The Rh(D) Antigen
Rh is the most complex system, with over
45 antigens
The complexity of the Rh blood group
Antignss is due to the highly polymorphic
genes that encode them.
Discovered in 1940 after work on Rhesus
monkeys
The 2
nd
most important after ABO in the
cross-match test
Only the most clinically significant Ags
will be discussed
ID CARD
The ID card combined testing of forward and
reverse grouping as well as Rh D determination.
Positive: Agglutinated cells forming red line on
surface of gel
Negative: Compact button of cells on the bottom
of microtube.
Rh blood group antigens are proteins
The antigens of the Rh blood group are proteins.
The RhD gene encodes the D antigen, which is a
large protein on the red blood cell membrane, &
the most important.
Rh Antigen Frequency
D antigen – 85%
d antigen – 15%
C antigen – 70%
c antigen – 80%
E antigen – 30%
e antigen – 98%
The presence or absence of D Ag determines if
the person is Rh+ or Rh-
Significance
After ABO, the Rh system is the second most important
system. This is because:
The D antigen is extremely immunogenic.
It causes the production of anti-D in 50 - 70% of Rh(D)
negative people who are exposed to the D antigen.
Moreover, anti-D is the most common cause of severe
HDN and can cause in Utero death.
Because of this, in blood transfusion, the patient and
donor are matched for Rh(D) type as well as ABO groups.
The C and E Ags are not as immunogenic as D, routine
typing for these Ags is not performed
•Weak expression of the Rh system on the RBC, (D
u
)
•D
u
red cells can be classified into three categories
according to the mechanism that account for the
Weak D antigen
Variants of D
Hemolytic disease of the Newborn (HDN)
Usually related to D antigen exposure and the formation
of anti-D
Usually results from D negative female and D positive
male producing and offspring.
The baby will probably be D positive.
1
st
pregnancy not effected, the 2
nd
pregnancy and on will be
effected-results in still birth, severe jaundice, anemia
related to HDN.
To prevent this occurrence the female is administered
RHIG.