Uncertainty in identification of blood group A subtypes by agglutination test

Identification of the blood group A subtypes, i.e. A1, A2, and A1-A2 intermediate (Aint), by agglutination test, particularly in AB red cells, is ambiguous. The expressions of A subtypes in red blood cells are the consequences of diverse formations of the A substances by the action of three types of blood group N-acetyl-galactosaminyl-transferases controlled by A1, A2, and Aint genes. Therefore, the A subtypes are more directly identified by examining the kinetic characters of A-enzymes existing in plasma. Several Black AB subjects classified as non-A1 by the agglutination test were identified as A1B and AintB on the enzyme basis. A subject serologically classified as A1 had A2-enzyme in her plasma, i.e. she is genetically A2O or A2A2. The present and previous studies indicate that red cell A2 status is occasionally expressed as a result of the combination of Aint and B, and of A1 and superactive B. The imbalance between A1/A2 and A1B/A2B observed in some Black populations could be attributed to high frequencies of the Aint and B. sup. genes in Blacks.