OTHER BLOOD GROUP SYSTEMS
The Lewis blood group system (ISBT 007, symbol Le) is related
the Lewis antigens Lea and Leb present on erythrocytes.
However, these antigens are not integral parts of the membrane but are soluble
plasma proteins which become reversibly adsorbed onto erythrocyte membranes.
The levels of bound antigens therefore vary, although the erythrocytes of
children 2 years old and above have approximately adult levels.
The Lea and Leb antigens are not the
products of different forms of a single gene, but arise from different actions
of a fucosyl transferase that attaches fucose residues to an oligosaccharide
known as type-1 precursor oligosac-charide. If the fucose is added to a
subterminal position it produces the Lea antigen, whereas attachment
to the terminal position gives the Leb antigen. Approximately 72% of
white populations are Le(a–b+), that is, they lack the Lea but have
the Leb, 22% are Le(a+b–), and 6% lack both antigens. Antibodies to
the Le antigens are usually of the IgM class and, as such, do not cause HDN
since they do not cross the placenta.
The Duffy system of blood group antigens (ISBT 008, symbol FY)
is comprised of six antigens, of which Fya and Fyb are
the most significant in transfusion reactions. These antigens are expressed on
an erythrocyte membrane glyco-protein and also form the site of attachment for
malarial parasites . Thus a Fy(a–b–) individual, who does not express the blood
group antigens, has a selective advantage in a malarial area. Indeed, 68% of
blacks of African descent are of this phenotype, which is rare in whites.
Antibodies to Duffy antigens belong to the IgG class and may cause HDN.
The Kidd antigens (ISBT 009, symbol JK) are expressed on a
membrane glyco-protein, which is associated with urea transport. The Jka
and Jkb antigens result from the expression of a codominant pair of
genes. Approximately 27% of whites, and 57% of blacks are Jk(a+ b–) while 50%
of whites and 34% of blacks are Jk(a+ b+). The Jk(a–b+) phenotype is found in
23% of whites and only 9% of blacks, while the Jk(a–b–) phenotype is rare in
both populations. Antibodies to Jka and Jkb belong to the
IgM or the IgG class and may cause a mild form of HDN.
The Kell blood group system (ISBT 006, symbol KEL) is formed
from 24 anti-gens expressed on a glycoprotein of the erythrocyte membrane. The
antigen K (formerly Kell) is highly immunogenic and IgM or IgG antibodies to it
are common in transfused patients. Similarly, antibodies to its allele,
designated k (formerly Cellano), can
also cause HDN, although specific antibodies arerare in transfused patients.
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