By M.D. Fulton Roberts
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Possibly Table VI may help in appreciating these points, though it should be understood t h a t much of this view is still speculative. TABLE VI Secretor genes for Substances in ABH Le« Saliva Red cells (Lewis only) + + + + ABH, (Le«) Leo Le« ABH none Le* Le« none none This theory seems to leave Le& in a rather anomalous position at present and it has even been suggested t h a t there may be no Le 6 gene. Anti-Le b sera, too, display some curious features. Some of them agglutinate Le b cells of Group A 2 or 0 but not those of Group A1# This could be explained by suggesting t h a t the A antigen may have used so much of the material available for the manufacture of soluble substance t h a t there is a shortage not only of Le a but also of Le b in the plasma for red cells to absorb ; the shortage would not diminish the amount of Le b in the saliva, and anti-Le b sera of this type are all neutralised by the saliva of ABH secretors.
Hence it appears t h a t a part of the human A antigen is also found in pig cells of Group A, and it is against this part t h a t the immune anti-A is directed ; the other part of the human A antigen, which is not found in pig cells, is recognised by the natural form of anti-A. The forms of antibody can thus be summarised : first, anti-AjL, a naturally-occurring room-temperature agglutinating antibody, specific for human A x cells. Second, THE ABO 59 SYSTEM anti-A, also a naturally-occurring room-temperature agglutinating antibody reacting with human A x and A 2 cells.
I t is necessary to ensure t h a t the patient is not likely to become immunised by the proposed transfusion against blood-group antigens other t h a n A or B. Of these the only one t h a t is taken into account in routine transfusion is the R h antigen D which is the most powerful, and hence the most troublesome, of the other blood-group antigens. For these reasons, and particularly because of the risk of subsequent hsemolytic disease in the children of female patients, it is essential to determine the R h group (D or d) of the patient so t h a t R h compatible blood is administered.