In honor of @RedCross #BloodDonorMonth, #HematologyTweetstory 15 is about blood groups: how they got their names. Most people know of ABO & Rh, but there are >35 (and counting!) blood group systems recognized by @ISBTCO. Antigen image: Williams text 9e. Bloodmobile:@DanaFarber./1 
Of course, blood groups didn't evolve just to make transfusion unsafe & create work for blood banks. The antigens have real physiologic functions (Table: Dacie & Lewis). There are also weird epi associations, eg O blood is tastier to mosquitoes & lowers von Willebrand factor./2
Transfusions have a long & complicated history, stretching back to Richard Lower in England and Jean-Baptiste Denys in France in the 1660s. Blood typing & grouping, however, clearly began with #KarlLandsteiner (1868-1943) in Vienna in 1900-1901. (R image source: Blausen staff) /3
By mixing red cells and plasma taken from several of his lab staff, Landsteiner discovered what he initially called the “ABC” blood group system. Each person's plasma agglutinated RBCs from some people but not from others. (Image source: VisionLearning/Biologie/Schulbuch-O-Mat)/4
AB blood group was discovered a year later by Adriano Sturli & Alfred von Decastello working in Landsteiner’s lab. For a while there was a *lot* of confusion, as Czech Jan Janský proposed using Roman numerals for blood groups; so did American William Moss, but different numbers!
Then Polish biologist Ludwik Hirszfeld (L) & German Baron Emil von Dungern (R) suggested re-naming C as O, signifying either zero/null or German “ohne” meaning “without”, since zero sera reacted with C/O RBCs. Finally, in 1927 Landsteiner said, "It will be ABO"- and it was so./6
If you don’t have A,B, or even the H antigen that defines O phenotype, that’s the Bombay (hh) phenotype, described by YM Bhende (pictured) in 1952 in what is now Mumbai. It's super rare. Bombay blood type people can only get blood from other Bombays – but can donate to any ABO.
In his spare time (!), Landsteiner co-discovered the polio virus. He moved to New York and to the @RockefellerInst in 1922; he received 1930 Nobel Prize. The next system Landsteiner discovered was not Rh, but MNS, in 1927 – now he was working in NYC with Philip Levine./8
The first 2 MNS antigens, M & N, came from letters of the word "immune", because antibodies were made by immunizing rabbits w/ human RBCs (and "I" could be confused with 1). They also found P antigen, shiga toxin receptor – next in the alphabet after M, N, O; now the P1PK system.
The MNS system proved to be more complicated than just M and N; S antigen, also part of the same system, was discovered 20 years later in Sydney, Australia. U is also part of the MNS system; it was named because this factor was almost (but not quite) “Universal”./10
In 1932 came the “Secretor vs non-secretor” distinction. While not a blood group per se, it was of forensic importance (image), because it could be tested on fluids at a crime scene. About 80% of people secrete ABH antigens in saliva, semen & other body fluids; 20% don’t.
Landsteiner kept looking for more blood groups. He & his colleague Alexander S. Wiener injected rabbits & guinea
pigs with rhesus macaque monkey RBCs. The resulting serum agglutinated RBCs of ~85% of European-origin people in NYC; Landsteiner & Wiener named them “Rh positive”.
pigs with rhesus macaque monkey RBCs. The resulting serum agglutinated RBCs of ~85% of European-origin people in NYC; Landsteiner & Wiener named them “Rh positive”.
Soon it was clear Rh is more complicated than +/-. R.A. Fisher in the UK named C, D, and E antigens in the 1940s./13
After Rh came the "Lutheran" group in 1945, discovered by Sheila Callender (pictured) in Oxford, Robert Russell Race in London & ZV Paykoc. It has naught to do with Protestantism, but was named after a patient with lupus named "Luteran". A mislabeled tube made that Lutheran!/14
In 1946 there was the "Lewis" group, named after a patient in London – perhaps a distant relation of @marklewismd 😉. The Lewis group was described by Arthur Mourant (depicted) in London, who founded the Blood Group Reference Laboratory that year and directed it for 2 decades./15
Lots of the other blood group systems are named after the first patient in which an antibody to a new RBC antigen was identified. Many were published before informed consent was routine, so we can only guess at whether the patients actually agreed to the use of their names... /16
My favorite patient-derived blood system name is the rather obscure “John Milton Hagen” blood group, described in the 1970s. No guessing as to which random Lewis or equivalent gave *that* group its name. Surprised it doesn't include JMH's address & Social Security number, too./17
Anyway, back to important groups. The Kell antigen system (AKA Kell–Cellano system) was named in 1945 after a pregnant woman named Kellacher with antibodies to K1. Cellano was also a pregnant woman, but with K2 antibodies. Like Rh, Kell can cause hemolytic disease in newborns./18
Kell – also known as CD238 - is highly polymorphic. There is effectively a whole book of Kells. (*groan*) 😜 /19
Absence of Kell antigens, the “McLeod phenotype” – a rare cause of acanthocytosis - was named in 1961 after a Harvard dental student, Hugh Stanford McLeod. McLeod died in 2004 and practiced orthodontics in Albuquerque for decades, so his phenotype didn’t seem to have hurt him./20
The Kidd antigen system was discovered by Fred Allen Jr, Louis K. Diamond (who has several diseases named after him) & Beverly Niedziela in Boston in 1951. It's named after Mrs Kidd, who delivered a baby with hemolysis. The antigen Jk is actually named after the baby! John Kidd.
In 1950, the Duffy antigen was discovered by Australian Marie Cutbush, P.L. Mollison & Dorothy Parkin, working in London. Mr. Duffy was a multiply-transfused hemophilia patient who had a hemolytic transfusion reaction. Some Duffy alleles confer resistance to malaria./22
The first Diego antigen, Dia, was discovered in 1953 in Venezuela, when a 3 day old child died of hemolytic disease. He was of indigenous descent, a group in which the antigen is relatively frequent. The baby's surname was Diego; his father reportedly gave permission to name use.
Xg system, discovered in 1962, is X linked. The G is for “Grand Rapids” where the patient who made the antibody was from. Most of my people are from Grand Rapids; Western Michigan is where the 2nd wave of Dutch immigrants settled when they came to the US beginning in the 1840s.
Yt is kooky: it was named after a patient Cartwright (not the family from "Bonanza"). All the other letters in Cartwright’s name were taken by other blood group systems except for the t, so that stuck. The Y is for “Why not?” (/25 but this thread continues just a bit longer)
Most of the rest of the blood groups are of minor importance & are named after patients. Auberger was a middle-aged French woman with varices. Dombrock (1965) was also a patient, as were Scianna (1974), Cromer (circa 1965), Knops, Gerbich, Chido (1965, London) & Rodgers (1975)/26
RAPH/MER2 at least breaks the trend – partly. RAPH was a patient (can't tell if surname or acronym of initials), but MER stands for 'monoclonal Eleanor Roosevelt’ after the research Institute in Denver where it was discovered (now part of @CUSystem)./27
There are many good sources on blood group systems if you're interested in learning more. In addition to original articles, I found The Blood Group Antigen Factbook helpful for doing this research. Hope you enjoyed this – and that it inspired you to give blood, if you can!/28End
