The antibodies of the MNS system

Anti-M is uncommon and reacts with about 80% of random samples. It is naturally occurring, more common in infants than adults, but can be immune and can very rarely cause HDN.

Anti-N is also rare and reacts with about 70% of random samples. It is nearly always a cold-reactive IgM antibody. Because of the 'N' activity of GPB, at low temperatures anti-N reacts with, and can be completely absorbed by, M/M cells, except those of the M+N-S-s- phenotype. Useful anti-N lectin can be prepared from the seeds of Vicia graminea.

A cold-reacting N-like antibody (anti-Nf) has been described in certain patients undergoing renal dialysis, regardless of their MN group. Although it may cause confusion in cross-matching tests, anti-Nf is usually of little clinical importance, but has been reported to cause hyperacute renal graft rejection. Nf arises from the effects of minute amounts of formaldehyde (used to sterilize the dialyser coil) on the patient's red cells; these changed cells stimulate anti-Nf.

Anti-S, the rarer anti-s and anti-U are usually immune, IgG, and can cause HDN. They have also been implicated in HTRs. Anti-U only occurs in S-s- black people and reacts with all cells that have the S or s antigens and up to 50% of cells that are S-s-. Finding compatible blood for a patient with anti-U may prove difficult.

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