OTHER BLOOD GROUP SYSTEM:
Lewis blood group system
INTRODUCTION:
The   lewis blood group system is not manufactured by the
red blood cells.
Lewis   antigens are not synthesized by red cells, but
incorporated into red cell membrane structure.
The   lewis antigens are manufactured by tissue cells and
secreted into body fluid, then adsorbed onto the red cell
membrane from plasma.
Therefore   lewis antigen is not an integral part of the
membrane structure.
lewis   antigen development begin in the first week of birth
and continue to 6 years.
INHERITANCE:
The   lewis gene (Le) code for L-fucosyltransferase enzyme
which add fucose sugar to the precursor substance one.
   fucose sugar added to the N-acetylglucosamine sugar.
The   Le gene is located in the short arm of the
chromosome 19.
Lewis   antigen production depends not only on the
inheritance of the lewis genes but also on the inheritance
of the secretor gene and H genes.
 INHERITANCE:
If    a Le gene is inherited , Lea antigens are found in the
secretions and are adsorbed onto the red blood cells regardless of
the secretor status.
Therefore,     an individual can be a non-secretor of ABH and still
secret Lea into the body fluids.
If    the Se gene is inherited in addition to Le gene, the lweis
transferase converts the available H soluble structure to a Leb ,
And the red cells adsorbs Leb instead of Lea
 If   the gene inherited from both parents is le, no antigen
structure is present on the red cells.
       SUMMARY OF LEWIS INHERITANCE AND
           BIOCHEMISTRY CONCEPTS:
Lea   and Leb are not alleles
Le(a-b+)   red blood cells arises from the inheritance of an Le,
Se, and H gene.
A   person can be a nonsecretor (sese) and still secrete Lea into
body fluid. Therefore, only antigens Lea are secreted by the
tissue cells and subsequently adsorbed to re blood cells from
plasma yielding the phenotype Le(a+b-).
Lewis   antigens found in the secretion are glycoproteins
Lewis   antigens found in the plasma are glycolipids.
Red   cells adsorb only glycolipids not glycoproteins, onto the
membrane.
Substances present in secretions and antigens present
on red blood cells, depending on the Lewis, Sese, Hh,
and ABH genes inherited.
 LEWIS ANTIBODIES:
Antibodies    to the lewis blood group antigen (anti- Lea and anti-
Leb) are generally produced by Le(a-b-) persons.
Lewis    antibodies are considered naturally occurring because they
are present without previous exposure to the antigen positive red
cells.
They    are generally IgM, do not cross placenta and do not cause
HDNF.
Can     activate complement. Therefore can cause hemolytic
transfusion reaction.
LEWIS ANTIBODIES:
Anti-    Lea is easily neutralized with plasma and body fluid
secretion.
Le(a-b+)    person do not make Anti- Lea because:
1.   the Lea antigen structure is contained within the Leb
antigen epitopes.
2.   Le(a-b+) persons have Lea substances in their plasma and
saliva.
The    lewis antigens dissociate from the red cells as they
adsorb. These antigen released into the plasma can
neutralized any lewis antibodies present in the recipient
plasma of Le(a-b-) persons.