Which antibodies can show hemolysis?

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Hemolysis occurs when an antibody binds its red cell antigen and activates destruction pathways, either in the body or in lab tests. Vel antibodies target the Vel antigen, which is present on nearly all red cells, so encountering Vel-positive units can lead to rapid, significant hemolysis if the antibody is present. Antibodies in the P1PK system include anti-Pk, which can cause clinically meaningful hemolysis because the Pk antigen is expressed on many cells and can trigger complement. Anti-P1 in this system is usually not strongly clinically significant, but it can still cause hemolysis under certain conditions. Lewis antibodies (anti-Lea or anti-Leb) are typically cold and often considered clinically insignificant, yet they can produce hemolysis in vitro under some testing conditions and, in rare cases, contribute to in vivo hemolysis. Together, these antibodies can all show hemolysis, so the best answer encompasses all three.