An antibody was discovered by Levine and Stetson in 1939 in a mother who required transfusion following the birth of a stillborn baby. They hypothesized that the father (the donor of the red cells the mother received) possessed a "factor" that the mother lacked and which the baby had inherited from the father. During previous pregnancies, the mother had been immunized by exposure to the red cells of previous babies that also possessed this factor.
By injecting guinea pigs and rabbits with the red cells of Rhesus monkeys, Landsteiner and Wiener advanced the understanding of the system ultimately named Rh (for Rhesus). The antibody stimulated in the guinea pigs and rabbits reacted with 85% of human red cells tested. Additional studies by Levine and coworkers provided further evidence that the antibody that caused the 1939 hemolytic transfusion reaction and the antibody identified by Landsteiner and Wiener seemed to be the same. Therefore, the antibody was called anti-Rh.
As more experiments were carried out, a better understanding of the differences in these antibodies was generated. It was determined that the antibody produced against the Rhesus monkey red cells recognized a different antigen. The antibody was renamed anti-LW (for Landsteiner and Wiener). The antibody that had caused the 1939 HTR/HDFN was assigned to the Rh system and was named anti-D.
There is a phenotypic similarity between the Rh and LW systems in that anti-LW reacts strongly with most D-positive RBCs, weakly with Rh-negative RBCs, and never with Rhnull cells. Anti-LW shows equal reactivity with cord cells regardless of their D type, making this an important characteristic in differentiating anti-LW from anti-D. In addition, anti-LW frequently appears as an autoantibody that does not present clinical problems.
As a result of the work of Landsteiner and Wiener, human red blood cells (RBCs) that react with anti-D are considered Rh-positive. RBCs that do not react with anti-D are considered Rh-negative.
Blaney, KD and Howard, PR: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 3rd ed. Elsevier, St. Louis, MO, 2013, p 108, 120.
Fung, MK, Eder, AF, Spitalnik, SL, Westhoff, CM (eds): Technical Manual, 19th ed. AABB, Bethesda, MD, 2017, p 295.
Harmening, DM,: Modern Blood Banking & Transfusion Practices, 6th ed. FA Davis, Philadelphia, PA, 2012, p 150,165, 204.
