Relative immunogenicity of blood group antigens: First report in a Korean population

Published:October 25, 2022DOI:



      The immunogenicity of a blood group antigen is a measure of its likelihood of inducing alloantibodies. Although the immunogenicity of blood group antigens has been analyzed in Caucasian populations, immunogenicity to date has not been analyzed in Asian subjects. The present study therefore evaluated the relative immunogenicity of blood group antigens in a Korean population.

      Study design and methods

      All available data of unexpected antibody identification tests performed at Asan Medical Center between 1997 and 2021 were analyzed. The relative immunogenicity of a blood group antigen relative to K antigen was calculated based on relative numbers of alloantibodies and the probabilities of antigen-negative recipients receiving antigen-positive RBC units.


      A total of 3898 antibody identification results were included, with 1632 (41.9 %) from male patients. The ranking of antigen immunogenicity was: E > c > e > C > K > Jk(a) > Lu(a) > S > Fy(a) > Fy(b) > Jk(b) > Di(b) > Di(a) in the total population and E > c > e > C > Jk(a) > Fy(a) > Fy(b) > S > K > Lu(a) > Jk(b) > Di(b) > Di(a) in male patients.


      The rank order of immunogenicity for blood group antigens in this study provides information about relative immunogenecity in Koreans. These findings also provide supporting evidence regarding antigen selection for extended antigen-matched transfusions in recipients of multiple transfusions.


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      1. Cohn C.S., Delaney M., Johnson S.T., Katz L.M. Technical manual. 20th ed. Bethesda (MD): American Association of Blood Banks; 2020.

        • Afenyi-Annan A.
        • Brecher M.E.
        Pre-transfusion phenotype matching for sickle cell disease patients.
        Transfusion. 2004; 44: 619-620
        • Osby M.
        • Shulman I.A.
        Phenotype matching of donor red blood cell units for nonalloimmunized sickle cell disease patients: a survey of 1182 North American laboratories.
        Arch Pathol Lab Med. 2005; 129: 190-193
        • Belsito A.
        • Costa D.
        • Signoriello S.
        • Fiorito C.
        • Tartaglione I.
        • Casale M.
        • et al.
        Clinical outcome of transfusions with extended red blood cell matching in β-thalassemia patients: a single-center experience.
        Transfus Apher Sci. 2019; 58: 65-71
        • Delaney M.
        • Harris S.
        • Haile A.
        • Johnsen J.
        • Teramura G.
        • Nelson K.
        Red blood cell antigen genotype analysis for 9087 Asian, Asian American, and Native American blood donors.
        Transfusion. 2015; 55: 2369-2375
        • Giblett E.R.
        A critique of the theoretical hazard of inter vs. intra-racial transfusion.
        Transfusion. 1961; 1: 233-238
        • Tormey C.A.
        • Stack G.
        Immunogenicity of blood group antigens: a mathematical model corrected for antibody evanescence with exclusion of naturally occurring and pregnancy-related antibodies.
        Blood. 2009; 114: 4279-4282
        • Stack G.
        • Tormey C.A.
        Estimating the immunogenicity of blood group antigens: a modified calculation that corrects for transfusion exposures.
        Br J Haematol. 2016; 175: 154-160
        • Pidala J.
        • Kim J.
        • Schell M.
        • Lee S.J.
        • Hillgruber R.
        • Nye V.
        • et al.
        Race/ethnicity affects the probability of finding an HLA-A, -B, -C and -DRB1 allele-matched unrelated donor and likelihood of subsequent transplant utilization.
        Bone Marrow Transpl. 2013; 48: 346-350
        • Noizat-Pirenne F.
        • Tournamille C.
        • Bierling P.
        • Roudot-Thoraval F.
        • Le Pennec P.Y.
        • Rouger P.
        • et al.
        Relative immunogenicity of Fya and K antigens in a Caucasian population, based on HLA class II restriction analysis.
        Transfusion. 2006; 46: 1328-1333
        • Hong Y.J.
        • Chung Y.
        • Hwang S.M.
        • Park J.S.
        • Kwon J.R.
        • Choi Y.S.
        • et al.
        Genotyping of 22 blood group antigen polymorphisms and establishing a national recipient registry in the Korean population.
        Ann Hematol. 2016; 95: 985-991
        • Shin K.H.
        • Lee H.J.
        • Kim H.H.
        • Hong Y.J.
        • Park K.U.
        • Kim M.J.
        • et al.
        Frequency of red blood cell antigens according to parent ethnicity in Korea using molecular typing.
        Ann Lab Med. 2018; 38: 599-603
        • Jekarl D.W.
        • Yoo J.
        • Lee S.
        • Yu H.
        • Kim M.
        • Kim Y.
        Blood group antigen and phenotype prevalence in the Korean population compared to other ethnic populations and its association with RBC alloantibody frequency.
        Transfus Med. 2019; 29: 415-422
        • Schabel A.
        • König A.L.
        • Schiebel M.R.
        • Sugg U.
        Incidence and persistence of anti-Kell after transfusion of Kell-positive blood.
        Beitr Infus Transfus. 1994; 32: 175-178
        • Kornstad L.
        • Heisto H.
        The frequency of formation of Kell antibodies in recipients of Kell-positive blood.
        in: Videbaek A.A. Neumark E. Schubothe H. Bernard J. Proceedings of the sixth congress of the european society for haematology. S. Karger, Base, Switzerland1957: 754-758
      2. Reid, M.E., Lomas-Francis, C., Olsson, M.L.2012. The blood group antigen factsBook. 3rd ed. Elsevier.