The biochemistry and molecular genetics underlying the related carbohydrate blood group antigens P, P k , and LKE in the GLOB collection and P1 in the P blood group system are complex and not fully understood. Individuals with the rare but clinically important erythrocyte phenotypes P 1 k and P 2 k lack the capability to synthesize P antigen identified as globoside, the cellular receptor for Parvo-B19 virus and some P-fimbriated Escherichia coli. As in the ABO system, naturally occurring antibodies, anti-P of the IgM and IgG class with hemolytic and cytotoxic capacity, are formed. To define the molecular basis of the P k phenotype we analyzed the full coding region of a candidate gene reported in 1998 as a member of the 3--galactosyltransferase family but later shown to possess UDP-N-acetylgalactosamine:globotriaosylceramide 3--N-acetylgalactosaminyltransferase or globoside synthase activity. Homozygosity for different nonsense mutations (C 202 3 T and 538insA) resulting in premature stop codons was found in blood samples from two individuals of the P 2 k phenotype. Two individuals with P 1 k and P 2 k phenotypes were homozygous for missense mutations causing amino acid substitutions (E266A or G271R) in a highly conserved region of the enzymatically active carboxyl-terminal domain in the transferase. We conclude that crucial mutations in the globoside synthase gene cause the P k phenotype.