The Nigerian Health Journal; Volume 23, Issue 4 – December, 2023

ABO Phenotypes, Rhesus and Kell2 antigens of Blood donors, Etura JE et al

Original

ABO Phenotypes, Rhesus and Kell2 antigens of Blood donors

attending University of Calabar Teaching Hospital
1Etura JE, 1Effiong UI, 1Asemota EA, 2,3Okoroiwu HU
1
Department of Haematology, Faculty of Medical Laboratory Science, University of Calabar, Cross River State, Nigeria.
2
Department of Medical Laboratory Science, David Umahi Federal University of Health sciences, Nigeria.
3
Department of Medical Laboratory Science, Arthur Jarvis University, Akpabuyo, Cross River State, Nigeria.

Corresponding author: Okoroiwu Henshaw Uchechi, Department of Medical Laboratory Science, David Umahi Federal
University of Health sciences, Nigeria; [email protected]; +2348038833901 -Q1

Article history: Received 3 March 2023, Reviewed 20 June 2023, Accepted for publication 28 December 2023

This is an open access journal and Abstract

articles are distributed under the Background: Modern blood transfusion entails the transfusion of
terms of the Creative Commons compatible blood units from a healthy donor to the recipient (patient). This
Attribution License (Attribution, study was aimed at evaluating rare and high- frequency blood antigens to aid
Non-Commercial, ShareAlike” planning in the study location.
4.0) - (CC BY-NC-SA 4.0) that Method: Descriptive cross-sectional study with systematic random
allows others to share the work sampling sample was employed in this study. The samples were analysed
with an acknowledgement of the using commercially prepared reagents via serological technique (Standard
work's authorship and initial tube agglutination method). The ABO was performed using anti-A, anti-B,
publication in this journal. and anti-AB reagent while Rh D was performed using anti D monoclonal
reagent. KELL 2 (k) was performed using anti-kell reagent.
Result: Out of the 100 blood donors tested, 28 (28%) were KELL 2 (k+)
positive while 100 (100%) were positive for Rh D antigen. ABO phenotype
How to cite this article: O constituted the majority (70%) of the studied subjects while A, B, and AB
Etura JE, Effiong UI, Asemota constituted 15%, 13%, and 2% respectively. The ABO cum Rhesus and
EA, Okoroiwu HU. ABO blood group were in the order 0+> A+>, B+>, AB+.
Phenotypes, Rhesus and Kell2 Conclusion: KELL 2 antigen was relatively low among the studied subjects,
antigens of Blood donors while Rh D antigen was found to be a high-frequency antigen. Blood group
attending University of Calabar O Rh D positive was found to be the most predominant blood group
Teaching Hospital. The Nigerian recorded among the studied participants.
Health Journal 2023; 23(4), xxx- Keywords: Rh D; Cellano; Kell 2, Kell antigen; ABO; blood group; Rh
xxx. antigen

Introduction blood group systems containing 345 red cell antigens by

Blood group is a term used in referring to blood group the International Society of Blood Transfusion (ISBT)
system made up of red blood cell antigens whose Working Party.3,4 The antigens may occur as integral
specificity is controlled by a sequence of genes that are proteins where the polymorphism lies in the variation in
allelic or linked very closely on the same chromosome.1,2 amino acid sequence (e.g., Rh and Kell) or as
These antigens have specific sites on different proteins, glycoproteins or glycolipids (e.g ABO).1
glycoproteins, or glycolipids that form part of the red
blood cell membrane, which the immune system can Since its discovery over 100 years ago by Karl
interact with. As of June 2021, there were 43 recognised Landsteiner, the ABO blood group system has

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ABO Phenotypes, Rhesus and Kell2 antigens of Blood donors, Etura JE et al

maintained prime importance in blood transfusion Nigeria. Calabar lies in the geographical coordinates:
medicine, being the most immunogenic of all blood 8°9'37.02E with an estimated population of 375,196
group antigens. Most common deaths due to (2006 census). Calabar metropolis is a fusion of Calabar
mismatches caused by clinical errors often involve ABO Municipality and Calabar South Local Government
incompatibility. The antigens of the ABO system are A Areas.14,15
and B. The ABO antigens are encoded by one genetic
locus which has three alternative (allelic) forms – A, B, Ethical clearance was obtained from the Health
AB and O. Irrespective of the obvious clinical Research Ethics Committee of the University of Calabar
significance, the physiological function of ABO blood Teaching Hospital with the approval number
group antigens remains a mystery.4 UCTH/HREC/33/566. Informed consent was
obtained from all participants before enrolment. Five
The Rhesus blood group is the second-most significant millilitres (5 ml) of blood were collected via
blood group after ABO in transfusion medicine.5 There venipuncture from the participants into a plain
are about 50 defined Rh antigens, out of which only five container.
are important. The most important Rh antigens include
D, C, c, E and e. Anti-D is the most important antibody The blood samples were analysed using commercially
in the Rhesus system, causing haemolytic transfusion prepared reagents by standard serological tube
reactions and haemolytic disease of the newborn.6,7,8 technique. The ABO grouping was performed using anti
- A, anti – B and anti – AB. Rhesus D was performed
The Kell blood group is complex and consists of many using anti – D monoclonal reagent from Biotec, while
antigens that are highly immunogenic. These antigens kell 2 grouping was analysed using a specific monoclonal
represent the third most immunogenic in transfusion antibody (anti-kell) supplied by Lorne Laboratories
medicine after ABO and Rhesus.9 The Kell blood Limited, Great Britain (UK). The validity of all negative
consists of more than 30 antigens with the most samples were confirmed microscopically for
important being K (KELL 1 or K+) and k (KELL 2 or agglutination.
k+) formerly “Cellano.”10 The antibodies to these
antigens are immune and are not naturally occurring.11,12 Data was curated using Excel 2007 (Microsoft) and
One of the critical challenges in blood transfusion analyzed using SPSS version 25 (IBM Inc). The results
medicine is the provision of compatible blood for were represented in frequencies and proportions
patients who are negative for a high frequency blood (percentage).
group, who also have alloantibody against the antigen.
High-frequency blood group antigens (k, Kpb, Jsb, Lub, Results
etc.) are present in ≥ 90% of the human population.10,13 Figure 1 shows the distribution of the sampled subjects
Consequently, patients lacking these antigens pose based on ethnicity. The majority of the subjects were of
challenges in transfusion support as procurement of Efik (29%) and Ibibio (26%) decent. The rest were Igbo
compatible blood is difficult in cases where the patient (8%), Ugep (7%), Obudu (6), Boki (5%), Akamkpa (4%),
bears the alloantibodies. Fulfilment of such a request Ogoja (3%), Obubra (25), Ikom (2%), Yala (1%), and
becomes herculean if a prior plan is not made. Yoruba (1%). Efik, Ugep, Obudu, Boki, Akamkpa,
Ogoja, Obubra, Ikom, and Yala are all ethnicities in
This study was aimed at evaluating some rare and high Cross River State where the study was performed.
frequency blood types to aid prior planning and ensure However, Ibibio is a tribe in neighbouring state Akwa
availability in case such requests are made within the Ibom, which was formally in Cross River State. The
study location. external ethnicities observed are the Igbos and Yorubas.

Method Table 1 shows the comparison of Rhesus D and KELL

The study made use of descriptive cross-sectional design 2 (k+) antigens among the studied subjects and other
with systematic random sampling. One hundred studies in Nigeria and other parts of the world. RhD
prospective blood donors visiting the University of antigen prevalence of 100% was found among the
Calabar Teaching Hospital Donor Clinic were recruited studied subjects, while KELL 2 antigen prevalence of
for the study. The University of Calabar is a tertiary 28% was recorded.
healthcare centre located in Calabar, Cross River State,

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ABO Phenotypes, Rhesus and Kell2 antigens of Blood donors, Etura JE et al

Table 2 shows the ABO phenotype of the studied Table 3 shows the distribution of both ABO and RhD
subjects and other studies in Nigeria and other parts of blood groups. Blood group O RhD positive constituted
the world. Phenotype O constituted the majority (70%) majority (70%) of the ABO/Rh blood group of the
of the subjects while A, B, and AB constituted 15%, 13% studied subjects. The order was O+> A+ > B+> AB+.
and 2%, respectively.
Table 1: Comparison of RhD and KELL 2 (k+) antigens among the studied subjects and other studies in Nigeria and
other parts of the world.
Antigen Percentage (%)
Traditional ISBT Present Another S. Arabia India China CDV Oman Pakistan Caucasians
study Nig. study [18] [19] [20] [21] [22] [25]

D RH1 100.0 92.7 [16] 80.0 93.4 98.9 92.9 89.3 89.1 [23] 85.0
k KELL 2 28.0 23.0 [17] 100.0 100.0 100.0 99.8 99.4 98.9 [24] 99.8
S.: Saudi; Nig.: Nigeria.

Table 2: Comparison of ABO phenotype of the studied subjects and other studies in Nigeria and other parts of the world
Studies ABO phenotypes
O A B AB
Present study 70.00 15.00 13.00 2.00
Other Nigerian studies
Calabar, Nigeria [26] 70.78 17.71 11.08 0.43
Bayelsa, Nigeria [27] 65.30 19.03 13.57 2.10
Benin, Nigeria [28] 53.22 23.72 20.09 2.97
Sokoto, Nigeria [29] 51.91 20.78 23.50 3.18
Kano, Nigeria [30] 57.20 20.50 20.70 1.60
Abakaliki, Nigeria [31] 57.30 22.10 18.10 2.10
Other countries’ studies
Ghana [32] 50.00 24.30 20.70 5.00
Cameroon [33] 48.62 25.07 21.86 4.45
Burkina Fasso [34] 43.30 22.54 28.56 5.60
India [35] 32.07 25.13 33.77 9.03
Iraq [36] 36.90 39.90 15.80 7.40
Saudi Arabia [37] 56.80 33.40 6.00 3.80
Turkey [38] 30.80 43.80 16.20 9.20

Table 3: Distribution of ABO phenotypes and RhD antigens in the studied population.
Blood group Sex Total (%)

Male (%) Female (%)

A RhD positive 13 (18.31) 2 (6.90) 15 (15.0)
B RhD positive 10 (14.08) 2 (6.90) 2 (12.0)
AB RhD positive 1 (1.41) 1 (3.44) 2 (2.0)
O RhD positive 47 (66.20) 24 (82.76) 71 (71.0)
A RhD negative 0 (0.0) 0 (0.0) 0 (0.0)
B RhD negative 0 (0.0) 0 (0.0) 0 (0.0)
AB RhD negative 0 (0.0) 0 (0.0) 0 (0.0)
O RhD negative 0 (0.0) 0 (0.0) 0 (0.0)

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ABO Phenotypes, Rhesus and Kell2 antigens of Blood donors, Etura JE et al

Figure 1: Distribution of blood donors based on ethnicity

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ABO Phenotypes, Rhesus and Kell2 antigens of Blood donors, Etura JE et al

Discussion > AB, while those of Iraq36 and Turkey38 showed A > O
In the present study, we determined the frequency of > B and > AB.
antigens of Kell (k), Rhesus D and ABO among
In view of both the ABO and Rh D blood groups, the
prospective blood donors.
blood groups were in the order O+ > A+ > B+ > AB+.
A prevalence of kell (k) antigen of 28% was found. This This is similar to the report by Okoroiwu and
value is similar to the 22% reported in another study in colleagues.39 On the other hand, Mubu and colleagues
Kano, Northern Nigeria.- Q2 However, the value is have reported O+> B+> A+ > AB+ >O- > A- > B- >
lower than reports from Pakistan (98.9%),24 Oman AB.29
(99.4%),22 Cote d’ Ivoire (99.4%),21 China (100%),20
The observed variation in blood group antigens across
India (100.0%),19 Saudi Arabia (100.0%),18 and
regions raises intriguing questions about the factors
Caucasians (99.8%).25 This means that while a good
shaping this variation. A confluence of evolutionary,
number of Nigerians in the study area develop anti-k,
historical, and even environmental influences likely
only a minute or nil population of Asians and Caucasians
contributes to this phenomenon. Via natural selection,
wont. The implication of this finding is mostly in travel
different environments and disease pressures can favour
medicine (particularly medical tourism). This implies
specific blood groups. For example, certain blood
that a Nigerian with anti – k on medical tourism who
groups might offer increased resistance to
requires blood in the above Caucasian and Asian
malaria, prevalent in parts of Africa.40,41,42,43 Over
countries may find it difficult to procure such k-negative
generations, such selective pressures can lead to higher
blood that is ABO and Rh compactible without prior
frequencies of adaptive blood groups in particular
planning. It has been documented that thousands of
regions.44 More so, when a small, isolated population
Nigerians travel every year to US, UK, India, China,
establishes itself in a new region, its initial gene pool
Saudi Arabia, and among others for medical treatment.
significantly influences future generations. This can lead
We found a Rh D antigen prevalence of 100% in the to unique blood group frequencies due to limited genetic
studied population. This is similar to the 92.7% reported diversity (Founder effect).45 Also, random fluctuations
in previous research in Nigeria by Adewoyin and in gene frequencies due to chance events (genetic drift)
colleagues.16 This is also similar to previous reports in can also contribute to variations in blood group
Saudi Arabia (80.0%),18 India (93.4%),19 China distribution, particularly in smaller populations.46 Other
(98.9%),20 Cote d’Ivoire (92.93%),21 Oman (89.3%),22 means are migration, the epidemiology of infectious
Pakistan (89.1%)23 and Caucasians (85.0%).25 This diseases and environmental factors.
portrays the Rh D antigen as a high frequency antigen
The findings of this study should be interpreted in view
(HFA) in the study location and the referenced Asian
of the limitations such as the relatively small sample size.
and Caucasian countries. The implication of this is the
However, the method of selection has ensured
availability of suitable blood unit(s) in the event of
representation of the blood group antigens within the
occasional cases of blood transfusion involving persons
study location.
lacking a high-frequency antigen. One of the challenges
of transfusion medicine is providing compatible blood Conclusion
for patients lacking a high-frequency antigen.10 Knowledge of the prevalence of various blood group
The ABO phenotype recorded in this study was in the antigens in any population is essential in handling cases
following order: O (70%) > A (15%) > B (13%) and AB of alloimmunization. This becomes essential in the
(2%), with the O phenotype being the predominant management of multiple transfused patients, such as
ABO phenotype. This trend is similar to the reports in sickle cell and cancer patients. Currently, Nigeria has the
Nigeria: Calabar,26 Bayelsa,27 Benin,28 Sokoto,29 Kano,30 highest incidence of sickle cell disease globally.47,48 The
and Abakaliki.31 Among studies outside Nigeria, similar blood group information provided in this study will be
trend was recorded in Ghana,32 Cameroon,33 Saudi useful in blood transfusion planning in the studied
Arabia37 However, studies in India35 showed O > B > A population.

Declarations

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ABO Phenotypes, Rhesus and Kell2 antigens of Blood donors, Etura JE et al

Ethical consideration: Ethical clearance was obtained 7. Wagner FF, Frohmajer A, Ladenig B, et al. Weak
from the Health Research Ethics Committee of the D alleles express distinct phenotypes Blood.
University of Calabar Teaching Hospital with the 2000;95(8): 2699-2708.
approval number UCTH/HREC/33/566. 8. David-Wert AS. Blood transfusion and blood
management in a tropical country. Clinics in
Authors’ contribution: JEE conceived the study, Hematology. 1981; 10(3): 1013-1023.
supervised it, performed the laboratory analysis, 9. Dean L. Blood Groups and Red Cell Antigens.
analyzed data. UIF conceived the study, performed National Center for Biotechnology Information
laboratory analysis, analyzed data. EAA analyzed data, (US). 2005. Chapter 8: The Kell blood group.
sourced for literature materials. HUO did literature Available from:
search, analyzed data, performed statistical analysis and https://www.ncbi.nlm.nih.gov/books/NBK2270/
prepared the manuscript draft. All authors read and 10. Gassner C, Degenhardt F, Meyer S, Voumeit C, et
approved the final manuscript. al. Low frequency blood group antigen in
Switzerland. Transfusion Medicine and
Conflict of interest: The authors declare no competing Hemotherapy. 2018; 45: 239-250.
interest. 11. Harmening D. Modern blood banking and
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Funding: There was no external funding for this Davis. 2012; 199.
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Acknowledgement: Not applicable Frequency of Kell antigens (K & K) among blood
donors of Northern Pakistan. Pak Armed Forces
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Q1 – Confirm details of authors, affiliations, ensure

name is properly written in this sequence – last names,
initials.

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