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Lewis antigen system From Wikipedia, the free encyclopedia Jump to: navigation, search

The Lewis antigen system is a human blood group system based upon genes on chromosome 19 q13.3, (FUT2) and 19p13.3 (FUT3), which both have fucosyltransferase activity. There are two main types of Lewis antigens, Lewis a and Lewis b. They are red cell antigens which are not produced by the erythrocyte itself. Instead, Lewis antigens are a component of exocrine epithelial secretions, and are subsequently adsorbed onto the surface of the erythrocyte.

It is possible to have any combination of Lewis a, Lewis b, both or neither antigens. The most common are Lewis a negative and Lewis b positive (Le a-, Le b+). Having both antigens is extremely rare.

The link between the Lewis blood group and secretion of the ABO blood group antigens was possibly the first example of multiple effects of a human gene.[1] The presence of fucosyltransferase converts the Lewis a antigen to Lewis b. People with Lewis a antigens are usually ABH non-secretors, and the presence of the Lewis b antigen makes a person a secretor. Lewis negative (Le a-, Le b-) can be either secretors or non-secretors.

Blood type

From Wikipedia, the free encyclopedia Blood type (or blood group) is determined, in part, by the ABO blood group antigens present on red blood cells.

A blood type (also called a blood group) is a classification of blood based on the presence or absence of inherited antigenic substances on the surface of red blood cells (RBCs). These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system. Some of these antigens are also present on the surface of other types of cells of various tissues. Several of these red blood cell surface antigens that stem from one allele (or very closely linked genes), collectively form a blood group system.[1] Blood types are inherited and represent contributions from both parents. A total of 30 human blood group systems are now recognized by the International Society of Blood Transfusion (ISBT).[2]

Many pregnant women carry a fetus with a different blood type from their own, and the mother can form antibodies against fetal RBCs. Sometimes these maternal antibodies are IgG, a small immunoglobulin, which can cross the placenta and cause hemolysis of fetal RBCs, which in turn can lead to hemolytic disease of the newborn, an illness of low fetal blood counts which ranges from mild to severe.[3] Contents [hide]

* 1 Serology * 2 ABO and Rh blood grouping * 3 Blood group systems o 3.1 ABO blood group system o 3.2 Rh blood group system o 3.3 ABO and Rh distribution by country o 3.4 Other blood group systems * 4 Clinical significance o 4.1 Blood transfusion o 4.2 Hemolytic disease of the newborn (HDN) * 5 Compatibility o 5.1 Blood products o 5.2 Red blood cell compatibility o 5.3 Plasma compatibility o 5.4 Universal donors and universal recipients * 6 Blood group genotyping * 7 Conversion * 8 History * 9 Cultural beliefs and other claims * 10 References * 11 Further reading * 12 External links

[edit] Serology

If an individual is exposed to a blood group antigen that is not recognized as self, the immune system may produce antibodies that can specifically bind to that particular blood group antigen, and an immunological memory against that antigen is formed. The individual will have become sensitized to that blood group antigen. These antibodies can bind to antigens on the surface of transfused red blood cells (or other tissue cells), often leading to destruction of the cells by recruitment of other components of the immune system. When IgM antibodies bind to the transfused cells, the transfused cells can clump. It is vital that compatible blood is selected for transfusions and that compatible tissue is selected for organ transplantation. Transfusion reactions involving minor antigens or weak antibodies may lead to minor problems. However, more serious incompatibilities can lead to a more vigorous immune response with massive RBC destruction, low blood pressure, and even death. [edit] ABO and Rh blood grouping Agglutination of blood cells tested with antibodies for determination of blood type in the laboratory. The discovery of this type of agglutination was an important medical breakthrough.[4]

Anti-A and Anti-B, the common IgM antibodies to the RBC surface antigens of the ABO blood group system, are sometimes described as being "naturally occurring"; however, this is a misnomer, because these antibodies are formed in infancy by sensitization in the same way as other antibodies. The theory that explains how these antibodies are developed states that antigens similar to the A and B antigens occur in nature, including in food, plants, and bacteria. After birth an infant's gut becomes colonized with normal flora that express these A-like and B-like antigens, causing the immune system to make antibodies to those antigens that the red blood cells do not possess. People who are blood type A will have Anti-B antibodies, blood type B will have Anti-A antibodies, blood type O will have both Anti-A and Anti-B antibodies, and blood type AB will have neither. Because of these so called "naturally occurring" and expected antibodies, it is important to correctly determine a patient's blood type prior to transfusion of any blood component. These "naturally occurring" antibodies are of the IgM class, which have the capability of agglutinating (clumping) and damaging red blood cells within the blood vessels, possibly leading to death. It is not necessary to determine any other blood groups because almost all other red blood cell antibodies can develop only through active immunization, which can occur only through either previous blood transfusion or pregnancy. A test called the Antibody Screen is always performed on patients who may require red blood cell transfusion, and this test will detect most clinically significant red blood cell antibodies.

The D antigen of the Rh blood group system is also important in determining a person's blood type. The terms "positive" or "negative" refer to either the presence or absence of the D antigen irrespective of the presence or absence of the other antigens of the Rh system. Anti-D is not a naturally occurring antibody as the Anti-A and Anti-B antibodies are. Cross-matching for the D antigen is extremely important, because the D antigen is immunogenic, meaning that a person who is D negative is very likely to make Anti-D when exposed to the D antigen (perhaps through either transfusion or pregnancy). Once an individual is sensitized to D antigens, his or her blood will contain D IgG antibodies, which can bind to D positive RBCs and may cross the placenta.[5] [edit] Blood group systems

A total of 30 human blood group systems are now recognized by the International Society of Blood Transfusion (ISBT).[2] A complete blood type would describe a full set of 30 substances on the surface of RBCs, and an individual's blood type is one of the many possible combinations of blood-group antigens. Across the 30 blood groups, over 600 different blood-group antigens have been found,[6] but many of these are very rare or are mainly found in certain ethnic groups.

Almost always, an individual has the same blood group for life, but very rarely an individual's blood type changes through addition or suppression of an antigen in infection, malignancy, or autoimmune disease.[7][8][9][10] An example of this rare phenomenon is the case of Demi-Lee Brennan, an Australian citizen, whose blood group changed after a liver transplant.[11][12] Another more common cause in blood-type change is a bone marrow transplant. Bone-marrow transplants are performed for many leukemias and lymphomas, among other diseases. If a person receives bone marrow from someone who is a different ABO type (eg, a type A patient receives a type O bone marrow), the patient's blood type will eventually convert to the donor's type.

Some blood types are associated with inheritance of other diseases; for example, the Kell antigen is sometimes associated with McLeod syndrome.[13] Certain blood types may affect susceptibility to infections, an example being the resistance to specific malaria species seen in individuals lacking the Duffy antigen.[14] The Duffy antigen, presumably as a result of natural selection, is less common in ethnic groups from areas with a high incidence of malaria.[15] [edit] ABO blood group system ABO blood group system - diagram showing the carbohydrate chains that determine the ABO blood group Main article: ABO blood group system

The ABO system is the most important blood-group system in human-blood transfusion. The associated anti-A antibodies and anti-B antibodies are usually "Immunoglobulin M", abbreviated IgM, antibodies. ABO IgM antibodies are produced in the first years of life by sensitization to environmental substances such as food, bacteria, and viruses. The "O" in ABO is often called "0" (zero/null) in other languages.[16] Phenotype 	Genotype A 	AA or AO B 	BB or BO AB 	AB O 	OO [edit] Rh blood group system Main article: Rh blood group system

The Rh system is the second most significant blood-group system in human-blood transfusion with currently 50 antigens. The most significant Rh antigen is the D antigen because it is the most immunogenic of the five main rhesus antigens. It is common for D-negative individuals not to have any anti-D IgG or IgM antibodies, because anti-D antibodies are not usually produced by sensitization against environmental substances. However, D-negative individuals can produce IgG anti-D antibodies following a sensitizing event: possibly a fetomaternal transfusion of blood from a fetus in pregnancy or occasionally a blood transfusion with D positive RBCs.[5] Rh disease can develop in these cases.[17] [edit] ABO and Rh distribution by country ABO and Rh blood type distribution by nation (population averages) Country ↓ 	Population[18]  ↓ 	 O+  ↓ 	 A+  ↓ 	 B+  ↓ 	AB+  ↓ 	 O-  ↓ 	 A-  ↓ 	 B-  ↓ 	AB-  ↓ Australia[19] 	21,262,641 	40% 	31% 	8% 	2% 	9% 	7% 	2% 	1% Austria[20] 	8,210,281 	30% 	33% 	12% 	6% 	7% 	8% 	3% 	1% Belgium[21] 	10,414,336 	38% 	34% 	8.5% 	4.1% 	7% 	6% 	1.5% 	0.8% Brazil[22] 	198,739,269 	36% 	34% 	8% 	2.5% 	9% 	8% 	2% 	0.5% Canada[23] 	33,487,208 	39% 	36% 	7.6% 	2.5% 	7% 	6% 	1.4% 	0.5% Denmark[24] 	5,500,510 	35% 	37% 	8% 	4% 	6% 	7% 	2% 	1% Estonia[25] 	1,299,371 	30% 	31% 	20% 	6% 	4.5% 	4.5% 	3% 	1% Finland[26] 	5,250,275 	27% 	38% 	15% 	7% 	4% 	6% 	2% 	1% France[27] 	62,150,775 	36% 	37% 	9% 	3% 	6% 	7% 	1% 	1% Germany[28] 	82,329,758 	35% 	37% 	9% 	4% 	6% 	6% 	2% 	1% Hong Kong SAR[29] 	7,055,071 	40% 	26% 	27% 	7% 	0.31% 	0.19% 	0.14% 	0.05% Iceland[30] 	306,694 	47.6% 	26.4% 	9.3% 	1.6% 	8.4% 	4.6% 	1.7% 	0.4% India[31] 	1,166,079,217 	36.5% 	22.1% 	30.9% 	6.4% 	2.0% 	0.8% 	1.1% 	0.2% Ireland[32] 	4,203,200 	47% 	26% 	9% 	2% 	8% 	5% 	2% 	1% Israel[33] 	7,233,701 	32% 	34% 	17% 	7% 	3% 	4% 	2% 	1% Netherlands[34] 	16,715,999 	39.5% 	35% 	6.7% 	2.5% 	7.5% 	7% 	1.3% 	0.5% New Zealand[35] 	4,213,418 	38% 	32% 	9% 	3% 	9% 	6% 	2% 	1% Norway[36] 	4,660,539 	34% 	42.5% 	6.8% 	3.4% 	6% 	7.5% 	1.2% 	0.6% Poland[37] 	38,482,919 	31% 	32% 	15% 	7% 	6% 	6% 	2% 	1% Portugal[38] 	10,707,924 	36.2% 	39.8% 	6.6% 	2.9% 	6.0% 	6.6% 	1.1% 	0.5% Saudi Arabia[39] 	28,686,633 	48% 	24% 	17% 	4% 	4% 	2% 	1% 	0.23% South Africa[40] 	49,320,000 	39% 	32% 	12% 	3% 	7% 	5% 	2% 	1% Spain[41] 	40,525,002 	36% 	34% 	8% 	2.5% 	9% 	8% 	2% 	0.5% Sweden[42] 	9,059,651 	32% 	37% 	10% 	5% 	6% 	7% 	2% 	1% Turkey[43] 	76,805,524 	29.8% 	37.8% 	14.2% 	7.2% 	3.9% 	4.7% 	1.6% 	0.8% United Kingdom[44] 	61,113,205 	37% 	35% 	8% 	3% 	7% 	7% 	2% 	1% United States[45] 	307,212,123 	37.4% 	35.7% 	8.5% 	3.4% 	6.6% 	6.3% 	1.5% 	0.6% Population-weighted mean 	(total population = 2,261,025,244) 	36.44% 	28.27% 	20.59% 	5.06% 	4.33% 	3.52% 	1.39% 	0.45% [show]Racial & Ethnic Distribution of ABO (without Rh) Blood Types[46] (This table has more entries than the table above but does not distinguish between Rh types.) PEOPLE GROUP ↓ 	O  ↓ 	A  ↓ 	B  ↓ 	AB  ↓ Aborigines 	61 	39 	0 	0 Abyssinians 	43 	27 	25 	5 Ainu (Japan) 	17 	32 	32 	18 Albanians 	38 	43 	13 	6 Grand Andamanese 	9 	60 	23 	9 Arabs 	34 	31 	29 	6 Armenians 	31 	50 	13 	6 Asian (in USA - General) 	40 	28 	27 	5 Austrians 	36 	44 	13 	6 Bantus 	46 	30 	19 	5 Basques 	51 	44 	4 	1 Belgians 	47 	42 	8 	3 Blackfoot (N. Am. Indian) 	17 	82 	0 	1 Bororo (Brazil) 	100 	0 	0 	0 Brazilians 	47 	41 	9 	3 Bulgarians 	32 	44 	15 	8 Burmese 	36 	24 	33 	7 Buryats (Siberia) 	33 	21 	38 	8 Bushmen 	56 	34 	9 	2 Chinese-Canton 	46 	23 	25 	6 Chinese-Peking 	29 	27 	32 	13 Chuvash 	30 	29 	33 	7 Czechs 	30 	44 	18 	9 Danes 	41 	44 	11 	4 Dutch 	45 	43 	9 	3 Egyptians 	33 	36 	24 	8 English 	47 	42 	9 	3 Eskimos (Alaska) 	38 	44 	13 	5 Eskimos (Greenland) 	54 	36 	23 	8 Estonians 	34 	36 	23 	8 Fijians 	44 	34 	17 	6 Finns 	34 	41 	18 	7 French 	43 	47 	7 	3 Georgians 	46 	37 	12 	4 Germans 	41 	43 	11 	5 Greeks 	40 	42 	14 	5 Gypsies (Hungary) 	29 	27 	35 	10 Hawaiians 	37 	61 	2 	1 Hindus (Bombay) 	32 	29 	28 	11 Hungarians 	36 	43 	16 	5 Icelanders 	56 	32 	10 	3 Indians (India - General) 	37 	22 	33 	7 Indians (USA - General) 	79 	16 	4 	1 Irish 	52 	35 	10 	3 Italians (Milan) 	46 	41 	11 	3 Japanese 	30 	38 	22 	10 Jews (Germany) 	42 	41 	12 	5 Jews (Poland) 	33 	41 	18 	8 Kalmuks 	26 	23 	41 	11 Kikuyu (Kenya) 	60 	19 	20 	1 Koreans 	28 	32 	31 	10 Lapps 	29 	63 	4 	4 Latvians 	32 	37 	24 	7 Lithuanians 	40 	34 	20 	6 Malaysians 	62 	18 	20 	0 Maoris 	46 	54 	1 	0 Mayas 	98 	1 	1 	1 Moros 	64 	16 	20 	0 Navajo (N. Am. Indian) 	73 	27 	0 	0 Nicobarese (Nicobars) 	74 	9 	15 	1 Norwegians 	39 	50 	8 	4 Papuas (New Guinea) 	41 	27 	23 	9 Persians 	38 	33 	22 	7 Peru (Indians) 	100 	0 	0 	0 Filipinos 	45 	22 	27 	6 Poles 	33 	39 	20 	9 Portuguese 	35 	53 	8 	4 Romanians 	34 	41 	19 	6 Russians 	33 	36 	23 	8 Sardinians 	50 	26 	19 	5 Scots 	51 	34 	12 	3 Serbians 	38 	42 	16 	5 Shompen (Nicobars) 	100 	0 	0 	0 Slovaks 	42 	37 	16 	5 South Africans 	45 	40 	11 	4 Spanish 	38 	47 	10 	5 Sudanese 	62 	16 	21 	0 Swedes 	38 	47 	10 	5 Swiss 	40 	50 	7 	3 Tartars 	28 	30 	29 	13 Thais 	37 	22 	33 	8 Turks 	43 	34 	18 	6 Ukrainians 	37 	40 	18 	6 USA (US blacks) 	49 	27 	20 	4 USA (US whites) 	45 	40 	11 	4 Vietnamese 	42 	22 	30 	5 Mean 	43.91 	34.80 	16.55 	5.14 Standard deviation 	16.87 	13.80 	9.97 	3.41

Blood group B has its highest frequency in Northern India and neighboring Central Asia, and its incidence diminishes both towards the west and the east, falling to single digit percentages in Spain.[47][48] It is believed to have been entirely absent from Native American and Australian Aboriginal populations prior to the arrival of Europeans in those areas.[48][49]

Blood group A is associated with high frequencies in Europe, especially in Scandinavia and Central Europe, although its highest frequencies occur in some Australian Aborigine populations and the Blackfoot Indians of Montana.[50][51] [edit] Other blood group systems Main article: Human blood group systems

The International Society of Blood Transfusion currently recognizes 30 blood-group systems (including the ABO and Rh systems).[2] Thus, in addition to the ABO antigens and Rh antigens, many other antigens are expressed on the RBC surface membrane. For example, an individual can be AB, D positive, and at the same time M and N positive (MNS system), K positive (Kell system), Lea or Leb negative (Lewis system), and so on, being positive or negative for each blood group system antigen. Many of the blood group systems were named after the patients in whom the corresponding antibodies were initially encountered. [edit] Clinical significance [edit] Blood transfusion Main article: Blood transfusion

Transfusion medicine is a specialized branch of hematology that is concerned with the study of blood groups, along with the work of a blood bank to provide a transfusion service for blood and other blood products. Across the world, blood products must be prescribed by a medical doctor (licensed physician or surgeon) in a similar way as medicines. In the USA, blood products are tightly regulated by the U.S. Food and Drug Administration. Main symptoms of acute hemolytic reaction due to blood type mismatch.[52][53]

Much of the routine work of a blood bank involves testing blood from both donors and recipients to ensure that every individual recipient is given blood that is compatible and is as safe as possible. If a unit of incompatible blood is transfused between a donor and recipient, a severe acute hemolytic reaction with hemolysis (RBC destruction), renal failure and shock is likely to occur, and death is a possibility. Antibodies can be highly active and can attack RBCs and bind components of the complement system to cause massive hemolysis of the transfused blood.

Patients should ideally receive their own blood or type-specific blood products to minimize the chance of a transfusion reaction. Risks can be further reduced by cross-matching blood, but this may be skipped when blood is required for an emergency. Cross-matching involves mixing a sample of the recipient's serum with a sample of the donor's red blood cells and checking if the mixture agglutinates, or forms clumps. If agglutination is not obvious by direct vision, blood bank technicians usually check for agglutination with a microscope. If agglutination occurs, that particular donor's blood cannot be transfused to that particular recipient. In a blood bank it is vital that all blood specimens are correctly identified, so labeling has been standardized using a barcode system known as ISBT 128.

The blood group may be included on identification tags or on tattoos worn by military personnel, in case they should need an emergency blood transfusion. Frontline German Waffen-SS had blood group tattoos during World War II.

Rare blood types can cause supply problems for blood banks and hospitals. For example Duffy-negative blood occurs much more frequently in people of African origin,[54] and the rarity of this blood type in the rest of the population can result in a shortage of Duffy-negative blood for patients of African ethnicity. Similarly for RhD negative people, there is a risk associated with travelling to parts of the world where supplies of RhD negative blood are rare, particularly East Asia, where blood services may endeavor to encourage Westerners to donate blood.[55] [edit] Hemolytic disease of the newborn (HDN) Main article: Hemolytic disease of the newborn

A pregnant woman can make IgG blood group antibodies if her fetus has a blood group antigen that she does not have. This can happen if some of the fetus' blood cells pass into the mother's blood circulation (e.g. a small fetomaternal hemorrhage at the time of childbirth or obstetric intervention), or sometimes after a therapeutic blood transfusion. This can cause Rh disease or other forms of hemolytic disease of the newborn (HDN) in the current pregnancy and/or subsequent pregnancies. If a pregnant woman is known to have anti-D antibodies, the Rh blood type of a fetus can be tested by analysis of fetal DNA in maternal plasma to assess the risk to the fetus of Rh disease.[56] One of the major advances of twentieth century medicine was to prevent this disease by stopping the formation of Anti-D antibodies by D negative mothers with an injectable medication called Rho(D) immune globulin.[57][58] Antibodies associated with some blood groups can cause severe HDN, others can only cause mild HDN and others are not known to cause HDN.[3] [edit] Compatibility [edit] Blood products

In order to provide maximum benefit from each blood donation and to extend shelf-life, blood banks fractionate some whole blood into several products. The most common of these products are packed RBCs, plasma, platelets, cryoprecipitate, and fresh frozen plasma (FFP). FFP is quick-frozen to retain the labile clotting factors V and VIII, which are usually administered to patients who have a potentially fatal clotting problem caused by a condition such as advanced liver disease, overdose of anticoagulant, or disseminated intravascular coagulation (DIC).

Units of packed red cells are made by removing as much of the plasma as possible from whole blood units.

Clotting factors synthesized by modern recombinant methods are now in routine clinical use for hemophilia, as the risks of infection transmission that occur with pooled blood products are avoided. [edit] Red blood cell compatibility

* Blood group AB individuals have both A and B antigens on the surface of their RBCs, and their blood serum does not contain any antibodies against either A or B antigen. Therefore, an individual with type AB blood can receive blood from any group (with AB being preferable), but can donate blood only to another type AB individual. * Blood group A individuals have the A antigen on the surface of their RBCs, and blood serum containing IgM antibodies against the B antigen. Therefore, a group A individual can receive blood only from individuals of groups A or O (with A being preferable), and can donate blood to individuals with type A or AB. * Blood group B individuals have the B antigen on the surface of their RBCs, and blood serum containing IgM antibodies against the A antigen. Therefore, a group B individual can receive blood only from individuals of groups B or O (with B being preferable), and can donate blood to individuals with type B or AB. * Blood group O (or blood group zero in some countries) individuals do not have either A or B antigens on the surface of their RBCs, but their blood serum contains IgM anti-A antibodies and anti-B antibodies against the A and B blood group antigens. Therefore, a group O individual can receive blood only from a group O individual, but can donate blood to individuals of any ABO blood group (ie A, B, O or AB). If anyone needs a blood transfusion in a dire emergency, and if the time taken to process the recipient's blood would cause a detrimental delay, O Negative blood can be issued.

RBC Compatibility chart In addition to donating to the same blood group; type O blood donors can give to A, B and AB; blood donors of types A and B can give to AB. Red blood cell compatibility table[59][60] Recipient[1] 	Donor[1] O− 	O+ 	A− 	A+ 	B− 	B+ 	AB− 	AB+ O− 	Check markY O+ 	Check markY 	Check markY A− 	Check markY 		Check markY A+ 	Check markY 	Check markY 	Check markY 	Check markY B− 	Check markY 				Check markY B+ 	Check markY 	Check markY 			Check markY 	Check markY AB− 	Check markY 		Check markY 		Check markY 		Check markY AB+ 	Check markY 	Check markY 	Check markY 	Check markY 	Check markY 	Check markY 	Check markY 	Check markY

Table note 1. Assumes absence of atypical antibodies that would cause an incompatibility between donor and recipient blood, as is usual for blood selected by cross matching.

A Rh D-negative patient who does not have any anti-D antibodies (never being previously sensitized to D-positive RBCs) can receive a transfusion of D-positive blood once, but this would cause sensitization to the D antigen, and a female patient would become at risk for hemolytic disease of the newborn. If a D-negative patient has developed anti-D antibodies, a subsequent exposure to D-positive blood would lead to a potentially dangerous transfusion reaction. Rh D-positive blood should never be given to D-negative women of child bearing age or to patients with D antibodies, so blood banks must conserve Rh-negative blood for these patients. In extreme circumstances, such as for a major bleed when stocks of D-negative blood units are very low at the blood bank, D-positive blood might be given to D-negative females above child-bearing age or to Rh-negative males, providing that they did not have anti-D antibodies, to conserve D-negative blood stock in the blood bank. The converse is not true; Rh D-positive patients do not react to D negative blood. This same matching is done for other antigens of the Rh system as C, c, E and e and for other blood group systems with a known risk for immunization such as the Kell system in particular for females of child-bearing age or patients with known need for many transfusions. [edit] Plasma compatibility Plasma compatibility chart In addition to donating to the same blood group; plasma from type AB can be given to A, B and O; plasma from types A and B can be given to O.

Recipients can receive plasma of the same blood group, but otherwise the donor-recipient compatibility for blood plasma is the converse of that of RBCs: plasma extracted from type AB blood can be transfused to individuals of any blood group; individuals of blood group O can receive plasma from any blood group; and type O plasma can be used only by type O recipients. Plasma compatibility table[60] Recipient 	Donor[1] O 	A 	B 	AB O 	Check markY 	Check markY 	Check markY 	Check markY A 		Check markY 		Check markY B 			Check markY 	Check markY AB 				Check markY

Table note 1. Assumes absence of strong atypical antibodies in donor plasma

Rh D antibodies are uncommon, so generally neither D negative nor D positive blood contain anti-D antibodies. If a potential donor is found to have anti-D antibodies or any strong atypical blood group antibody by antibody screening in the blood bank, they would not be accepted as a donor (or in some blood banks the blood would be drawn but the product would need to be appropriately labeled); therefore, donor blood plasma issued by a blood bank can be selected to be free of D antibodies and free of other atypical antibodies, and such donor plasma issued from a blood bank would be suitable for a recipient who may be D positive or D negative, as long as blood plasma and the recipient are ABO compatible.[citation needed] [edit] Universal donors and universal recipients

With regard to transfusions of whole blood or packed red blood cells, individuals with type O Rh D negative blood are often called universal donors, and those with type AB Rh D positive blood are called universal recipients; however, these terms are only generally true with respect to possible reactions of the recipient's anti-A and anti-B antibodies to transfused red blood cells, and also possible sensitization to Rh D antigens. Exceptions include individuals with hh antigen system (also known as the Bombay blood group) who can only receive blood safely from other hh donors, because they form antibodies against the H substance.[61][62]

Blood donors with particularly strong anti-A, anti-B or any atypical blood group antibody are excluded from blood donation. The possible reactions of anti-A and anti-B antibodies present in the transfused blood to the recipients RBCs need not be considered, because a relatively small volume of plasma containing antibodies is transfused.

By way of example: considering the transfusion of O Rh D negative blood (universal donor blood) into a recipient of blood group A Rh D positive, an immune reaction between the recipient's anti-B antibodies and the transfused RBCs is not anticipated. However, the relatively small amount of plasma in the transfused blood contains anti-A antibodies, which could react with the A antigens on the surface of the recipients RBCs, but a significant reaction is unlikely because of the dilution factors. Rh D sensitization is not anticipated.

Additionally, red blood cell surface antigens other than A, B and Rh D, might cause adverse reactions and sensitization, if they can bind to the corresponding antibodies to generate an immune response. Transfusions are further complicated because platelets and white blood cells (WBCs) have their own systems of surface antigens, and sensitization to platelet or WBC antigens can occur as a result of transfusion.

With regard to transfusions of plasma, this situation is reversed. Type O plasma, containing both anti-A and anti-B antibodies, can only be given to O recipients. The antibodies will attack the antigens on any other blood type. Conversely, AB plasma can be given to patients of any ABO blood group due to not containing any anti-A or anti-B antibodies. [edit] Blood group genotyping

In addition to the current practice of serologic testing of blood types, the progress in molecular diagnostics allows the increasing use of blood group genotyping. In contrast to serologic tests reporting a direct blood type phenotype, genotyping allows the prediction of a phenotype based on the knowledge of the molecular basis of the currently known antigens. This allows a more detailed determination of the blood type and therefore a better match for transfusion, which can be crucial in particular for patients with needs for many transfusions to prevent allo-immunization.[63][64] [edit] Conversion

In April 2007 a method was discovered to convert blood types A, B, and AB to O, using enzymes. This method is still experimental and the resulting blood has yet to undergo human trials.[65][66] The method specifically removes or converts antigens on the red blood cells, so other antigens and antibodies would remain. This does not help plasma compatibility, but that is a lesser concern since plasma has much more limited clinical utility in transfusion and is much easier to preserve. [edit] History

The two most significant blood group systems were discovered by Karl Landsteiner during early experiments with blood transfusion: the ABO group in 1901[67] and in co-operation with Alexander S. Wiener the Rhesus group in 1937.[68] Development of the Coombs test in 1945,[69] the advent of transfusion medicine, and the understanding of hemolytic disease of the newborn led to discovery of more blood groups, and now 30 human blood group systems are recognized by the International Society of Blood Transfusion (ISBT),[2] and across the 30 blood groups, over 600 different blood group antigens have been found,[6] many of these are very rare or are mainly found in certain ethnic groups. Blood types have been used in forensic science and in paternity testing, but both of these uses are being replaced by genetic fingerprinting, which provides greater certainty [70]. [edit] Cultural beliefs and other claims

The Japanese blood type theory of personality is a popular belief that a person's ABO blood type is predictive of their personality, character, and compatibility with others. This belief is also widespread in South Korea.[71] Deriving from ideas of historical scientific racism, the theory reached Japan in a 1927 psychologist's report, and the militarist government of the time commissioned a study aimed at breeding better soldiers.[71] The fad faded in the 1930s due to its unscientific basis. The theory has long since been rejected by the scientists, but it was revived in the 1970s by Masahiko Nomi, a broadcaster who had no medical background.[71]

The blood type diet is a diet advocated by Peter D'Adamo, a naturopathic physician, and outlined in his book Eat Right 4 Your Type. D'Adamo's claim is that ABO blood type is an important factor in determining a healthy diet, and he promotes distinct diets for people with O, A, B, and AB blood types. This is viewed skeptically by many scientists and physicians (e.g.,http://www.earthsave.org/health/bloodtyp.htm).