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Medical Forum / General / General / December 2005

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blood type

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phatcaramelgirl - 07 Dec 2005 21:05 GMT
Is it possible for an AB+ male and an O- female to have an O+ child?

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"and knowing is half the battle"

Sbharris[atsign]ix.netcom.com - 07 Dec 2005 22:01 GMT
> Is it possible for an AB+ male and an O- female to have an O+ child?

Classically, no. However you should never decide on a question like
this without a full genetics paternity panel. Single lab tests can be
wrong, and tests at a single genetic locus (such as this one) can
occasionally be wrong due to crossovers or mutations.

SBH
Robert - 08 Dec 2005 00:15 GMT
> > Is it possible for an AB+ male and an O- female to have an O+ child?
>
[quoted text clipped - 4 lines]
>
> SBH

I have never seen a point mutation you are talking about with mutations in A
subgroups common but we do as stated get a wrong blood type due to cord
blood samples sent with the wrong patient label on them.
Either the baby is not O+ or the father is O+ and not AB+.
Sometimes a mixed field result can result from the mixing of the mothers
blood into the sample.  The other problem with baby blood is that one can
not double check the ABO with the plasma antibodies because babies don't
have any.
One needs to use monoclonal antibody Anti-A and Anti-B for forward typing so
as not to miss weak A subgroups. In an adult the type can be checked with
the back-type and is a clue to weak antigens.
The AABB procedures no longer require the testing of O- mothers for weak D
antigens. Patients years ago were typed as O- weak D positive by coombs only
with polyclonal reagent antibodies. Now with the use of monoclonal
antibodies these patients can type as O+. Almost everybody uses monoclonal
antibodies now although it has created problems with patients believing they
are O- and receive O+ blood.
David Rind - 08 Dec 2005 00:48 GMT
> Is it possible for an AB+ male and an O- female to have an O+ child?

A rare event, but it is possible to have an O phenotype child where the
underlying genotype is AO or BO. See information on the Bombay phenotype
such as http://anthro.palomar.edu/blood/Bombay_pheno.htm

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David Rind
drind@caregroup.harvard.edu

Robert - 08 Dec 2005 02:37 GMT
> > Is it possible for an AB+ male and an O- female to have an O+ child?
>
> A rare event, but it is possible to have an O phenotype child where the
> underlying genotype is AO or BO. See information on the Bombay phenotype
> such as http://anthro.palomar.edu/blood/Bombay_pheno.htm

Lets just say that you have a stronger chance of winning the lotto than you
do in seeing one of these cases. One generally thinks of horses rather than
zebras or in this case an albino zebra.
Bombay phenotypes can only recieve blood from other Bombay phenotype
individuals and only a few units are stored frozen  in the country.
The more common cause as stated would be a labeling error on the specimen or
a different parent. It is more common, and we have seen a few, of type O
mothers having AB babies which automatically generates a call on our part
only to find out the mother is a serogate.
It is also more common in us seeing a patient who is phenotypically Rh pos
and have an anti-D antibody. These are mosaics and require Rh neg blood. The
key would be a negative direct coombs before any transfused blood in both
this case and in the Bombay phenotype cases.
I have heard ads for paternity testing by Cellmark Diagnostics with mouth
swab specimens. That would be the best way to go.
Sbharris[atsign]ix.netcom.com - 08 Dec 2005 05:09 GMT
> > Is it possible for an AB+ male and an O- female to have an O+ child?
>
> A rare event, but it is possible to have an O phenotype child where the
> underlying genotype is AO or BO. See information on the Bombay phenotype
> such as http://anthro.palomar.edu/blood/Bombay_pheno.htm

Yes, but that can't be the case in AB unless the "AB" parent happens to
be a chimera of AO and BO individuals, or various other double
combinations of AA, BB, OO, AO, and BO which give all three antigens
somewhere, and allow for O sperm. That really is rare.

SBH
Robert - 08 Dec 2005 09:53 GMT
> > > Is it possible for an AB+ male and an O- female to have an O+ child?
> >
[quoted text clipped - 8 lines]
>
> SBH

OK I dragged out an old book.

Here it goes under the heading of "Trans or Cis effects".

"Both A and B genes can be inherited as one unit on the same chromosome,
known as Cis-AB. In this rare exception , an AB parent may have an O child.,
normally considered as exclusion of maternity or paternity.
This variant can be recognized by both the weakness of the B antigen and a
weak anti-B present in the serum."

1: Vox Sang. 2004 Jul;87(1):41-3. Related Articles, Books, LinkOut
The serological and genetic basis of the cis-AB blood group in Korea.

Cho D, Kim SH, Jeon MJ, Choi KL, Kee SJ, Shin MG, Shin JH, Suh SP, Yazer MH,
Ryang DW.

Department of Laboratory Medicine, Chonnam National University Hospital,
Gwangju, South Korea.

BACKGROUND AND OBJECTIVES: The cis-AB blood group is rare, although
relatively common amongst Koreans. The serological characteristics and
genetic basis of Korean cis-AB blood donors were investigated. MATERIALS AND
METHODS: Polymerase chain reaction-restriction fragment length polymorphism
(PCR-RFLP), designed to detect the cis-AB01 allele, was performed on 194 AB
samples which demonstrated weak or unusual expression of either or both of
the A or B antigens. RESULTS AND CONCLUSIONS: Sixty cis-AB01 donors were
identified. cis-AB01/O01 or O02 were the most common genotypes (36/60)
detected only in A(2)B(3) donors, and cis-AB01/B101 (nine of 60) was the
least common genotype identified only in A(2)B donors. Surprisingly
cis-AB01/A102 (15/60) was identified in a variety of phenotypes (A(1)B(3),
A(1)B(x) or el, A(int)B(3)).

PMID: 15260821 [PubMed - indexed for MEDLINE]

This under the heading of "mutations".

"Theoretically, the presence of a genetic marker in a child not found in
both parents can be explained on the basis of mutation. However, the
mutation rate in man has been estimated as close to one in a million, and no
convincing example of a mutation involved in paternity testing has ever been
found."

With regards to Bombay et al

"If the regulator gene is absent, not functioning properly, or being
suppressed, there is no precursor substance being formed for the structural
gene to act upon, with the end result of an incomplete or non-detectable
genetic marker. In this case, the normal structural gene can be passed on to
the child. If the child then inherits a normal regulator gene from the other
parent, a normal genetic marker will be produced. The Bombay phenotype, Rh
null, and McCloud phenotype can all be explained by this hypothesis.

"In the ABO system, the H substance has been shown to be the precursor of A
and B substances. Thus in Bombay phenotype, the regulator H gene is absent,
while the A and B structural gene capable of transforming precursor  H
substance to A or B substance is normal; in a group O person, both the A and
B genes are absent"

"It is possible for two seemingly group O individuals to have a group A or B
child, just as it is possible for two Rh null individuals to have a child
with normal Rh antigens."

Bottom line in the past 20 blood group antigens were used in paternity
testing and not just ABO.

Now the exclusion rate for DNA testing is so large that there is no
comparison.
Sbharris[atsign]ix.netcom.com - 08 Dec 2005 21:07 GMT
> > > > Is it possible for an AB+ male and an O- female to have an O+ child?
> > >
[quoted text clipped - 76 lines]
> Now the exclusion rate for DNA testing is so large that there is no
> comparison.

VERY good!  That was a varient I didn't know about. In any case, it's
always standard to insist on the paternity panel of 20, just so
somebody doesn't end up divorcing or shooting somebody on the basis of
a wierd chromosomal rearrangement or lab error. Biology is always more
complicated than you think it is!

SBH
David Rind - 09 Dec 2005 00:19 GMT
>>>Is it possible for an AB+ male and an O- female to have an O+ child?
>>
[quoted text clipped - 8 lines]
>
> SBH

Unless I'm misunderstanding  how the Bombay phenotype works (which is
certainly possible), that's not correct. One parent could be AB and Hh
and the other could be OO and Hh. The child can have a genotype of AO
(or BO) and hh and will appear phenotypically to be O because the hh
will prevent expression of the A or B proteins.

Signature

David Rind
drind@caregroup.harvard.edu

Robert - 09 Dec 2005 00:52 GMT
> >>>Is it possible for an AB+ male and an O- female to have an O+ child?
> >>
[quoted text clipped - 14 lines]
> (or BO) and hh and will appear phenotypically to be O because the hh
> will prevent expression of the A or B proteins.

I am not an expert on Bombay either because we haven't seen one but It would
appear that the Hr heterozygous person has a baby with another Hr
heterozygous person can have a rr Bombay baby. I don't see the A or B status
relevant to phenotypic expression of the recessive trait rr. The
heterozygous parents may be any ABO type.
It has relevance on what the ABO type would be of the Bombay person's
offspring. One would see what was there but not expressed or not.
That is the way I interpreted the chart and the old info from the book.
Robert - 09 Dec 2005 01:06 GMT
"Robert" <Robertsononlin@hotmail.com> wrote in message

> > > Yes, but that can't be the case in AB unless the "AB" parent happens to
> > > be a chimera of AO and BO individuals, or various other double
> > > combinations of AA, BB, OO, AO, and BO which give all three antigens
> > > somewhere, and allow for O sperm. That really is rare.
> > >
> > > SBH

I almost forgot, I didn't think Steve was talking about the Bombay Phenotype
there specifically but in terms of general mosaic expressions of ABO which
are much more common.
 
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