Immunohematology: Chromosome Associations & Lectins

• The document covers immunohematology.

Chromosome Immunology

• The short arm (p) of chromosome 6 is associated with MHC.
• Chromosome 14 is associated with Heavy chain.
• Chromosomes 2 or 22 are associated with Light chain.

Immunohematology Chromosome Associations

• Chromosome 1 is associated with Rh, Duffy, Knops (Complement Receptor 1), Scianna.
• Chromosome 4 is associated with MNS.
• Chromosome 6 is associated with Chido / Rodger.
• Chromosome 7 is associated with Kell.
• Chromosome 9 is associated with ABO.
• Chromosome 18 is associated with Kidd.
• Chromosome 19 is associated with H, Lewis, Lutheran.
• Chromosome 22 is associated with P1.
• The short arm (p) of chromosome X is associated with Xg.

Lectins and Their Origins

• Anti-A1 originates from Dilochos biflorus.
• Anti-B originates from Griffonia (Old: Banderiaea) simplicifolia.
• Anti-H originates from Ulex europaeus.
• Anti-M originates from Ibenis amara.
• Anti-N originates from Vicia graminea, Bauhinia variegate, and Bauhinia purpura.
• Soybean Extract comes from Glycine soja.
• Peanut comes from Arachis hypogaea.
• The "Plant" lectin is from Salvia horminum.
• Plant with Anti-Tn originates from Salvia sclarea.

Substances for Neutralization

• Anti-I can be neutralized by Mother's Milk.
• Anti-H can be neutralized by Saliva.
• Anti-Sda can be neutralized by Guinea pig urine.
• HTLA Anti-Chido and Anti-Rodgers can be neutralized by Plasma or Serum.
• Anti-Lewis can be neutralized by Secretor saliva and Plasma or Serum.
• Anti-P1 can be neutralized by Hydatid cyst fluid, Pigeon droppings, and Turtle dove egg white.

Reagents and Dyes

• Anti-A is blue and uses Typan Blue dye.
• Anti-B is yellow and uses Acriflavine dye.
• AHG is green and uses Patent blue dye and Tartrazine.
• Anti-A1, Anti-AB, Anti-D, Bovine Serum Albumin and LISS are clear.

Antibody Characteristics Overview

• Marthin Luther and Lewis antigens are “ABOve (the) Piano”, referring to their presence in the ABO blood group system.
• Naturally occurring antibodies include MN, Lua - Lutheran A, Lewis, I, ABO, and P1.
• Clinically significant antibodies include those targeting the SSU, Rh, ABO, Kell, Duffy, Kidd, and Lub antigens [(Si) Rhea nagpa-ABOrt, Killed Duffy’s Kid (para) LUBayan (na siya)].

Antibody Warmth and Reaction

• Cold antibodies (IgM) include MaNa (ni), LEWIS (ang), I, Phone ABа.
• Warm antibodies (IgG) include RicH KID (can) DeFinitely KiLL Someone U LUB.
• MN, Lewis, I, and P1 react at Room Temperature (RT).
• MN and Lewis are Iam-cold and react at RT.
• Duffy, Kell, and Kidd react only with AHG.
• Lewis reacts at ANY Phase.

Enzyme Effects on Antibodies

• Enhanced by Enzyme: All (the) Rich Kids (around the) Globe Like I Phone like ABO, Rh, Kidd, Globoside, Lewis, I, and P1.
• Unaffected by Enzymes: LUTHER (and) KELLY are 35 (years old), Fy3 and Fy5, and Lutheran antigens.
• Destroyed by Enzyme: Men, Xga “SIGA” (sila) DUFFY (at) ROGER, RIGHT?, destroying MNS, Xga, Duffy: Fya and Fyb, Ch/Rg – Chido/Rogers, and Yt - Cartwright.

Antibody Complement and Dosage

• Complement Binding: P, I, Lewis, ABO, Kidd can bind complement.
• Most common cause of DHTR is Kidd.
• Dosage Effect is observed in the following blood groups Duffy, Rh (except D), Lutheran, Kidd, and MNSs.
• Acidification enhances ABO > Rh > Kell. Formaldehyde-Sterilized Equipment affects Dialysis Patients.
• Increasing Immunogenecity goes as follows: ABO > Rh > Kell.

Antibody Reaction Details

• Anti MN (ISBT #001): Not significant, IgM class, reacts at RT or lower, reaction phase is RT/AHG, and is destroyed by enzymes.
• ISBT #002 (Anti-S): Significant, IgG class, reacts at 37°C, AHG reaction phase, variable enzyme effect.
• ISBT #003 (Anti-P1PK): Not significant, IgM class, reacts at RT or lower, RT reaction phase, enhanced by enzymes.
• Anti-Lua (ISBT #005): Not significant, IgM class, reacts at RT or lower, RT reaction phase, no enzyme effect.
• Anti-Lub (ISBT #006): Significant, IgG class, reacts at 37°C, AHG reaction phase, no enzyme effect.
• Anti-Lewis (ISBT #007): Not significant, IgM class, reacts at RT or lower, RT/AHG reaction phase, enhanced by enzymes.
• Anti-Duffy (ISBT #008): Significant, IgG class, reacts at 37°C, AHG reaction phase, destroyed by enzymes.
• Anti-Kidd (ISBT #009): Significant, IgG class, reacts at 37°C, AHG reaction phase, enhanced by enzymes.
• Anti-I (ISBT #027): Not significant, IgM class, reacts at RT or lower, RT reaction phase, enhanced by enzymes.
• Anti-Globoside (ISBT #028): Significant, IgM, IgG class, reacts at RT or lower and 37°C, RT/AHG reaction phase, enhanced by enzymes.

Blood Group Antigens & Associations

• Lewis antigens (Leb Antigen) act as H. pylori RECEPTORs.
• MN Antigens act as Pyelonephritic E. coli Receptors.
• MNSs antigens act as P. falciparum Receptors
• M-N-: En(a-) is linked to RESISTANCE to P. falciparum merozoites (also Cad+).
• Anti-Nf is associated with Dialysis patients with formaldehyde-sterilized equipment.

P Blood Group System

• P Antigens (General) are P-fimbriated Uropathogenic E. coli (UPEC) Receptors.
• P Antigen is linked to Parvovirus B19 Receptor (5th Disease: Eryhtema infectiosum).
• P1 Pk Antigens act as Shiga toxin Receptors which is linked to Shigella dysentery with E. coli-associated HUS.
• Pk Antigens provide RESISTANCE to HIV for bacteria with Streptococcus and Pseudomonas. Burkitt’s Lymphoma, Lymphoblastic Leukemia.
• Autoanti-P is related to Paroxysmal Cold Hemoglobinuria (PCH).
• Anti-P1 is related to Parasitic infections like Hydatid Disease and Fascioliasis and Billiary Cirrhosis.
• Anti-Pk is linked to Autoimmune Hemolytic Anemia.
• Anti-PP1Pk is linked to Spontaneous abortions in early pregnancy.

I Blood Group System

• i Adult Null (I-negative) is linked to Hereditary Erythroblastic Multinuclearity with Positive Acidified Serum (HEMPAS) and Congenital Dyserythropoetic Anemia Type II.
• Anti-I is associated with M. pneumoniae (Primary Atypical Pneumonia) and L. monocytogenes (Cold Autoimmune Hemolytic Anemia).
• Anti-I can cause Cold Hemagglutinin Disease and Cold Agglutinin Syndrome.
• Anti-i is linked to RES Disorders and WAIHA, Alcoholic cirrhosis, Reticuloses, Myelogenous leukemia and Hodgkin's Disease.

Kell, Duffy, Lutheran, Kidd, Diego, and Indian Blood Groups

• (-) Kx Antigen is linked to WBC (Chronic Granulomatous Disease) and RBC (Acanthocytes, Chronic Hemolytic Anemia) and Neonatal Thrombocytopenia.
• Anti-Kell can cause Neonatal Thrombocytopenia.
• Fy6 Antigen acts as a P. vivax Receptor, with Fy (a-b-) providing RESISTANCE to P. vivax and P. knowlesi.
• Duffy Null is known to provide assistance vs Sickle Cell Disease.
• Anti-Lu is associated with SLE.
• Anti-Jka and Anti-Jkb cause Delayed HTR, and Jk (a-b-) provides RESISTANCE to lysis by 2M Urea.
• Anti-Wrb causes Autoimmune Hemolytic Anemia.
• AnWj Antigen acts as a H. influenza Receptor.

Blood Group Locations and Population

• Diego is located on Anion Exchange Molecule (AE-1) and targets the Mongolian Ancestry population.
• Xg is located on the p Chromosome X and primarily target Females (Sex-linked).
• MNS is located on Glycophorin A and B which is the Glycophorin A: MN and Glycophorin B: S. Scianna (SC2) is found in Mennonite Population,
• CD44 is located on Glycophorin C and/or D and targets the Indian (Ina) population.
• Kidd is located on C4 Complement component and targets the Polynesian population.
• Cromer is located on Decay Accelerating Factor (DAF).
• Knops are located on Chromosome 1 Complement Receptor 1.
• Bennet-Goodspeed (BG) is located on HLA Class I on RBCs.
• Cartwright is located on Acetylcholinesterase.
• Colton is located on Channel-forming Integral Protein (CHIP), Aquaporin 1 (AQP1).
• Gil is located on Aquaporin 3.

Superlatives and Commons in Immunohematology

• The most important blood group is ABO.
• The most common cause of HTR and HDN is Rh (Anti-D).
• The most severe cause of HDN is R1R.
• The most common D (+) genotype is rr.
• The most common D (-) genotype is R0 (Dce).
• The most commonly seen Rh antigen among the black population is Fy (a-b-).
• The most commonly seen Duffy phenotype among the black population is R1 (DCe).
• The most commonly seen Rh antigen among Whites, Asians, and Native Americans is Del.
• The most common blood group antigen among South East Descent is Fy (a+b-).
• The most common Kidd phenotype among Filipinos is Jk (a-b-).

Common Blood Groups Associated with HDN

• Common major blood groups: ABO, Rh (Anti-D alone or with Anti-C/Anti-E or Anti-c), Anti-Kell, Anti-Duffy, Anti-Kidd.
• The common minor blood group is Gerbich.

Transfusion Reactions and Autoimmunity

• The Most Severe Hemolytic Transfusion Reaction (HTR) has an ABO cause.
• The Common cause of Immediate and Delayed Hemolytic Transfusion Reaction (HTR) are ABO and Kidd > Duffy > Rh
• The Most common cause of Fatal Hemolytic Transfusion Reaction (HTR) is Clerical Errors
• The Most commonly encountered Autoimmune Hemolytic Anemia (AIHA) is Warm AIHA with Rh specificity.
• The Most common antibody encountered in blood bank: ABO > Rh > Anti-K, P and Anti-P1, Lutheran with Anti-Lua, Kell with Anti-K, Lewis with Anti-Lea, Duffy with Anti-Fya and Kidd with Anti-Jka.
• The most common cause of transfusion-related death is TACO.
• The most common blood component associated with Transfusion Sepsis is Platelet
• The gram positive cocci and normal skin flora were introduced during collection.

Contamination and RBC Preservation

• The Predominant bacteria associated with Platelet contamination at room temp include Gram (+) Cocci and Normal skin flora (introduced during collection).
• The Predominant bacteria associated with RBC contamination in the refrigerator include Gram (-) Rods in the Enterobacteriaceae Family.
• #1, the most common isolate found in red cell units is the bacteria Yersinia enterocolitica with contamination leading to death.
• The #2 most common cause of death associated with contaminated units (CDC) is Pseudomonas putida, Pseudomonas fluorescens.
• Previously the most common bacterial contaminant in RBC was Propionibacterium acnes now.

Contamination of Donated Blood

• The first most common contaminant in donated fluids, according to Harmening 7th Ed, is Staphylococcus aureus and Staphylococcus epidermidis, while in Platelets it is commonly Staphylococcus epidermidis and Bacillus cereus.

Risks and Solutions

• Most Common post-transfusion transmitted disease is Hepatitis B.
• Common post-transfusion transmitted disease in order of occurence is Hepatitis C (due to unavailable detection method) > Hepatitis B > CMV and EBV.
• Most common parasitic complication of transfusion is Malaria
• Most common anticoagulant-preservative solution for RBC is CPDA-1
• The Most common blood group associated with Drug-Induced Autoantibody is Kidd and Rh

Poikilocytes and Blood Groups

• Spherocytes are associated with ABO blood group.
• Stomatocytes are associated with Rh Null Disease.
• Acanthocytes are associated with Kell McLeod Phenotype.
• Elliptocytes are associated with Gerbich Leach Phenotype (Ge: -2, -3, -4).
• Diego blood group is associated with Hereditary Spherocytosis, Congenital Acanthocytosis, and Southeast Asian Ovalocytosis.

An overview of immunohematology, detailing the associations between specific chromosomes and various blood group systems. It also lists the origins of different lectins used in blood typing and antibody identification.