Incidence of Maternal Rh Immunization by ABO Compatible and Incompatible Pregnancies

The incidence of maternal Rh immunization in Rh-negative women following a single ABO compatible Rh-positive pregnancy is about 17%. This incidence was determined by following Rh-negative women through two Rh-incompatible pregnancies and analysing their sera for anti-Rh at the time of delivery of their second observed pregnancy. Maternal Rh immunization occurs almost exclusively after delivery; however, antibodies may not be detectable in the absence of further antigenic stimulation.The incidence of maternal Rh immunization when maternal-foetal ABO incompatibility is also present is 9–13% and 17% for group O and non-group O women respectively. This study emphasizes the need to offer Rh-immune prophylaxis to Rh-negative women having Rh-positive infants whether or not ABO incompatibility exists between the mother and infant.     

Selective interactions among Rh,ABO, and sex ratio of newborns

Summary The hypothesis that the Rh and ABO blood systems behave like the HLA system in relation to mother-conception tolerance-rejection mechanisms was tested in 25,501 mother-infant pairs. According to this hypothesis, heterozygotes carrying a paternal gene that is not present in their mother should be better tolerated than homozygotes. Significantly more BO infants born to AO mothers. AO infants born to BO mothers, Rh(+) heterozygotes born to Rh(-) mothers, and less significantly AO infants born to OO mothers confirm the hypothesis. Fewer homozygotes occurred in Rh(-) infants born to Rh(+) mothers and in O infants born to non-O mothers. Deviations from the Hardy-Weinberg equilibrium found in the ABO system were modified by the Rh and sex of the infant. These data strongly support the hypothesis that at least two feto-maternal systems influence the denstiny of pregnancies: the classical known incompatibility system which operates late in pregnancy and a new one which is based on the induction of maternal tolerance early in pregnancy: maternal tolerance seems to be better elicited by heterozygous eggs or embryos carrying a gene not present in the mother. The data also support the hypothesis that the sex ratio is influenced by feto-maternal tolerance-rejection mechanisms associated with the ABO and Rh systems.     

Acuity of selective mechanisms operating on ABO, Rh, and MN blood groups

Selection in ABO, Rh, and MN blood groups was studied in 216 matings and their children in an endogamous population. Incompatibility status with respect to these three systems was considered simultaneously. There is no effect of incompatibility on number of pregnancies. Analysis of variance between groups confirms that prenatal loss is associated with incompatibility, and it is greater when the matings are incompatible for any two systems. There is no significant intergenerational change in ABO and Rh polymorphisms. Segregation analysis for the ABO system suggests that there is no significant difference in the proportion of A, B, and O children, based on the compatibility of the parents, while analysis for Rh-D system showed a segregation distortion which is not related to the known antigenic specificities (mother-child incompatibility).     

Distribution of blood antigens A, B, and D, in the population of Bogotá (Analysis of 30,000 samples)

As tested by anti-A and anti-B sera, blood drawn from 30,000 inhabitans of Bogotá, Colombia, showed the following phenotype percentages: A — 26.5, B — 8.0, AB — 1.1, and O — 64.4. The allele frequencies were: A — 0.150, B — 0.048, and O — 0.802. In the same samples anti-D (Rh₀) was used: 94.6% of the individuals carried the D antigen. All bloods were typed with fresh commercial sera. No back-typing was performed. Hemolytic disease of the newborn, caused by Rh-Hr isoimmunization, is more frequent (0.40%) in Bogotá than should be expected for a population having only (5.4%) or less “Rh negative” individuals. This paradoxical fact was observed in the analysis of 12,672 deliveries in an obstetrical hospital of Bogotá. A possible explanation could be the multiparity of Colombian women since the possibility of isoimmunization and hemolytic disease increases with each succeeding pregnancy in a given woman. Also it is well established that when Rh-Hr incompatibility is combined with ABO incompatibility, it is less apt to produce disease than when it occurs alone. AO isoimmunization should therefore be less frequent in Bogotá than in populations that have a higher frequency of A individuals. Thus, the women of Bogotá are less “protected” from Rh-Hr immunization by ABO incompatibility.     

Frequencies of ABO, Rh and Kell phenotypes in couples from Han, Kazak, Uyghur and Hui in Xinjiang: an inheritance simulation model for blood group incompatibility in new-born

The Xinjiang region with residents from more than 13 minorities represents an area of many diverse ethnicities. This ethnic diversity in relation to their blood groups and immune status may have a consequential impact on the clinical status of married couples. To evaluate the risks of haemolytic disease in new-born infants, we investigated the rate of blood-group incompatibility among 487 married couples from four ethnic minorities, namely the Han, Hui, Uyghur and Kazak populations. Han minority married couples showed significantly different ABO, Rh and K phenotype frequencies between marrial relationship, whereas there was no significant difference in ABO, Rh and K phenotypes between the Uyghur, Hui and Kazak .There was a significant difference between ABO blood types in Han married couples, in the Kazak Rh-C phenotype and in the Uyghur Rh-D phenotype. The Hui married couples only demonstrated ABO, Rh and K phenotypes. The Hui minority showed the highest incompatibility rate for Rh-C and Rh-E phenotypes between mothers and their new-born infants. The highest incompatibility rate for the ABO phenotype occurred in the Kazak group. These results particularly demonstrate the clinical issues relating to ABO and Rh incompatibility, in the Kazak and Hui minorities, respectively.     

ABO incompatibility and reproductive failure. I. Prenatal selection

An analysis of previous spontaneous abortions and the frequencies of blood-group combinations in mother-child pairs was carried out in 500 gravidae. The rate of previous spontaneous abortions in blood-group-O women whose latest child has blood group B is significantly higher than in all other women. On the other hand, the combination mother B/child AB is rarer than expected, but no increase in the rate of previous spontaneous abortions is obvious among these women. These discrepancies are interpreted as an indication that prenatal selection associated with ABO incompatibility may operate at various stages from fertilization through pregnancy, and that different incompatible combinations may be subject to selection at different stages.     

Serological and molecular analysis of ABO and Rh blood group chimeras

The serological examination, blood transfusion strategies and the molecular analysis to blood group chimera were conducted to demonstrate existent of chimera in blood group. The blood grouping of ABO or/and RhD, newborn red blood cells separated by capillary centrifugation. Aabsorption tests and DTT treated agglutination erythrocyte tests were implemented in four patients. Further molecular biological research was conducted on one patient''s sample. The results showed that for patient 1: ABO blood group was AB/B chimera, Rh blood cells contained the RhCE chimera gene; Patient 2: Rh blood cells contained the RhD chimera gene; Patient 3: ABO blood group was AB/B chimera, Rh blood cells contained the RhD chimera gene; Patient 4: ABO blood group was O/B chimera, Rh blood cells contained the RhCE chimera gene. The study suggests that the individuals categorized as chimeras are likely to be more common than existing literature reports. According to the serological tests, in the absence of a history of recent blood transfusion or disease to cause reduced antigen, the phenomena of hybrid aggregation of the ABO and Rh blood system were the main feature. In terms of transfusion strategy, the selection of ABO and Rh blood groups should be depended on the group of cells with more antigens.     

Empirical validation of the Essen-Möller probability of paternity.

The validity of the Essen-Möller formulation probability of paternity is supported by demonstrating its correctness in a model genetic system--the ABO system. An analysis was made of 1,393 paternity cases typed uniformly for HLA-A and -B, ABO, Rh, and MNSs, in which the mother named one man only as the child''s father and in which both mother and putative father identified themselves as Caucasian. For purposes of analysis, putative fathers not excluded from paternity by the four systems tested were regarded as actual fathers. The joint distribution of observed triplets of ABO phenotypes is shown to be statistically consistent with expected values, and the fractions of "true" fathers for a given triplet closely approximated the probability of paternity calculated using a realistic prior probability. Recent allegations of fallaciousness of the method by Li and Chakravarty and Aickin are discussed in terms of the results presented.     

Association of ABO and Rh(D) blood groups with filariasis

ABO and Rh blood groups in 344 filarial patients and 320 controls matched with respect to age, community and residence are reported. An excess of B and a deficiency of AB was observed among the filarial patients. The relative risks for the B and AB were 1.53 and 0.36, respectively. Only males showed clearly significant risks. The Rh(D) blood groups revealed no association with filariasis.     

Human sociogenetics

In three cities of Chile (Santiago, Valparaiso, Valdivia) the A allele and phenotype (ABO blood group) are more frequent in the higher socioeconomic strata (SES) and the O allele and phenotype are in the lower ones. This constitutes a structured sociogenetic cline (SGC). The B allele and phenotypes (B+AB) present a rather erratic or contradictory distribution among SES. This SGC was also found in England. The standard interpretation of the origin and maintenance of this SGC in Chile is founded on socio-ethno-historic-cultural and drift factors followed by socioeconomic assortative mating that has occurred since the origin of Chileans by the admixture of Europeans and Amerindians. This interpretation is insufficient to explain the coincidence of the cline in England and Chile, and for some findings in Chile. 1) The A and Rh(-) frequencies of the highest SES in Chile are significantly higher than those found in Europeans. 2) The B gene and phenotypes (with AB) behave differently and in contradiction to the socio-ethno-cultural-historical process. 3) There is a significant interaction of the SGC with gender in Chile and England. There is not at present a putative relationship between ABO and psycho-social factors that could account for this sociogenetic interaction. This SGC seems to be present in societies with a hierarchical organization in relation to power, prestige, ownership, income and life style, and when sampling includes the most extreme SES. It has not been found in two samples from Ireland and in a sample from Chile taken from a public hospital, probably because those variables and conditions were not ascertained.     

Genetic mechanism of blood group (ABO)-expression

It has generally been believed that human blood group ABO is controlled by allelic ABO genes. However, this hypothesis has not yet been experimentally proven, and other possibilities such as the non-allelic gene model and the regulatory gene model for ABO locus have also been proposed. The genetic mechanisms of many unusual blood group expressions remain unanswered. Purification of human blood group N-acetylgalactosyltransferase (A-enzyme) which synthesizes A-substance, and blood group galactosyltransferase which is responsible for synthesis of B-substance, allows us to resolve these problems from an immuno-biochemical approach. It was found that rabbit antibody against-A-enzyme completely neutralized not only A-enzyme but also B-enzyme activity. Moreover, plasma from blood type O subjects contained an enzymatically inactive but immunologically cross-reactive material (CRM). Plasma from heterozygous AO and BO subjects also contained CRM, but plasma from homozygous AA and BB subjects did not contain CRM. These facts led us to conclude that the ABO genes are allelic in the strict sense, refuting other genetic models for ABO locus. Genotypes of phenotype A and B subjects can be unequivocally determined by examining the presence or absence of CRM in their plasma. Mechanism of the unusual blood group inheritance of Cis-AB (i.e., AB and/or O childbirth from AB X O parent) was elucidated by examining properties of the A and B enzymes, CRM in their plasma, and separation of active enzymes and CRM by affinity chromatography. It became clear that Cis-AB expressions in one family was due to unequal chromosomal crossing-over producing a single chromosome with the genes for A and B enzymes. In contrast, in the other two unrelated families, the Cis-AB expression was due to a structural mutation in A or B gene producing a single abnormal enzyme which was capable of transferring both GalNAc and Gal to H-substance. Mechanism of very weak B expression in a family with A1Bm character was studied. Plasma enzyme activity and kinetic characteristics of B-enzyme from the subjects was not different from that of normal. However, the A1Bm red cells contained a large amount of unoccupied H-sites which can be galactosylated in vitro and become B active. Examination of membrane components by isoelectric focussing revealed that blood group components of the A1Bm membranes were distinctively different from that of the usual membranes. Consequently, the weak B expression is not due to direct mutation of ABO locus, but due to a secondary consequence of genetic abnormality of a membrane component (or components) associated with blood group substances.     

A de novo recombination in the ABO blood group gene and evidence for the occurrence of recombination products

We have encountered a paternity case where exclusion of the putative father was only observed in the ABO blood group (mother, B; child, A1; putative father, O), among the many polymorphic markers tested, including DNA fingerprints and microsatellite markers. Cloning a part of the ABO gene, PCR-amplified from the trio’s genomes, followed by sequencing the cloned fragments, showed that one allele of the child had a hybrid nature, comprising exon 6 of the B allele and exon 7 of the O1 allele. Based on the evidence that exon 7 is crucial for the sugar-nucleotide specificity of A1 and B transferases and that the O1 allele is only specified by the 261G deletion in exon 6 of the consensus sequence of the A1 allele, we concluded that the hybrid allele encodes a transferase with A1 specificity, resulting, presumably, from de novo recombination between the B and O1 alleles of the mother during meiosis. Screening of random populations demonstrated the occurrence of four other hybrid alleles. Sequencing of intron VI from the five hybrid alleles showed that the junctions of the hybrid alleles were located within intron VI, the intron VI-exon 7 boundaries, or exon 7. Recombinational events seem to be partly involved in the genesis of sequence diversities of the ABO gene. Received: 25 October 1996     

Abo blood groups and completed reproductive performance of rural Haryanavi couples: analysing measures of selection intensities

The possible differential effects of ABO blood group materno-paternal (fetal) incompatibility on completed reproductive performance were investigated on a sample of 100 couples (100 fathers and 100 mothers) from three villages in the Jind district of Haryana state, India. The average number of live births per mating couple was slightly higher for the incompatible matings (5.32) than the compatible ones (5.05). This advantage was offset by higher postnatal mortality in the former. Consequently, the average number of living children in the compatible matings (4.64) was higher than in the incompatible ones (4.18). With reference to individual ABO matings, the index of relative fertility (Irf) was the highest in A x AB followed by B x A type of incompatible matings. No decrease in live births in O x A and O x B incompatible matings was observed compared with their reciprocal compatible ones, i.e. A x O and B x O matings, as has been hypothesized in previous studies. The total pregnancy wastage was substantially higher in ABO-incompatible matings (24.59%) than compatible matings (8.45%). About 71% of the postnatal deaths took place within one year of the birth in the case of incompatible matings compared with 50% in the case of compatible matings. The study supports the hypothesis that selection is operative at the ABO locus as revealed by the measures of selection intensity. The loss of fitness in the present sample was associated with differential mortality. There were no differences in the proportions of average number of male live births in the compatible (0.55) and incompatible matings (0.58). However, in the individual mating types, there was some evidence of higher or lower proportions of male live births.     

安徽省宁国县畲族红细胞血型分布

调查１６０名安徽省宁国县畲族村民的ＡＢＯ、Ｒｈ、Ｐ、ＭＮ系统红细胞血型,结果显示ＡＢＯ血型表型频率分布为Ｏ（０．４６８７）〉Ｂ（０．２３７５）〉Ａ（０．２２５０）〉ＡＢ（０．０６８８）,基因频率ｐ＝０．１５００,ｑ＝０．１５７５,ｒ＝０．６９２５;Ｒｈ血型表型频率分布为ＣＣｄｅｅ（０．５３８５）〉ＣＣＤＥ（０．１６６７）〉ＣｃＤＥ（０．１４７４）〉ＣｃＤｅｅ（０．０９６１）〉ｃｃＤＥ（０．０３２１     

ABO and Rh blood groups in diabetes mellitus

The present investigation was conducted with a view to testing the hypothesis that there is some association between blood groups (ABO and Rh) and diabetes mellitus. 520 proven cases of adult diabetes mellitus from the Diabetic Clinic of Rajendra Hospital, Patiala, were studied in 1979-1980. A large sample of 6204 normal individuals studied by Jolly et al. (1969) for ABO and Rh blood groups was taken as control for comparison with the patients. There is a strong indication of an association of diabetes mellitus with blood groups, especially with A, AB and Rh-positive blood groups. The maximum differences are in the AB groups in the two series and minimum in the A group. Individuals with gene p seem to be more susceptible to this disease. Thus the association between blood groups and diabetes mellitus is not a chance finding, but implies an aetiological relationship.     

ABO blood groups in medieval remains (Ras,Novi Pazar,X-XII A.D.)

Bone samples from a medieval cemetery (Ras, Novi Pazar, Serbia, X-XII A.D.) were serologically examined in order to determine ABO blood groups. The frequency of the AB blood group was much higher in the inhabitants of the medieval Ras than in the inhabitants of the Ras region of the 20th century. On the other hand, the incidence of the O blood group was smaller in the Ras population of the early Middle Ages. It was assumed that migrations which took place in that part of the Balkan Peninsula and Serbia influenced the distribution of ABO blood groups.     

ABO Incompatibility and parity effects on perinatal mortality

Abstract

The perinatal mortality rate is known to increase with parity. This parity effect is shown to be steepest for “O"‐type mothers, compared to mothers with blood groups A, B, or AB. Thus, there is a heightened parity effect in mothers who are likeliest to be antigenically dissimilar from their fetuses. This model may also be germane to other clinical conditions where negative parity effects are observed. Maternal‐fetal immunoreactivity is a likely explanation for parity effects on perinatal mortality attributable to ABO incompatibility and may also contribute to the occurrence of negative parity effects in other conditions.     

ABO blood groups and fertility—with special reference to intrauterine selection due to materno-fetal incompatibility

The purpose of the present investigation was to study whether there is differential fertility between different mating types of ABO blood group system. Selective force which is operating through maternal-fetal incompatibility has been observed in the differential fertility between compatible and incompatible mating groups in the present sample of 183 families of Visakhapatnam town of Andhra Pradesh, India. The differences in the mean numbers of pregnancies as well as living children between the two major mating groups, compatible and incompatible are significant. The fertility rates of O fathers and O mothers were significantly higher than those in matings in which neither parents belongs to O. The selection is operating to reduce the gene ratio of A and to increase the gene ratios of O and B in this sample.     

An unusual case of blood group ABO inheritance: O from AB X O

An unusual blood group inheritance, that is, a phenotype O child from AB X O parents, was found in a Japanese family. Since two other children from the parents are blood type B, this is not a case of Cis-AB inheritance. The mother is not blood A/B chimera, and normal levels of blood group N-acetylgalactosaminyltransferase (A-enzyme) and galactosyltransferase (B-enzyme) were detected in her plasma. Therefore, the mother is genetically true AB heterozygous. The two sons with phenotype B had normal levels of plasma B-enzyme, but had no A-enzyme, and the father and the daughter with phenotype O had neither A- nor B-enzyme in their plasma. The analyses of 24 genetic marker systems indicated that the O daughter was a true child of the parents. The affirmative probability of parentage on the O daughter was calculated to be .9999999917 by Bayes' theorem. We concluded that the genotype of the O daughter was not the usual 00, and that this rare O expression might be due to a new structural mutation or a deletion in either maternal A or B gene during oogenesis.     

Maternal-fetal interaction in the ABO system: a comparative analysis of healthy mothers and couples with recurrent spontaneous abortion suggests a protective effect of B incompatibility.

We investigated the possible differential effects of A and B blood group materno-fetal incompatibility on human fertility through a comparative analysis of couples with recurrent spontaneous abortion (RSA) and healthy mothers. ABO phenotype was determined in 5180 healthy mothers and their newborn babies from the population of Sassari (Sardinia) and in 1359 healthy puerperae (women who have just given birth) from the population of Rome. Mother-newborn joint ABO distribution in healthy mothers was compared with wife-husband joint ABO distribution in RSA couples. Distortions from expected distribution were evaluated by symmetry analysis. In both RSA couples and healthy mothers significant deviation from expected symmetry patterns were observed. Deviations in RSA are in the opposite direction to those observed in healthy puerperae. The most important difference observed concerned the symmetric joint phenotypes mother (women) A/infant (husband) B (B incompatible) and mother (women) B/infant (husband) A (A incompatible). A low number of B incompatible in RSA couples and a high number of B incompatible in healthy mothers was observed. The phenomenon is much more evident in women aged 24-28 years, a period of maximum fecundity. It is possible that the presence of anti-B immunoglobulin in the mother might have a protective effect against fetal loss in some cases of mother-infant ABO incompatibility.