Several forms of anti-H exist.

1 Clinically significant 'true' anti-H occurs in the serum of persons with Bombay phenotype and is very rare. When it does occur, it is very important from the point of view of selecting blood for transfusion; as the antibody is active at 37°C, only Bombay phenotype blood may be transfused.

2 Anti-H and anti-HI, commonly found in the serum of group A1, B and A1B persons, react much more strongly with adult than with cord red cells. Anti-H is inhibited by secretor saliva; anti-HI is not. Although these antibodies agglutinate O red cells at 20°C, they do not usually agglutinate them at temperatures above 30°C. Very occasionally, anti-H/-HI may cause rapid destruction of at least some of the transfused O red cells in vivo. However, these antibodies will not interfere with the survival of transfused cells if ABO identical units, i.e. A1, B or A1B donor units are chosen for A1, B or A1B recipients respectively.

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