Indian Journal of Medical Research

: 2016  |  Volume : 143  |  Issue : 5  |  Page : 633--635

Frequency of Mia antigen: A pilot study among blood donors

Raj Nath Makroo, Aakanksha Bhatia, Mohit Chowdhry, NL Rosamma, Prashant Karna 
 Department of Transfusion Medicine, Molecular Biology & Transplant Immunology, Indraprastha Apollo Hospitals, New Delhi, India

Correspondence Address:
Dr Raj Nath Makroo
Department of Transfusion Medicine, Molecular Biology & Transplant Immunology, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110 076


The Miltenberger (Mi) classes represent a group of phenotypes for red cells that carry low frequency antigens associated with the MNSs blood group system. This pilot study was aimed at determining the Mia antigen positivity in the blood donor population in a tertiary care hospital in New Delhi, India. The study was performed between June to August 2014 on eligible blood donors willing to participate. Antigen typing was performed using monoclonal anti-Mia antiserum by tube technique. Only one of the 1000 blood donors (0.1%) tested was found to be Mia antigen positive. the Mia antigen can, therefore, be considered as being rare in the Indian blood donor population.

How to cite this article:
Makroo RN, Bhatia A, Chowdhry M, Rosamma N L, Karna P. Frequency of Mia antigen: A pilot study among blood donors.Indian J Med Res 2016;143:633-635

How to cite this URL:
Makroo RN, Bhatia A, Chowdhry M, Rosamma N L, Karna P. Frequency of Mia antigen: A pilot study among blood donors. Indian J Med Res [serial online] 2016 [cited 2019 Nov 20 ];143:633-635
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Full Text

The Miltenberger (Mi) classes represent a group of phenotypes for red cells that carry low frequency antigens associated with the MNSs blood group system. The Mia antigen is expressed on several glycophorin variants that are hybrids between the usual forms of glycophorin A and B[1]. Anti-Mia was first described in 1951 by Levine and co-workers[2] in the serum of Mrs. Miltenberger, who developed this antibody in response to immunization from her antigen positive foetus. The corresponding antigen was named after her[2]. The incidence of the blood group antigen Mia among most populations is low[3][4][5]. Higher frequencies of occurrence are, however, noted in the Chinese and South East Asians[6][7][8]. Anti-Mia is also frequently reported among the South East Asians especially the Chinese[9][10][11][12].

The antigen frequencies in Indian population have not been documented. This pilot study was aimed at determining the Mia antigen positivity in blood donor population attending a tertiary care hospital in north India.

This study was carried out in the department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, India, between June and August 2014, on apparently healthy blood donors, after being approved by the institutional Ethical Committee. All donors coming to the department for blood donation during the study period were assessed as per the screening criteria laid down by the Drug and Cosmetics Act, 1940[13]. Donors found fit to donate blood after initial screening were informed about the Mia antigen testing. The first 1000 donors giving written informed consent to participate in the study were included.

Blood donation was taken as per the departmental protocols. Blood samples (4 ml) collected in tubes containing EDTA (ethylene diamine tetra acetic acid) were subjected to Mia antigen testing using monoclonal anti Mia-antiserum (Immucor Inc. Norcross, GA, USA). The tests were performed using “tube technology” by adding two drops of anti-Mia antiserum to one drop of 2-4 per cent red cell suspension. The tubes were incubated for 15 min at room temperature and centrifuged. The haemagglutination reaction was read thereafter. Positive and negative controls using known Mia antigen positive and negative cells were run along with each batch of tests.

Of the 1000 donors tested, only one was found to be Mia antigen positive. The Mia positive donor was a 42 yr old Hindu male. The overall frequency of Mia antigen in this pilot study was 0.1 per cent.

The Miltenberger is a series of relatively rare phenotypes associated with the MNSs system, related to each other through the overlapping specificities of a number of low frequency alloantigens[1]. As the series became more complex with the incorporation of several new variants, a terminology based on glycophorins (Glycophorin. Vw, Glycophorin. Hop, etc.) was suggested by Tippett and co-workers in 19923. This new terminology has been widely accepted and has replaced the original concept of 'Miltenberger subclasses'.

Since, the Mia antigen is present on red cells of many Miltenberger phenotypes, the existence of Mia antigen as an independent entity was questioned until Chen et al in 2001[14] reported the first monoclonal anti-Mia, thereby confirming the existence of the Mia antigen.

The frequency of Mia has been reported to be less than one per 1000 among Caucasians, Negro and Japanese people[3][4][5], but in South-East Asia, the frequency in Chinese blood donors in Hong Kong was 6.28 per cent[15], 88 per cent in the Ami, mountain people of Taiwan[7] and 9.6 per cent in Malaysian blood donors[16].

Anti-Mia is regarded as clinically significant and has been reported in high frequency in the South East Asians[9][10][11][12]. It has been reported as the most frequently detected alloantibody in immunized patients in Malaysia[17] as well as in Taiwan[9]. The frequency of Mia antigen observed in this pilot study in the Indian population was comparable to that reported in literature for Caucasians and other populations[3][4][5], however, it was much lower than reported in the Chinese and other South-East Asian populations[7],[15],[16]. At a frequency of 0.1 per cent, Mia can be considered a low frequency antigen and incorporation of regular screening for corresponding antibodies during the pre-transfusion testing may not be necessary. However, considering the expansion in medical tourism in India and an influx of patients from various Asian and African countries, the need for screening for anti-Mia needs to be further evaluated. Besides, this being a pilot study of only 1000 subjects, a larger study is required to accurately determine the frequency of Mia antigen in the Indian population.


Authors thank Immuncor Inc., USA for providing reagents for performance of the tests.

Conflicts of Interest: None.


1Daniels G, Human blood groups, 2nd ed., Oxford, UK: Blackwell Publishing Ltd.; 2002.
2Levine P, Stock AH, Kuhmichel AB, Bronikovsky N. A new human blood factor of rare incidence in the general population. Proc Soc Exp Biol 1951; 77: 402-3.
3Tippett P, Reid ME, Poole J, Green CA, Daniels GL, Anstee DJ. The Miltenberger subsystem: is it obsolescent? Transfus Med Rev 1992;6: 170-82.
4Mohn JF, Lambert RM, Rosamilia HG. Incidence of the blood group antigen Mia in the Caucasian and Negro populations of Western New York. Transfusion 1961; 1: 392-3.
5Mohn, JF, Lambert RM, Iseki S, Masaki S, Furukawa K. The blood group antigen Mia in Japanese. Vox Sang 1963;8: 430-7.
6Lin M, Broadberry RE. Immunohematology in Taiwan. Transfus Med Rev 1998;12: 56-72.
7Broadberry RE, Lin M. The distribution of the MiIII (Gp. Mur) phenotype among the population of Taiwan. Transfusion Med 1996;6: 145-8.
8Reid ME, Lomas-Francis C.The blood group antigen facts book.2nd ed. London: Academic Press; 2004.
9Jan RH, Yu LC, Wen SH, Tsai SS, Lin TY. Incidence of alloantibodies in transfused patients in Eastern Taiwan. Tzu Chi Med J 2009;21: 66-9.
10Broadberry RE, Lin M. The incidence and significance of anti-Mia in Taiwan. Transfusion 1994;34: 349-52.
11Lin CK, Mak KH, Cheng G, Lao TT, Tang MH, Yuen CM, et al. Serologic characteristics and clinical significance of Miltenberger antibodies among Chinese patients in Hong Kong. Vox Sang 1998;74: 59-60.
12Lee CK, Ma ES, Tang M, Lam CC, Lin CK, Chan LC. Prevalence and specificity of clinically significant red cell alloantibodies in Chinese women during pregnancy-a review of cases from 1997 to 2001. Transfus Med 2003;13: 227-31.
13Part XIIB. Department of Health Schedule F. The Drugs and Cosmetics Act, 1940 and the Drugs and Cosmetics Rules, 1945, as amended up to 30th June; 2005. Ministry of Health and Family Welfare, New Delhi; Government of India. p. 326. Available from:, accessed on October 29, 2015.
14Chen V, Hafverson G, Wasniowska K, Lisowska E, Chen J, Moulds M, et al. Direct evidence for the existence of Miltenbergera antigen. Vox Sang 2001;80: 230-3.
15Poole J, King MJ, Mak KH, Liew YW, Leong S, Chua KM. The MiIII phenotype among Chinese donors in Hong Kong: immunochemical and serological studies. Transfus Med 1991;1: 169-75.
16Musa RH, Ahmed SA, Hashim H, Ayob Y, Asidin NH, Choo PY, et al. Red cell phenotyping of blood from donors at the National blood center of Malaysia. Asian J Transfus Sci 2012;6: 3-9.
17Yousuf R, Aziz SA, Yusof N, Leong CF. Incidence of red cell alloantibody among the transfusion recipients of Universiti Kebangsaan Malaysia Medical Centre. Indian J Hematol Blood Transfus 2013; 29: 65-70.