Test Your Knowledge - Blood Group Antigen History

A Blog from Eric Ching:
I bought a book written by Drs. Marion Reid and Ian Shine entitled “ The Discovery and Significance of the Blood Groups” a couple of years ago but I didn’t get a chance to read it until my long flight to Melbourne last week. I’m sure most blood group serologists know Marion Reid through lectures at AABB or her concise reference of Blood Group Antigen Facts book, coauthored with Christine Lomas-Francis.

In this entry, I would like to give you clues to guess who and where blood group antigens were discovered. In future entries, I would like to arouse my fellow blood bankers’ interest to learn more about the significance of blood group antigens.

Best yet, get a copy of this book from Amazon ($24.95) to enjoy it in the holiday season and I am sure you and your colleagues will enjoy these two great story tellers as much as I did! ☺

1. Who?

• A  melancholic genius who was intense, systematic, thorough, and dedicated physician and scientist… He wrote 346 papers during his long career contributing to hematology, immunology and virology. 5 points if you guessed his name correctly now!

• A Nobel Laureate who wished his work on the chemical basis of antibody specificity was better recognized than the prize winning experiment he conducted decades earlier. 4 points

• He coined the term hapten, defined cold agglutinin, elucidated pathogenesis and devised a test diagnostic for paroxysmal nocturnal hemoglobinuria. 3 points 

• He immunized rabbits and guinea pigs with rhesus monkey blood to produce anti-Rh. 2 points

• In his original experiment of mixing red cells and sera taken from himself and five of his colleagues, he observed that no plasma clumped the red cells from the same donor while two red cell samples were agglutinated by all four plasma samples but not by one another; likewise the second group of two samples behaved the same. His own red cells and one of his colleagues, Dr. Adriano Sturli. were not clumped by any plasma. He arbitrarily named the first group A, second group B and his and Sturli’s red cells group C which was later renamed O. 1 point

• If you still don’t know who he was. No point

2. Who?

• A graduate of veterinary medicine but never practiced as a vet, he went to Cambridge as a doctorate  candidate in Immunology at the Cambridge University in 1943. 5 points 

• Together with Philip Gel, they classified different types of allergic reactions. 4 points

• One of his colleagues had shown him that the invisible blocking anti-D was a globulin and he was intrigued to see how he could devise a test for it. A few days later, while taking a dimly lit night train from London to Cambridge, the light bulb in his head got lit brightly! - his “eureka moment” of the test which was named after him. 3 points

• Without his knowledge, the anti-antibody concept was first reported by Carlo Moreschi 37 years earlier in 1908. 2 points

• The co-authors of this important test were Rob Race and Arthur Mourant. 1 point

3. Who?

• A British research scientist and medical doctor whose assistant Marie Cutbush later married Dr. John Crookston who described HEMPAS in Toronto. Together, they published numerous papers in transfusion medicine. 5 points

• Most of us would regard him as the “father of transfusion medicine” who formulated acid citrate dextrose to preserve blood.  He improved preservation and transfusion of donor blood had saved many lives in the second world war. 4 points 

• He and Cutbush found the first example of anti-K and anti-Fy^a. 3 points

• He conducted red cell survival studies using  Cr51-labelled red cells to determine clinical significance of different antibodies. 2 points 

• He solely authored the first 7 editions of the classic text book “Blood Transfusion in Clinical Medicine” which is now at the 12th edition. 1 point 

4. Where were they discovered?

         One point for each mix and match correct answer below:

            1. MNP1

            2. Xg^a

            3. Duffy

            4. D

            5. CcEe

            a. Newark

            b. London

            c. New York

            d. Cambridge

            e. Grand Rapid

5. More Names: Mix and  Match

        One point for each mix and match correct answer below:

            1. Name of Mrs. Kidd’s son

            2. Nocella is an anagram of a blood group antigen

            3. Famous Winnipeggers contributed significantly in perinatal immunohematology

            4. Misread label on the blood sample leading to misnaming of this blood group

            5. Immunologist who made highly concentrated Rh IgG for human trial. He also advanced the “Zeta Potential Theory”.

            a. Bruce Chown, Marion Lewis and John Bowman

            b. John

            c. Lutheran

            d. William Pollack

            e. Cellano

6. True or False
        One point for each correct answer

1. M and N antigens were named by Landsteiner and Levine because they are the middle two letters of the alphabets to allow more antigens to be named later when discovered as well as both letters are in the word immune.
2. The first crossmatch was performed by Dr. James Blundell in England to rescue patients with post partum hemorrhage.
3. Human anti-Rh is a misnomer.
4. The concept of prophylactic use of RhIg  was suggested by Dr. Edward Winbaum from Windsor, Ontario, but the actual experiment was conducted by Drs. Vince Freda, John Gorman and William Pollack on volunteers at the Sing Sing penitentiary.  The recommendation of injection RhIg following exposure was determined by the warden as he considered return visit less than 3 days would post a risk!
5. Anti- Duffy  was first discovered in a maternal serum causing hemolytic disease of the newborn.

And now let's see how you did.......

Answers

1. Karl Landsteiner

     2.  Robin Coombs

     3.  Patrick Mollison

     4.  1-c, 2-e, 3-b, 4-a, 5-d

     5.  1-b, 2-e, 3-a, 4-c (the sample tube was correctly labelled as Lutteran), 5-d

     6.  True or False

            1. True

          2. False: In 1910, Dr. Reuben Ottenberg  ay Mount Sinai Hospital in New York performed routine crossmatching to prevent donor patient “intragroup” incompatibility. Dr. Charles Blundell in 1825, performed a successful direct donor to patient transfusion in a case of post partum hemorrhage.

          3.  True: In the mid 1930’s, Landsteiner and Wiener used rhesus monkey red cells to immunize rabbits, they found a new antibody reacted weakly with 85% of human red cells. They called the antibody anti-Rh named after the rhesus monkey. The project was not reported until 1940 as they were using guinea pigs instead of rabbits to produce stronger reactions. A year earlier in 1939, Levine and Stetson reported the first case of a new antigen, other than ABO, M,N P1 known at that time, could alloimmunize to cause HDN. Unfortunately, they did not name that antigen which is now known as D. In the mean time Landsteiner, Wiener and Peters had compiled cases to show that anti-Rh was the reason for Dr. Stetson’s index case of HDN and the subsequent transfusion reaction using her husband’s blood (both group O). We now know that D is a membrane lipoprotein while LW is an intercellular adhesion molecule of the immunoglobulin superfamily

         4.  True

         5.  False: In 1950, anti-Fya was found in a multi-transfused hemophiliac, Mr. Richard Duffy in London; he was cared for by Dr. Patrick Mollison. Fyb was found a year later in Berlin in a case of HDN.

Score

• 15-30     Excellent
• 10-14     Good
• 5-10       Average  (had I not read the book.....)
• 0-4         It’s OK!

Hope you had fun!

Eric