Dombrock Blood Group System

Dombrock blood group system, classification of human blood based on the presence of certain glycoproteins, originally only the so-called Do antigens, on the surface of red blood cells. Antibodies to the Dombrock antigen Do^a were discovered in 1965 in a patient who had received a blood transfusion; the Do antigen takes its name from the original blood donor. In 1973 a second Dombrock antigen, Do^b, was identified; its name is representative of its antithetical relationship to Do^a. The Dombrock blood group was expanded in the 1990s to include three other antigens—Gy^a (Gregory antigen), Hy (Holley antigen), and Jo^a (Joseph antigen)—that occur on the same protein as the Do antigens.

The Dombrock antigens are located on a glycosylphosphatidylinositol (GPI)-anchored protein that is encoded by the gene ART4 (ADP-ribosyltransferase 4). The GPI is embedded in the membrane of Dombrock-expressing cells, thereby enabling the protein and its antigen-containing residue to remain exposed on the outside surface of the cells. Genetic variations in ART4 that result in an altered amino acid sequence of the encoded protein give rise to the different Dombrock antigens. The Do^b antigen is distinguished from the Do^a antigen in that it contains an amino acid sequence known as an arginine-glycine-aspartic acid (RGD) motif, which is known to play a role in cell-to-cell interactions.

Studies have indicated that about 65 percent of northern Europeans carry the Do^a antigen and that the Do^b antigen has an increased incidence in Africans and Asians. In all populations studied, the Gy^a, Hy, and Jo^a antigens have been estimated to occur in more than 99 percent of individuals. In addition to the expression of the Do^a antigen on circulating red blood cells, it is found on lymphocytes and lymph nodes, in bone marrow, and in the tissues of the spleen, ovaries, testes, intestines, and fetal heart. The expression of Dombrock antigens is highest in the fetal liver. In very rare cases, none of the five Dombrock antigens are expressed on red blood cells, resulting in a Dombrock-null phenotype.

Antibodies to Dombrock antigens have been associated with severe transfusion reactions. In addition, the absence of Dombrock antigens can occur as a result of the loss of GPI-anchored proteins from the surface of red blood cells. The loss of these proteins underlies a rare condition known as paroxysmal nocturnal hemoglobinuria, in which red blood cells undergo premature destruction by immune cells.