The Rh and LW Blood Grouping Systems1.ppt

Rh and LW blood groups

1. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
This educational material has been produced by
the London and South East Joint Technical
Advisory Groups’ Transfusion Training
Committee.
It is presented on an “as is” basis to assist in
training. Please feel free to use or modify as
required.
We positively welcome constructive feedback. Please
contact Malcolm Needs on 020-8258-8346 or
[email protected].

2. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Acknowledgements

Slides 23, 28, 47, 49, 53, 55-64 and 80
are based on values obtained from
Reid ME and Lomas-Francis C, “The
Blood Group Antigens FactsBook”,
Academic Press Limited, London, 1
st

Edition, 1997 (ISBN 0-12-585965-1),
as is the figure in slide 84.

3. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Acknowledgements

Slides 22 and 24-27 are based on
figures from the “IMMUNOBASE-
DIAMED” CD.

4. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Acknowledgements

Slides 20-21, 39-42 and 52 are based
on figures obtained from
Sonneborn HH, Voak D (eds), “A
review of 50 years of the Rh blood
group system.”, Biotest Bulletin
1997; 5: No.4.

5. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Acknowledgements

Slides 32, 70 and 74 are based on
figures from Race RR, Sanger R,
“Blood groups in man”, Blackwell
Scientific Publications, Oxford, 6
th

Edition, 1975 (ISBN 0-632-00431-0)

6. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Those slides marked with a
red asterisk* are considered
essential knowledge for the
HPC “Yellow Book”. Others
may be thought of as “the
icing on the cake”!

7. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Rh and LW
Blood Group
Systems.

8. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Rh Blood
Group System.

9. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Nomenclature.

Please note.Please note. It is the Rh Blood
Group System, NOTNOT the Rhesus or
rhesus Blood Group System.

Rhesus was an ancient king of Thrace.

rhesus is a monkey (Macaca mulatta)

Neither worked in blood transfusion!Neither worked in blood transfusion!
*

10. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
After All, Would You Let
This Crossmatch for You?

11. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
History.

The Rh Blood Group System, in the
guise of D, was first described in
1939 by Levine and Stetson.

Levine P, Stetson RE. An unusual case of
intra-group agglutination. J Amer med
Assoc 1939; 113: 126-127.
*

12. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
History.

In 1941, two more antigens
were added to the system: C,
described by Weiner, and c,
described by Levine et al.

13. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
History.
Weiner AS. Haemolytic reactions following
transfusions of blood of the homologous
group. II. Further observations on the rôle of
property Rh, particularly in cases without
demonstrable iso-antibodies. Arch Path 1941;
32: 227-250.
Levine P, Burnham L, Katzin EM, Vogel P. The
rôle of iso-immunization in the pathogenesis of
erythroblastosis fetalis. Amer J Obstet Gynec
1941; 42: 925-937.

14. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
History.

The E antigen was added to the system
in 1943.

Weiner AS, Sonn EB. Additional variants of the Rh
type demonstrable with a special human anti-Rh
serum. J Immunol 1943; 47: 461-465.

Race RR, Taylor GL, Boorman KE, Dodd BA.
Recognition of Rh genotypes in man. Nature, Lond.
1943; 152: 563.

15. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
History.

The e antigen was added in 1945.

Mourant AE. A new rhesus antibody.
Nature, Lond. 1945; 155: 542.

16. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
History.

The antigen C
w
was described in
1946.

Callender ST, Race RR. A serological and
genetical study of multiple antibodies
formed in response to blood transfusion
by a patient with lupus erythematosus
diffuses. Ann Eugen, Lond. 1946; 13: 102-
117.

17. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Antigens.
D C E c e ce Ce C
w
C
x
V E
w
G Hr
o Hr hr
S
VS C
G
CE
D
w
c-
LIKE
cE hr
H
Rh29 Go
a
hr
B
Rh32 Rh33
Hr
B
Rh35 Be
a
EvansRh39 TarRh41Rh42 Rh43
Nou Riv Sec Dav JALSTEM FPTTMAR BARC
JAHK DAK LOCR

18. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Antigens.
D C E c e ce Ce C
w
C
x
V E
w
G Hr
o Hr hr
S
VS C
G
CE
D
w
c-
LIKE
cE hr
H
Rh29 Go
a
hr
B
Rh32 Rh33
Hr
B
Rh35 Be
a
EvansRh39 TarRh41Rh42 Rh43
Nou Riv Sec Dav JALSTEM FPTTMAR BARC
JAHK DAK LOCR

19. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Genes.

The RH locus is found on chromosome 1
between 1p36.13-p34.3.

For years, there was an argument as to
what genes were present. Originally, it
was assumed there were three; D, C and
E.

It is now known there are only two; RHD
and RHCE.

20. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Red Cell Membrane
Lipid
Bilayer
Cytosol
E1 E2 E3 E4 E5 E6 E7
E8
E9
E10
Exon
Boundary
(1)
NH
2
(417)
COOH
49 112
162
212
267
313
358
398
409
60
68
103
127
128
152
169
170
121
172
182
193
198
201
218
223
226
233
238
245
263
267
306
311
314
323
325
327
329
330
331
342
350
353
354
398
D Specific
Residues
The Carrier Molecule

21. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
1
3
7
8
12
14
15
16
30
Loop 4
29
25
23
6
5
Loop 6
2
26
9 10 11
19 20
21
4
27
22
28
13 17
18
Loop 3
Loop 2
The Carrier Molecule

22. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Biochemistry
Ankyrin
4.2
4.1
P55Actin
Band 3
Diego
GPA
MNS
GPB
MNS
Carbohydrate
ABO, H and Lewis
Rh Polypeptide
Rh Glycoprotein
Cell surface
Lipid
bilayer
Spectrin tetramer
Cytosol

23. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Carrier Molecule.

The D and CE polypeptides both consist of 417 amino acid
residues.

MSSKYPRSVR RCLPLWALTL EAALILLFYF FTHYDASLED
QKGLVASYQV GQDLTVMAAI GLGFLTSSFR RHSWSSVAFN
LFMLALGVQW AILLDGFLSQ FPSGKVVITL FSIRLATMSA
LSVLIVDGAV LGKVNLAQLV VMVLVEVTAL GNLRMVISNI
FNTDYHMNMM HIYVFAAYFG LSVAWCLPKP LPEGTEDNDQ
TATIPSLSAM LGALFLWIFW PSFNSALLRS PIERKNAVFN
TYYAVAVSVV TAISGSSLAH PQGKISKTYV HSAVLAGGVA
VGTSCHLIPS PWLAMVLGLV AGLISVGGAK YLPGCCNRVL
GIPHSSIMGY NFSLLGLLGE IIYIVLLVLD TVGAGNGMIG
FQVLLSIGEL SLAIVIALTS GLLTGLLLNL KIWKAPHKAK
YFDDQVFWKF PHLAVGF

24. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Rh Antibodies.
0 7 14 21 28 35 42
Days
0
1
10
10
2
10
3
10
4
10
5
A
n
t
i
b
o
d
y

T
i
t
r
e

(
l
o
g
)
Primary Immunisation Secondary Immunisation (Boost)
IgM
IgG
*

25. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Rh Antibodies.
J-chain
Carbohydrate unit
*

26. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Rh Antibodies.
Immunoglobulin IgG subclasses
IgG3IgG1 IgG2 IgG4
*

27. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.
Red Cells With
Antigens
Antigen Consisting
Of Epitopes
Antibodies Directed Against
Respective Epitopes
1
2
3
1, 2, 3 = Epitopes
Not to Scale!
*

28. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.
85
92
99 99
75
80
85
90
95
100
%
Cauc. Blacks Asians Nat. Am.
D

29. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.

There is no such antigen as “d”. An
individual is either D+ or D-.

This, however, is not the whole story!

An individual may have a weak D
phenotype (previously known as D
u
).

An individual may have a partial D
phenotype (previously known as a
D
variant
).
*

30. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.

A weak D is different from an ordinary D
only in terms of quantity of antigens.
There is no extra-cellular structural
difference.

As there is no extra-cellular structural
difference, a person with the weak D
phenotype will never be stimulated to
produce an allo-anti-D, with however
many stimuli they may be challenged.
*

31. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.

The weak D phenotype can be
either inherited or come about as a
result of inheriting an C antigen in
the trans position, rather than in
the cis position (the “Ceppellini”
effect).

32. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.
dCe/DCe
215
dce/dce
0
dCe/dce
0
DCe/dce
440
dCe/dce
0
DCe/dce
444
dCe/dce
0
dCe/DCe
219
dce/dce
0
DCe/dce
450

33. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.

An individual with a partial D phenotype
has a qualitative difference from the
normal D antigen. There may also be a
quantitative difference (as with weak D).

Some of the epitopes may be missing
altogether, replaced by RHCE epitopes or
altered by point mutations.
*

34. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.
As a result, some individuals with a partial
D phenotype (particularly D
VI
) can produce
an allo-anti-D when stimulated with a
normal D antigen, and should be treated
as an D negative when receiving blood.
Conversely, these individuals are quite
able to stimulate the formation of an allo-
anti-D in a true D negative individual, and
should be treated as an D positive when
giving blood.
*

35. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.

Certain partial D antigens exhibit
novel epitopes, e.g. D
VI
Ce
complexes express the Rh antigen
BARC. D
VI
cE complexes do not.

36. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.

37. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.

38. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.

39. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Carrier Molecule Showing
the Amino Acid Changes in the
Various Weak D Phenotypes.
Red Cell Membrane
Lipid
Bilayer
Cytosol
E1 E2 E3 E4 E5 E6 E7
E8
E9
E10
Exon
Boundary
(1)
NH
2
(417)
COOH
270
385
3
201
223
149
10
339
307
294
393
295
277
276
182
198
201
282
220

40. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Diagram of the 10 Exons
of RHD and RHCE.
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
D
DFR
R
0Har
D
DBT
D
VI
cE
D
VI
Ce
D
VII
D
IVb
D
IVa
D
Va
D
Va
D
FPTT
Rh33 FPTT
Rh32
BARC
Tar
Go
a
D
W
D
W
D

41. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Diagram of the 10 Exons
of RHD and RHCE.
/
/
/
/
/
/
/
/
/
/
D
D
IIIb
D
IIIc
D--
D--

42. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Diagram of the 10 Exons
of RHD and RHCE.
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
dce*
dce*
D
..
r
G
r’
s
*
dce
s
Dce
s
D(C)(e)
D(C)(e)
D(C)C
x
e
C
w
C
x
Rh32
Rh32
VS V
VS V
VS Rh42
JAHK
Evans
D(C)C
w
e
Gln41 stop

43. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.

44. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.
Number of D antigen sites per red cell.
Common D phenotypes: 10,000 - 33,000
Exalted D phenotypes: 75,000 –
200,000
Weak D phenotypes: 200 – 10,000

45. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The D Antigen.
Exalted D phenotypes include:
D--/D--
D
..
/D
..
Other Rh antigen partial deletions,
e.g. DC
w
-/DC
w
-.

46. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The C and c Antigens.

C and c are allelic.

C and c are antithetical.

PLEASE NOTEPLEASE NOTE:

Genes cannot be antithetical.

Antigens cannot be allelic.
*

47. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The C and c
Antigens.
68
80
27
96
93
47
0
10
20
30
40
50
60
70
80
90
100
%
Cauc. Blacks Asians
C
c

48. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The E and e
Antigens.

E and e are allelic.

E and e are antithetical.

PLEASE NOTEPLEASE NOTE:

Genes cannot be antithetical.

Antigens cannot be allelic.
*

49. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The E and e
Antigens.
29
98
22
98
39
96
0
10
20
30
40
50
60
70
80
90
100
%
Cauc. Blacks Asians
E
e

50. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Carrier
Molecule.

C has serine at position 103

c has proline at position 103

E has proline at position 226

e has alanine at position 226

51. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Red Cell Membrane
Lipid
Bilayer
Cytosol
E1 E2 E3 E4 E5 E6 E7
E8
E9
E10
Exon
Boundary
(1)
NH
2
(417)
COOH
49 112
162
212
267
313
358
398
409
103
226
The Carrier Molecule
Ser C
Pro c
Pro E
Ala e

52. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The C
w
Antigen.

Many people still believe that C
w
is
antithetical to C and c. This is
probably because it usually travels
with C. It is not!

It is, however, antithetical to both
C
x
and MAR (Rh51).
*

53. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The C
w
Antigen.
2 1
4
9
0
10
20
30
40
50
60
70
80
90
100
%
Cauc. Blacks Finns Latvians
Cw

54. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Rh Haplotypes.

DCe

DcE

Dce

DCE

dCe

dcE

dce

dCE
R
1
R
2
R
o
R
z

r’

r”

r
r
y
*

55. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Rh Haplotypes.
42
2
14
1
4
37
00
0
10
20
30
40
50
60
70
80
90
100
%
Caucasians
DCe
dCe
DcE
dcE
Dce
dce
DCE
dCE

56. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Rh Haplotypes.
17
2
11
0
44
26
00
0
10
20
30
40
50
60
70
80
90
100
%
Blacks
DCe
dCe
DcE
dcE
Dce
dce
DCE
dCE

57. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Rh Haplotypes.
44
2
34
6
2
66
0
0
10
20
30
40
50
60
70
80
90
100
%
Native Americans
DCe
dCe
DcE
dcE
Dce
dce
DCE
dCE

58. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Rh Haplotypes.
70
2
21
0
33
10
0
10
20
30
40
50
60
70
80
90
100
%
Asians
DCe
dCe
DcE
dcE
Dce
dce
DCE
dCE

59. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Rh Phenotypes.
18.5
2.3
34.9
11.8
2.1
0.010.20.1
13.3
0
10
20
30
40
50
60
70
80
90
100
%
Caucasians
R1R1
R2R2
R1r
R2r
Ro
RzRz
R1Rz
R2Rz
R1R2
*

60. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Rh Phenotypes.
2
0.2
21
18.6
45
000
4
0
10
20
30
40
50
60
70
80
90
100
%
Blacks
R1R1
R2R2
R1r
R2r
Ro
RzRz
R1Rz
R2Rz
R1R2
*

61. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Rh Phenotypes.
51.8
4.4
8.5
2.5
0.301.40.4
30
0
10
20
30
40
50
60
70
80
90
100
%
Asians
R1R1
R2R2
R1r
R2r
Ro
RzRz
R1Rz
R2Rz
R1R2

62. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Rh Phenotypes.
0.800.90
15.1
0.050
0
10
20
30
40
50
60
70
80
90
100
%
Caucasians
r'r
r'r'
r"r
r"r"
rr
r'r"
ryry
*

63. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Rh Phenotypes.
0000
6.8
00
2
0
10
20
30
40
50
60
70
80
90
100
%
Blacks
r'r
r'r'
r"r
r"r"
rr
r'r"
ryry
r'Sr
*

64. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Rh Phenotypes.
0.10 0 00.10 0
0
10
20
30
40
50
60
70
80
90
100
%
Asians
r'r
r'r'
r"r
r"r"
rr
r'r"
ryry

65. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Dd
D
Dd
D
DD
D
Dd Dd dd
D D d
Phenotype
Genotype
Genotype
Phenotype
Genetics.
*

66. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
DCedce
DCcee
DcEdce
DccEe
DCeDcE
DCcee
Phenotype
Genotype
Genotype
Phenotype
DCedce dceDcE dcedce
DCcEe DccEe ccee
R
1
R
2
R
1
R
1
R
2
r rr
R
1
r
R
2
r
Genetics.
*

67. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Rh
null
Phenotype.

In 1961, Vos et al reported on a
blood sample that lacked all the Rh
antigens.

Vos GH, Vos D, Kirk RL, Sanger R. A
sample of blood with no detectable Rh
antigens. Lancet 1961; i: 14-15.

68. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Rh
null
Phenotype.
There are two types of Rh
null
; The
amorph type and the regulator
type.
*

69. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Rh
null
Phenotype.

The amorphic type results in the
mating of two individuals with
(probably) one common Rh
haplotype and one --- haplotype,
where the individual inherits both
--- haplotypes.
*

70. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Rh
null
Phenotype.
R
o
r or R
o
R
o
Dce/---
R
1
R
1
DCe/---
Rh
null
---/---
Rh
null
---/---
R
o
r or R
o
R
o
Dce/---
R
1
R
o
or R
1
r
DCe/Dce
R
1
R
1
DCe/---

71. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
DCe---
DCCee
DcE---
DccEE
DCeDcE
DCCee
Phenotype
Genotype
Genotype
Phenotype
DCe--- ---DcE ------
DCcEe DccEE ---/---
R
1
R
2
R
1
R
1
R
2
R
2
---/---
R
1
R
1 R
2
R
2
The Rh
null
Phenotype.
*

72. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Rh
null
Phenotype.

It was thought that the regulator
type, the individual inherits normal
RH genes, but is unable to express
them because of a regulator gene
(X
o
) inherited on a different
chromosome.
*

73. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Rh
null

Phenotype.

It is now known to be caused by
mutations in the Rh associated
glycoprotein.

Frame shift Tyr 51, termination Ile 107

Frame shift Ala 361, termination Val 375.

74. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Rh
null
Phenotype.
X
R
1
r
DCe/dce
Phenotype
Genotype
Rh
null
DCe/dce
R
1R
2
DCe/DcE
R
2r
DcE/dce
R
1R
1
DCe/DCe
Propositus

75. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Rh
null
Phenotype.
Rh
null
individuals of the amorph
type, can produce an allo-antibody
(anti-Rh29) that will react with all
samples of blood, except those
from other Rh
null individuals.

This is sometimes, quite
incorrectly, called anti-Total-Rh.
*

76. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The LW Blood
Group System.

77. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
LW Was Described in 1940.

Landsteiner K, Wiener AS. An
agglutinable factor in human blood
recognized by immune sera for
rhesus blood. Proc. Soc. Exp. Biol.
NY 1940; 43: 223.

78. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.

Originally, anti-D and anti-LW were
thought to be one and the same.
*

79. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Only in 1963 was it realised that
Rh and LW are different Blood
Group Systems.

Levine P, Celano MJ, Wallace J,
Sanger R. A human ‘D-like’
antibody. Nature 1963; 198: 596-
597.
*

80. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
It is now known that the
gene for LW is located at
19p13.3 (RH is located at
1p36.13-p34.3).

81. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Although D and LW are
different antigens, they are
phenotypically related. D
positive red cells from adults
express LW more strongly
than D negative red cells.
*

82. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
As a result, anti-LW can
mimic anti-D.
*

83. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
All true Rh
null
individuals
are LW(a-b-), but not all
LW(a-b-) individuals are
Rh
null
.
*

84. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
The Carrier Molecule
208
229
241
1
NH
2
COOH

85. The London and South East Joint Technical Advisory Groups’ Transfusion
Training Committee.
Unlike its Rh counterparts,
anti-LW has caused neither
a haemolytic transfusion
reaction nor HDN/HDF.
*