotein (CD147) 19p13.3 025 Raph RAPH Transmembrane glycoprotein 11p15.5 026 JohnMiltonHagen JMHProtein (fixed to cell membrane by GPI). Also known as Semaphorin 7A or CD108 15q24.1 027 Ii I Branched (I) / unbranched (i) polysaccharide 6p24.2 028 Globoside GLOB Glycolipid, Antigen P 3q26.1 029 Gill GILAquaporin 3 9p13.3 030 Rh-associated glycoprotein RHAg Rh-associated glycoprotein 6p21-qter 031 Forssman FORS Globoside alpha-1,3-N-acetylgalactosaminyltransferase 1 (GBGT1) 9q34.13 032 Langereis LAN ABCB6, human ATP-binding cassette (ABC) transporter, mitochondrial porphyrin transporter 2q36 033 Junior JR ABCG2, Multi-drug transporter protein 4q22 034 Vel VEL Human red cell antigens 1p36.32 035 CD59 CD59 — 11p13 036 Augustine AUG Protein (transporter) 6p21.1 037 KannoNational Center for Global Health and Medicine, Japanese Red Cross Society, Fukushima Medical University and Japan Agency for Medical Research and Development (2019-08-05) 新たなヒト血液型「KANNO」の国際認定―国立国際医療研究センターなど、日本の研究グループとして初めての登録― (in Japanese)"Omae, Y.; Ito, S.; Takeuchi, M.; Isa, K.; Ogasawara, K.; Kawabata, K.; Oda, A.; Kaito, S.; Tsuneyama, H.; Uchikawa, M.; Wada, I.; Ohto, H.; Tokunaga, K. (2019). "Integrative genome analysis identified the KANNO blood group antigen as prion protein" Transfusion. 2019 Jul;59(7):2429-2435. DOI:10.1111/trf.15319. Epub 2019 Apr 24. KANNO — 20p13038SIDSID17q21.32039CTL2CTL219p13.2040PELPEL13q32.1041MAMMAM19q13.33042EMMEMM4p16.3043ABCC1ABCC116p13.11044ErERProtein16q24.3Era, Erb, Er3, Er4, and Er5Illustrates potential antigenicity of low abundance membrane proteins and contributes to understanding of in vivo characteristics of the Piezo1 protein in transfusion biology045CD36CD367q21.11046ATP11CATP11CXq27.1047MALMAL2q11.1048PIGZPIGZ3q29

Antibodies Following is a comparison of clinically relevant characteristics of antibodies against the main human blood group systems: ABO Rh Kell Duffy Kidd Lutheran MNS Lewis P Ii Most common in immediate hemolytic transfusion reactions A Yes Fya Jka Most common in delayed hemolytic transfusion reactions E,D,C Jka Most common in hemolytic disease of the newborn Yes D,C Yes Commonly produce intravascular hemolysis Yes Yes Yes Reactive at room temperature Yes M,N Lea, Leb P1 Nearly always clinically insignificant Yes M,N Yes P1 Naturally occurring Yes Yes M,N Yes Yes Yes Enhanced by ficain and papain Yes Yes Yes Yes P1Yes Destroyed by ficain and papain Fya, Fyb Yes Yes Displaying dosage Cc, Ee Yes Yes Yes

Compatibility testing

Blood compatibility testing is performed before blood transfusion, including matching of the ABO blood group system and the Rh blood group system, as well as screening for recipient antibodies against other human blood group systems. Blood compatibility testing is also routinely performed on pregnant women and on the cord blood from newborn babies, because incompatibility puts the baby at risk for developing hemolytic disease of the newborn. It is also used before hematopoietic stem cell transplantation, as it may be responsible for some cases of acute graft-versus-host disease.

Other human blood group systems than ABO and Rh have a relatively small risk of complications when blood is mixed. Therefore, in emergencies such as major hemorrhage, the urgency of transfusion can exceed the need for compatibility testing against other blood group systems (and potentially Rh as well). Also, blood compatibility testing beyond ABO and Rh is generally limited to antibody detection (not necessarily including forward typing). Still, in Europe, women who require blood transfusions are often typed for the K and extended Rh antigens to prevent sensitization to these antigens, which could put them at risk for developing hemolytic disease of the newborn during pregnancy.

When needing to give red blood cell transfusion to a patient, the presence of clinically significant antibodies produced by the patient can be detected by mixing patient serum with 2 to 4 "screening" or "control" red blood cells that together display essentially all relevant antigens. If any of these mixes display a reaction (evidence of patient antibodies binding to the screening red blood cells), a more extensive antibody panel is warranted (as imaged at right).

Human blood group systems

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