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Prevalence of C, c, E, e, K, and k antigens in RhD-negative blood donors in and around Puducherry

 Department of Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

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Date of Submission09-Jul-2021
Date of Decision20-Sep-2021
Date of Acceptance10-Oct-2021
Date of Web Publication04-Jun-2022

How to cite this URL:
Gopal S, Kulkarni R, Basavarajegowda A. Prevalence of C, c, E, e, K, and k antigens in RhD-negative blood donors in and around Puducherry. Asian J Transfus Sci [Epub ahead of print] [cited 2022 Jul 6]. Available from:

Rh blood group system with its gene located on Chromosome 1p36.11 is the second-most important blood group system next to ABO. At present, 55 antigens have been identified in the Rh system.[1] However, the most important antigen is the D antigen, followed by E, c, C e, which can cause HTR and HDFN.[2] The prevalence of these antigens is determined by ethnicity and geographical distribution.[3] The Kell blood group system with its gene located on chromosome 7q33 has 36 antigens, of which K antigen is the most immunogenic after correction for transfusion exposures.[1],[2]

In this report, we tried to analyze the distribution of clinically significant blood group antigen for Rh (C, c, E, e) and Kell (K, k) in Rh (D), negative donors, at a tertiary level care hospital in Southern India. Rh D typing was performed on 30,971 donors over 22 months, from September 2014 to June 2016. One thousand nine hundred and sixty six of them tested to be Rh D negative (6.3%). Of these RhD-negative donors, we chose only first-time donors to avoid duplication, i.e., 596 (30.3%). The column agglutination technique was used to phenotype C, c, E, e, K antigens with ID Card, “DiaClon Rh-subgroups antisera” and “DiaClon Kell group antisera” from Diamed AG, Switzerland.

The positivity for the antigens was C = 30 (5%), c = 594 (99.67%), E = 6 (1%), e = 594 (99.67%), K = 594 (99.7%), and k = 595 (99.8%), the results of the predicted genotypes are depicted in [Table 1].
Table 1: Predicted genotypes and their prevalence in the tested population

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The prevalence of Rh(D) negative in India ranges from 5% tp 10%.[4],[5] Rh and Kell systems are the next most immunogenic after ABO. However, after searching the literature, we could not find any study, which had done phenotyping for Rh(C, c, E, e) and Kell(K, k), exclusively among Rh(D)-negative donors. Our study is comparable with a study conducted by Thakral et al., which showed that Rh(C) was positive in 8.54% of Rh(D)-negative donors. They did phenotyping for Rh(C, c, E, e) and Kell(K, k) systems in 1240 voluntary “O” blood group donors, which included only 82 Rh(D)-negative donors.[6] The prevalence of all the other Rh antigens agreed with the prevalence that we obtained. Rh(E) antigen prevalence is very low in Rh(D)-negative donors with 1.01% (6 out of 596) in our study. A study done by Kahar and Patel showed a prevalence of 16.67%, and a study by Gundrajukuppam et al. showed 8.47%, which is higher.[7],[8] In both studies, the sample size was very less with 18 and 59 of Rh(D)-negative donors in their study, which may be the limitation.

Our present study highlights the prevalence of Kell(K) antigen as 0.34% of Rh(D)-negative donors, as expected from other studies. Kell(k) cellano is again a high prevalence antigen, and it is usually present in almost 100% of individuals. The same holds good in our study, with 99.83% (595 out of 596) donors turning to be positive for Kell(k) antigen in Rh(D)-negative donors.[3],[6]

The importance of our study on phenotyping Rh and Kell, especially in Rh(D)-negative donors, is that usually, Rh(D)-negative donors are eligible for transfusion to ABO-compatible Rh(D) positive donors, whereas the reverse is not. Attempts at having a rare donor registry have been started in our country, which should pave the way for a leap in providing them to needy patients.

Financial support and sponsorship

Intramurally funded by JIPMER.

Conflicts of interest

There are no conflicts of interest.

   References Top

ISBT: Red Cell Immunogenetics and Blood Group Terminology. Available from: [Last accessed on 2020 Dec 09].  Back to cited text no. 1
Stack G, Tormey CA. Estimating the immunogenicity of blood group antigens: A modified calculation that corrects for transfusion exposures. Br J Haematol 2016;175:154-60.  Back to cited text no. 2
Makroo RN, Bhatia A, Gupta R, Phillip J. Prevalence of Rh, Duffy, Kell, Kidd & MNSs blood group antigens in the Indian blood donor population. Indian J Med Res 2013;137:521-6.  Back to cited text no. 3
[PUBMED]  [Full text]  
Patidar GK, Dhiman Y. Distribution of ABO and Rh (D) Blood groups in India: A systematic review. ISBT Sci Ser 2020;16:37-48. [doi: 10.1111/voxs. 12576].  Back to cited text no. 4
Abhishekh B, Mayadevi S, Meena D, Usha K. Distribution of ABO and Rhesus-D blood groups in and around Thiruvananthapuram. Kerala Med J 2011;1:28-9. [doi: 10.4103/0973-6247.59391].  Back to cited text no. 5
Thakral B, Saluja K, Sharma RR, Marwaha N. Phenotype frequencies of blood group systems (Rh, Kell, Kidd, Duffy, MNS, P, Lewis, and Lutheran) in north Indian blood donors. Transfus Apher Sci 2010;43:17-22.  Back to cited text no. 6
Kahar MA, Patel RD. Phenotype frequencies of blood group systems (Rh, Kell, Kidd, Duffy, MNS, P, Lewis, and Lutheran) in blood donors of south Gujarat, India. Asian J Transfus Sci 2014;8:51-5.  Back to cited text no. 7
[PUBMED]  [Full text]  
Gundrajukuppam D, Vijaya S, Rajendran A, Sarella J. Prevalence of principal Rh blood group antigens in blood donors at the blood bank of a tertiary care hospital in southern India. J Clin Diagnostic Res 2016;10:EC07-10. [doi: 10.7860/JCDR/2016/16621.7726].  Back to cited text no. 8

Correspondence Address:
Abhishekh Basavarajegowda,
Department of Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Room No 5042, Superspeciality Block, Puducherry
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajts.AJTS_94_21


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