SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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U. E. Nydegger

1R&D, Clinic for Cardiovascular Surgery, University Hospital Bern, Switzerland

Under physiological and forensic conditions, blood group antigens are alloantigens whereby natural anti-A/B antibodies in individuals not expressing the cognate antigen make up the hallmark of the ABO histo-blood group system. In clinical medicine, autoimmune haemolytic anaemia, both Rhesus (Rh) polypeptides constitute the targets for pathogenic anti-red blood cell autoantibodies in about one third of all cases. The proteinaceous Rh system is one of the few blood group systems expressed on erythroid tissue only.

Autoimmunity against blood groups might encompass other (histo-) blood group specificities. Formation of allo-antibodies crossreactive with the host's antigens appears in Treponema pallidum syphilis, patients developing haemolytic anaemia with antibodies against the MN blood type system, a glycosylated glycophorin. The advent of molecular biology, i.e. PCR and FISH techniques, allows to study gene expression of blood group system in various tissues important in transplant medicine, such as kidney, heart, lung and liver, immunohistochemistry remaining the mainstay in histo-blood group tissue typing.

Due to shortage of cadaveric grafts, transplant surgeons have looked at the Japanese experience with ABO-incompatible living donor kidney transplantation since the early 1990ies; in infants, elective mismatched organ transplantation is becoming an option.
Similarly to HLA, most of the about 30 blood group systems (www.bioc.aecom.yu.edu/bgmut/index.htm) are also expressed in tissues used for allotransplantation and might represent a so far underestimated array of antigens in graft rejection.

Histo-blood group antigen polymorphism plays an important role in the fragile equilibrium that maintains tolerance in transplantation and it exposes target epitopes in autoimmune disease important in diagnosis and follow up of patients with autoimmune haemolytic anaemia.

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