International Journal Dental and Medical Sciences Research

Volume 4, Issue 4, July-Aug 2022 pp 425-431 www.ijdmsrjournal.com ISSN: 2582-6018

Study of Prevelance of Rhesus (Rh) Blood Group Antigens

Profiling Among Blood Donors
* Dr.Indumathi S 1, **Dr.Udayakumar 2, **Dr.Deepthi 3, ***
Dr.Thippeswamy4
*1
Department of pathology,Sambhram Institute of Medical Science and Research,KGF,Karnataka.
2,3
** Department of pathology PES Institute of Medical Science and Research, Kuppam,Andhra Pradesh.
***4 Department of pathology, Institute of Medical Science and Research, Davangere,Karnataka.

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Submitted: 01-08-2022 Accepted: 07-08-2022
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ABSTRACT now and are most significant antigens in blood
Background : The Rhesus (Rh) blood group transfusion [1]. Rh system is controlled by two
literature recognizes 50 antigens in Rh system. Rh closely linked loci, RHD gene and RHCE gene.
blood group antigens D, C E, c, and e are RHD locus carries the gene for RHD polypeptide
significant in blood transfusion. In practice only that expresses Rh D antigen. RHCE locus carries
ABO and Rh D antigen are done and reported as genes for RHCE polypeptide that expresses both
ABO and Rh positive or Rh negative. Studies have C/c and E/e antigens. The RHD and RHCE genes
shown blood transfusion reactions have occurred are homologous and are located on chromosome
[2,3]
due to Rh E, e and C antigens also. Aims and .
Objective: To determine distribution of 5 Rh In common practice only ABO and Rh
antigens- D, C,E, c and e. To generate a database blood grouping are done. In Rh blood grouping
and to provide a compatible blood to recipient only D antigen is done and reported as ABO and
without Rh rare antigens that can prevent Rh positive or Rh negative. There are possibilities
transfusion reaction in multiple blood transfusions. of alloimmunization and antibody production in
Materials & Methods: 1000 healthy voluntary recipients against the Rh blood group antigens
blood donors selected..Males - 974 and Females - other than Rh D antigen even after transfusing
26. ABO and Rh anti sera used.. Results: ABO and Rh D compatible blood. Studies have
Frequency of Rh D is 95 %, Rh C is 78.3%, Rh E is shown that blood transfusion reactions had
43.7%, Rh c is 21.7 and Rh e antigen is 92.1 % The occurred due to presence of antibodies against Rh
common Rh antigen is D and least Rh antigen is c. C, E, c and e antigens. Studies have also shown that
Frequency of Rh phenotypes obtained were DCe hemolytic disease of new borns has occurred due to
(66.2%), DCE(29.1%), Dce (20.6%), DEc (4.2%), antibodies against Rh C antigen, E antigen, c
dCe (3.8%), dCE (1.5%), dce (1.2%) and dEc antigen and e antigen other than D antigen .[4,5,6,7]
(0.2%).Commonest Rh phenotype observed is DCe Hence determination of different Rh antigens and
and the least common is dEc. Conclusion: their phenotypes can play a major important role in
Determination of Rh phenotypes can play a major preventing alloimmunization and blood transfusion
role in preventing alloimmunization and adverse reactions in multi transfusion cases. Rh phenotype
reactions in multitransfusion and can prevent in human beings occurs in combination of three
haemolytic disease of newborns caused by Rh antigens ( eg. DCe or CcE or dEc or Dce ...).
antigens other than Rh D antigen. Phenotypes varies in different ethnic groups. The
Keywords: Rh antigens - Rh D, Rh C, Rh E, Rh c present study is undertaken to determine the
and Rh e , Rh phenotypes, . frequencies of five Rh antigens viz., D, C, E, c and
e and their phenotypes among voluntary blood
I. INTRODUCTION donors in a particular region.
ABO and Rhesus (Rh) blood group AIMS OF THE STUDY: 1. To study the
systems are two important blood group systems in prevalence and distribution of different Rh antigens
transfusion medicine. ABO and Rh blood group and phenotypes in the blood donors, this can helps
antigens are located on Red blood cell surface to provide a compatible blood for recipient. 2. To
membrane. Antigens are inherited substances. The determine the percentage of different Rh antigens
Rh antigens are nonglycosylated protein. There are D, C, E, c, and e. 3. To phenotype all five Rh
50 antigens in Rh system. The Rh antigens D, C, E, antigens among blood donors and to generate a
c and e are the only 5 Rh antigens identified till

DOI: 10.35629/5252-0404425431 |Impact Factorvalue 6.18| ISO 9001: 2008 Certified Journal Page 425
 International Journal Dental and Medical Sciences Research
Volume 4, Issue 4, July-Aug 2022 pp 425-431 www.ijdmsrjournal.com ISSN: 2582-6018

database of blood donors to prevent future blood After taking donor consent, donors were screened
transfusion reactions in multiple blood transfusions. as per WHO protocol. Samples were checked for
HIV, HBsAg, HCV, Malarial parasite and VDRL.
II. MATERIAL AND METHODS 5% red cell suspension from blood samples was
Present study was carried out on 1000 healthy prepared. Conventional test tube method by using
voluntary blood donors, at outdoor blood camps monoclonal antibodies Anti - D, C, E, c and e
conducted at borders of Karnataka(Kolar Gold reagents. Tulip diagnostics Rh anti sera was used
Fields) and Andhra Pradesh(Kuppam) states of (Fig .1). For one sample 5 test tubes are taken for
South India and also at blood banks of Sambhram Anti-D,Anti-C,Anti-c, and Anti-E, Anti-e Rh
Institute of Medical Sciences and Research (KGF) Antisera. To 10ul of sample(5% cell suspension),
and PES Institute Medical Sciences and Research 10 ul of corresponding anti serum is added, mixed
(Kuppam). Study conducted between January well gently, centrifuged at 1000 rpm for one minute
2019–20. .Males were 974(97.4%) and females and kept in room temp. After 16 seconds, its
were 26(2.6%). Male to female ratio is 37.4:1. Age observed for agglutination macroscopically. If no
group between 18 and 45 years were considered. agglutination macroscopically, a drop of mixture is
Study design: Prospective-descriptive case study. placed on a slide with a cover slip and observed
Inclusion Criteria: All ABO ,Rh positive and Rh under microscope. Presence of agglutination
negative blood groups were considered. indicates Antigen is present. If no agglutination
Exclusion criteria: Blood donors who were not fit indicates Antigen is absent. Grading of
for blood donation were not considered in the agglutinations noted
study. (Fig.2).Results are compared with positive and
negative controls.

Fig 1. Rh REAGENTS (ANTI-D, ANTI- C, ANTI- E, ANTI- c and ANTI- e

Fig. 2. GRADING OF AGGLUTINATION

Grade 4+ agglutination Grade 3+ agglitination

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 International Journal Dental and Medical Sciences Research
Volume 4, Issue 4, July-Aug 2022 pp 425-431 www.ijdmsrjournal.com ISSN: 2582-6018

Grade 2+ agglutination Grade 1+ agglutination

Grade 0 – Negative reaction

III. RESULTS group was 333(33.3%), AB group was 60 (6%) and

Total of 1000 voluntary blood donor samples of all O blood group was 418(41.8%) ,was most common
ABO groups were typed for the presence of Rh (D, and AB group is the least. There were 950 (95%)
C, E, c, e) antigens. Rh D positive donors and 50 (5%) Rh D negative
Among ABO blood group the frequency of donors.( Table 1).
occurrence of A blood group was 189 (18.9%), B

TABLE 1: NO. OF Rh D POSITIVE AND Rh D NEGATIVE BLOOD GROUPS

Rh D +ve 950 95%

Rh D –ve 50 5%

Among Rh positive blood grouping are DCe - 662 (66.2), DCE - 291 (29.1), Dce - 206
,occurence of frequencies of 5 Rh antigens are Rh (20.6%), DEc - 42 (4.2%), dCe - 38(3.8%), dCE -
D antigen is 950 ( 95%), Rh C antigen is 783 15 (1.5%), dce - 12 (1.2%) and dEc – 02 (2%).
(78.3%), Rh E antigen is 437 (43.7%), Rh c The most common phenotype among Rh D positive
antigen is 217 (21.7%) and Rh e antigen is 912 donors is DCe 662 (66.2%) and least common is
(91.2%). The D antigen was found to be in highest phenotype is Dec 42 (4.2%). The common
frequency followed by e antigen next common Rh phenotype among negative donors is dCe 38
antigen frequency are C and E antigen respectively (3.8%) and less common is dEc 02 (0.2%). Table
and the least Rh antigen is c (Table 2). 4.
Among 50 Rh negative donors, the
highest incidence Rh antigen is “e” (90%). Next IV. DISCUSSION
common antigen frequencies are C and E (76% and The aim of the current study is to know the
42 %) respectively and the least common Rh distribution of 5 different Rh antigens and their
antigen is “c” (24%) Table 3 . Out of 950 Rh D phenotypes among blood donors. This would give
positive donors the incidence of e antigen is 867 an idea of prevalance of different Rh antigens in
with 86.7%, C antigen is 745 with 74.5 % , E local population. Besides the distribution of Rh
antigen is 416 . Eight probable phenotypes antigens and their phenotypes present study was
obtained in the study,they are DCe, DCE, Dce, compared with the study conducted from
DEc, dCe, dCE, dce and dEc. Their frequencies

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 International Journal Dental and Medical Sciences Research
Volume 4, Issue 4, July-Aug 2022 pp 425-431 www.ijdmsrjournal.com ISSN: 2582-6018

TABLE 2: FREQUENCIES OF 5 Rh ANTIGENS AMONG Rh POSITIVE DONORS.

TABLE 3. FREQUENCY OF Rh ANTIGENS

AMONG Rh NEGATIVE DONORS

N0. Rh Frequency %
Phenotypes
1 DCe 662 66.2
2 DCE 291 29.1
3 Dce 206 20.6
4 DEc 42 4.2
5 dCe 38 3.8
6 dCE 15 1.5
7 dce 12 1.2
8 dEc 02 0.2

TABLE 4. INCIDENCE OF Rh PHENOTYPES

Other geographic areas. This study helps Thakral et al [8] and Kumar et al [10]. In comparison
to generate and document a data base of donors at to the research mentioned above, the prevalence of
Blood Bank Centre, which will be useful in future the Rh D positive antigen (95%) is slightly higher
to issue a compatible blood for blood transfusion to and Rh negative (5%) is slightly less in the present
the recipients who require multiple blood study .
transfusions, for example, Thalessemia patients in According to a study by Roy et al. [11]
whom alloimmunization can be prevented. The 97.8% of blood donors from the East India
data on incidence of antigens of various blood population were Rh D positive, whereas 2.2% were
groups in the local blood donor population helps in Rh D negative. When compared to the current
upgrading the blood transfusion practices. The study 95% of donors were Rh D positive and 5%
literature gives few studies about the incidence of were Rh negative. The distribution of Rh D
various Rh blood group antigens of blood donor positives in East India is higher, while only 2.2 %
population from North India.[8,9] The reason for of East India participants were Rh D negative.
conducting this study was the paucity of studies Prevalence of D antigen in present study is slightly
from the southern state of India. higher. In a study conducted by Verma et al [12]
The prevalence of Rh D positive blood shows the occurrence of Rh D antigen is 95.5%.
group among population of Chandigarh and North The prevelance of Rh D antigen in present study is
India are 93.4% and 93.0% and Rh negative are same as Verma et al study with only 0.5%
6.6% and 6 % respectively in studies conducted by difference. Hence incidence of D antigen among

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 International Journal Dental and Medical Sciences Research
Volume 4, Issue 4, July-Aug 2022 pp 425-431 www.ijdmsrjournal.com ISSN: 2582-6018

donor population of Lucknow is same as the prevalence of Rh D negative in other part of South
present study. Prevalence of Rh D negative blood India in a study conducted by Das et al [13]
group in present study is nearly same with the (Table5).

Autho Yea Region No.of % %

r r dono RhD Rh D
rs +ve -ve
dono dono
rS rs
Thakra 201 Chandiga 1000 93.4 6.6
l et al[ 0 rh
8]

Roy et 200 East 1000 97.8 2.2

al [11] 4 India
Kumar 200 North 1000 93.0 6.3
et al [10] 1 India
Verma 200 Lucknow 1000 95.5 4.7
et al[12 ] 6
Das et 200 South 1500 93.3 5.5
al [13] 2 India
Presen 201 AP & 1000 95.0 5.0
t study 9 Karnata
ka
border
TABLE 5. COMPARISON OF PREVALENCE OF Rh D ANTIGENS IN BLOOD DONORS IN
DIFFERNENT PARTS OF INDIA

A study conducted by Jeremiah ZA et al Study conducted by Thakral et al [8] from

[14]
in Nigeria population observed that the North India observed that among Rh D positive
incidence of most frequently occurring Rh antigen donors , e was the most common (98.3%), even in
was c (99.8%) followed by e (98.7%), D (95%), E the present study, e antigen is common among D
(20.5%) and finally C(17.7%) [55]. Present study postive donors. Younis Abed EL [16] studied among
shows same distribution of D antigen. 232 students who donated blood in the city of Gaza
Jenan Y Taha[15] reported that most in Palestine, reported that the percentages of Rh
frequently occurring Rh antigens among the antigen D+, D−, C, c, E and e in the total samples
population in UAE was Rh e antigen (97.3%), were 92%, 8%, 69%, 81%, 38% and 97%,
followed by D (91.1%), C (73.2%), c (71%) and E respectively. In the current study Rh e antigen
(21%).The common antigen is‟ e‟ and least is „E‟ found to be highest and next highest antigen is D
antigen.[56] In the present study most common is D antigen. Rh E is least common antigen seen in Rh
antigen(95%) and the next to it is e antigen positive people as only 38% of the population has
(91.2%). this antigen[.57] (Table 6).

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TABLE 6 COMPARISON OF Rh ANTIGENS FREQUENCIES IN DIFFERENT STUDIES WITH

PRESENT STUDY

The prevalence of DCe, DCE, dCe, and and anti-e alloantibodies are thought to be the most
dce is considerably lower than that of the current widespread Rh blood group system alloantibodies
study in a research by Thakral et al. [42] and Verma in patients who received blood transfusions. (Table
et al [10]. Occurrence of DCe in the population of 7)
India, is most prevalent. Therefore, anti-D, anti-C,

Phenotype Thakral Verma et Present

et al [8] al [12] (%) study(%)
(%)
DCe 43.8 39.8 66.2

DCE 8.2 11.4 29.1

dCe 07 0 3.8
dce 03 0 1.2

Table. 7 COMPARISON OF Rh PHENOTYPE FREQUENCY AMONG NORTH INDIANS AND

PRESENT STUDY

Since D antigen is the most significant antigen of The standard practice of ABO and Rh D
Rh blood group system, there is a clinical blood grouping is tested in Blood Banks. Screening
importance to the wide variations in D antigen for other Rh antigens are not tested which are
distribution in the different segments of the important in patients who requires multi
population. Rh antibodies are thought to be the transfusions. Studies had shown blood transfusion
potential causes of infant hemolytic illness and reaction have occured due to Rh antigens other than
hemolytic transfusion reactions[17]. D antigen and hemolytic disease of new borns have
occurred in Rh D positive mother due Anti-C, Anti-
V. CONCLUSION E,Anti- c and Anti- e. Hence all Rh antigens
According to the study, Rhesus antigenic detection can be can be considered when there is
phenotyping, antibody screening, and their no any other causes for transfusion reaction.
detection before transfusion to patients with a
history of multiple transfusions or multiple REFERRENCE
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