4/17/2020 Blood groups beyond A, B and O: what are they and do they matter?

Academic rigour, journalistic flair

We know about A, B and O - but there are hundreds of other blood groups. from www.shutterstock.com.au

Blood groups beyond A, B and O: what are they and do

they matter?
July 26, 2017 6.08am AEST

This week we’re running a series in collaboration with the Australian Red Cross Author
Blood Service looking at blood: what it actually does, why we need it, and what
happens when something goes wrong with the fluid that gives us life. Read other
articles in the series here.

Robert Flower
Associate Professor, University of Sydney

There are many molecules on the surface of red blood cells that vary between individuals, and these
form the basis of blood groups. The most commonly recognised of these are the ABO blood groups,
and Rh antigens (which are signified by the “positive” or “negative” that comes after A, B or O on your
blood type).

What you may not know is that there are 34 other blood group systems with more than 300 known
variants. These are all classified by the “antigens” found on the surface of our red blood cells. Antigens

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4/17/2020 Blood groups beyond A, B and O: what are they and do they matter?

are molecules (most often proteins, but also carbohydrates) capable of provoking our immune
systems to attack.

People also have antibodies - the proteins that attack infections and other foreign bodies. So when a
patient needs someone else’s blood transfused into them, we have to make sure they don’t have the
type of antibodies that will attack the antigens on the blood the donor has provided for them.

We do this by identifying the blood group the antibody reacts with and then matching blood from
donors whose blood type has been extensively tested and established. Additional blood typing is
carried out when an antibody to a blood cell antigen has been identified in a patient.

Knowing what antigens we have in our blood is crucial in case of a transfusion. Unmatched blood could make our bodies
attack the donated blood cells. from www.shutterstock.com

What are some of these blood groups?

The “MNS blood group antigens” were discovered in the 1920s by Karl Landsteiner (the same scientist
who discovered the ABO system). This is a complex blood group system found on some of the most
important structural proteins on the surface of red cells. It’s common to find antibodies to the M
blood group in the plasma of patients, as these are sometimes formed after infection, and testing is
required to ensure the patient’s anti-M antibodies do not destroy donated red blood cells.

Another blood group, the “S/s variants”, are named after Sydney, where the blood group was
discovered. This blood group is signified by a particular type of molecule on the red blood cells that is
a target of the malaria parasite. Interestingly, some people from Africa do not have these molecules on
the surface of their cells at all, making them less likely to contract malaria.

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4/17/2020 Blood groups beyond A, B and O: what are they and do they matter?

Infographic - From animal experiments to saving lives: a history of blood transfusions

A blood group known as Duffy is also associated with infection by another type of malaria (known as
Plasmodium vivax). When this protein is absent from the red blood cells, the cells are resistant to
infection by the malaria parasite. This protein is absent from the blood cells of 90% of sub-Saharan
Africans, conferring malaria resistance on this population. Antibodies to the Duffy antigens are
commonly found in a patient’s plasma and are a cause of transfusion reactions if carefully matched
antigen negative blood is not given.

The K antigen (colloquially called Kell) was first detected in the 1940s as a result of a woman without
the K antigen on her red blood cells being pregnant with a baby with the K antigen on the red blood
cells. While almost all women post-partum have antibodies to some antigens found on the baby’s
white blood cells, red cell antibodies are less common.

Some people from Africa lack a certain molecule on their blood cells, meaning they can’t get malaria. Artwork: The Mums
by Jipil Jung (Sth Korea), Courtesy of the artist as part of Science Gallery Melbourne’s BLOOD exhibition

Following the discovery of the K antigen, more antigens were also found in this blood group system,
which is a common pattern of discovery in this field. The red cells of 9% of the Caucasian population
have the K antigen on their surface. After the Rh antigens, anti-K is the most common antibody found
in testing patients prior to transfusion.

Another blood group, Kidd, was named after the patient in whom it was discovered. The Kidd proteins
are related to proteins in the kidney that help get rid of waste from the body. For the Kidd blood group

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4/17/2020 Blood groups beyond A, B and O: what are they and do they matter?

it’s very important to avoid damaging reactions, and therefore carefully matched antigen negative
blood is given.

How did we discover all these groups?

The most common way these blood groups were discovered was through investigation of patients who
had poor outcomes from transfusion. Their plasma has been used to study donors and find blood
suitable for transfusion. This would then be used to prevent reactions in patients with similar
antibodies. The chain of discovering a problem and then working out how to stop it happening again
is the basis of testing blood prior to transfusion.

Although we don’t know the function of all the cell surface molecules that make up the blood group
antigens, we do know some of them have functions elsewhere. For example, the Kell antigen is an
enzyme (the biological catalysts). Other red cell antigens are involved in the structure of the cell
membrane, and the transport of chemicals between the inside and outside of the cell. All antigens
should be considered when matching blood for transfusion.

The field of blood group antigens is always growing, particularly with the application of modern
genetic sequencing techniques. Using these techniques, the research team at the Australian Red Cross
Blood Service have discovered at least three new blood group antigens in recent years, and have also
deciphered the blood types of ancient people such as Denisovans and Neanderthals, based on their
DNA sequence.

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4/17/2020 Blood groups beyond A, B and O: what are they and do they matter?

What are blood

types?
Scroll to start

Read other articles in the series:

Essays on blood: why do we actually have it?

From animal experiments to saving lives: a history of blood transfusions

Explainer: what’s actually in our blood?

What can go wrong in the blood? A brief overview of bleeding, clotting and cancer

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4/17/2020 Blood groups beyond A, B and O: what are they and do they matter?

Antibodies blood series essays on blood Australian Red Cross Blood Service On blood
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