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system 2
Describe the causes and effects of:
Weak D; partial D; Rh null.
Predict the reactions of antibodies
to compound antigens with the
common Rh genotypes.
Discuss the usefulness of compound
antibodies in determining genotypes.
Overview
Weak D
Partial D
Rhnull
Compound antigens
Separating a mixture of antibodies
LW
Weak D Antigen.
Single amino acid switch in
transmembrane region of the RHD
protein.
Reduced expression of all epitopes.
Do not produce allo-anti-D.
Can immunise RhD neg recipients.
RHD
Reduced Rh Rh antigens
antigen expression not expressed
Rhmod Rhnull
Compound (cis) antigens
Additional antigen present when
genes are inherited in cis.
Cis antigen Haplotype
ce (RH6) R0 : r
Ce (RH7) R1 : r
cE (RH27) R2 : r
CE (RH22) RZ : ry
Antibodies Rare.
Anti-f (ce) is more common.
Marked dosage effects.
Inseparable.
Compound (cis) antibodies
Used to determine inherited
genotypes or haplotypes.
Cells tested with anti-
D C E c e Phenotype
+ + + + + DCcEe
Possible Genotypes
DCe/DcE Dce/dCE DCE/dce
R1R2 R0ry Rzr
Compound (cis) antibodies
R0RZ 0 0 3 3
R0ry 0 0 3 3
R2r 0 4 0 0
R 1R 1 4 0 0 0
rr 0 4 0 0
rr 3 0 0 3
rr 0 0 0 4
G antigen (RH12)
R 0r 3
rr patients transfused with R0r donor
rr 3
blood often form anti-D + anti-G
rr 3
rr 0
rr 0
Adsorption
C+
Y
can be separated by C+
D-
Y Y Y
adsorption. Y Y
Y Y
Anti-D Y
Y C+
Y
anti-D in the serum Y Y
Y
Adsorption
Anti-C + anti-G mixture
C-
D+
C-
D+
can be separated by Y
Y Y Y
C-
D+
adsorption. Y Y
Y Y
Anti-C Y
D positive C negative Y
Anti-G
C-
D+
Y D+
C-
D+
Y
anti-C in the serum Y Y
Y
LW
1963 - RH and LW different Blood
Groups (Levine, Cellano et.al)
Chromosome 19p13.3
Similar serologic properties but not
genetically related.
Alleles are LWa, LWb, and LW
(amorph).
LW
D positive RBCs from adults
express LW more strongly than D
negative red cells.
anti-LW made by LW(a-b-) people
can mimic anti-D.
All RHnull individuals are LW(a-b-),
but not all LW(a-b-) are RHnull
Further reading
Daniels G, Bromilow I, Essential guide to Blood Groups,
Wiley-Blackwell, Oxford.
Overfield J, Dawson D, Hamer D. Transfusion Science
2nd Ed 2008, Scion
Blainey and Howard, Basic and Applied Concepts of
Immunohematology Ch 5.2nd Ed.MOSBY Elsevier.
Missouri
Reid ME and Lomas-Francis C, The Blood Group
Antigens FactsBook, Academic Press Limited, London,
1st Edition, 1997
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