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- 2nd most important Blood Group System after - 85% Agglutinated = Rh (+)
ABO - 15% Non-agglutinated = Rh (-)
- Greatest clinical importance in Hemolytic - Ab in Female = Anti-Rh
Disease of the Newborn (erythroblastosis - Ab in Rabbit = Anti-LW
fetalis) and Transfusion Reactions
- 50 Rh antigens ( Rh1 -> Rh57) C. Weiner and Peter
- Come from Rhesus monkey - Rh(-) who received Rh(+) blood are compatible
- Most common based on antigenicity:
D>c>E>C>e 4 NOMENCLATURES
- D – primary antigen, would be Rh(+) or Rh(-) 1. Fischer-Race – DCE Terminology
due to this no matter what 2. Weiner – rH, Hr
- Location: 3. Rosenfield – Alpha/Numeric
Non-glycosylated protein on RBC membrane 4. ISBT – Numeric
(Chromosome 1) along with Fisher-Race
1. genes for elliptocytosis - 3 closely linked genes that can be inherited
2. 6-phosphoglucoronic dehydrogenase from each parent has 3 closely linked loci that
3. phosphoglucomutase carry the Rh genes
4. phosphopyruvate hydratase - Crossing over is rare cause they are closely
- no glucose moity linked
- Autosomal dominant - MNSS
- Difficulty in describing structure - CDE -> cde
- 174,000 MW compound Weiner
- 1 gene at a single locus controls the entire Rh
HISTORY system
- Discovered by Blood Transfusion - D – Rh0
A. (1939) Levine and Stetson - C – RhI
- Antibody of D Antigen (Anti-D) - E – RhII
- In serum of woman whose fetus had HDN - c – hrI
(second birth) - e – hrII
- Mother is Rh(-), Father is Rh(+) - Has agglutinogen w/c is made up of 3 blood
B. (1940) Landsteiner and Weiner factors
-Identified the Rh Blood Group System - Antigen – subscript
Rosenfield
Rh RBC - Aims to bridge the confusion between first 2
- A number in chronological discovery
- No genetic basis
Rabbit - Presence or absence only of Ag
- D–1
- C–2
Produce Anti-Rh - E–3
antibodies - e–4
against Rh RBC - c–5
ISBT (International Society for Blood Transfusions)
- 6 numerical numbers
Ab reaction - 004 = Rh
- D – 004001
with human - C – 004002
RBC - E – 004003
- c – 004004
- e – 004005
Variants of Rh
- Cu 2. Partial or Mosaic
- Cf - Because Rh is a low MW compound (174,000
- Cw daltons), it is said that the D-antigen is a mosaic
- Eu structure composed of 4 fragments and if one part
- Du – Weakened expression of D-Antigen or others is/are missing, it shows weak expression of
(Blacks>Caucasians) detectable only by Indirect D-antigen.
Method. It is few in number A B A B
- D+w is the phenotype
C D D
Mechanisms of Weak D Antigen
No Weak D Weak D with Anti-C
1. c-Trans Disadvantage – if you are Rh(-), you can receive only
- C is in cis position with D Rh(-)
- if C is in trans position it causes weak D
3. Genetic Weak D
- All fragments are present but only in few number
D d D d and thus weakly expressed.
Cis Trans
C c c C 2 types of Du
e E e 1. Low Grade
E
- Direct product of inherited gene detectable only by
Normal Weak-D IAG, and can be passed unto future generations.
2. High Grade
- Cannot be passed unto future generations, rarely
need Anti-globulin test
Problems
1. Rouleaux
2. Panagglutination – spontaneous clumping
of cells against given serum caused by:
- bacteriologic (20°C Thomsen Friedenrich)
- non-bacteriologic (37°C, Acute Hemolytic
Anemia, Rare specific antibodies)
4. Prozone
5. Polyagglutination
6. Wharton’s Jelly
7. Ag-Ab degradation