“…In contrast to red blood cell (RBC)-induced alloantibody formation ( 13 , 14 , 15 , 16 , 17 , 18 , 19 ), antibodies against ABO(H) antigens are naturally occurring and form within the first few months of life ( 20 ). While conflicting data exist regarding the development of naturally occurring anti-ABO(H) antibodies ( 21 , 22 , 23 , 24 , 25 ), several studies suggest that microbes that express ABO(H)-like antigens may stimulate anti-ABO(H) antibody formation relevant to transfusion and transplantation ( 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ). However, as tolerance mechanisms prevent the formation of anti-ABO(H) antibodies in ABO(H) blood group–positive individuals, how these individuals protect themselves against blood group–decorated microbes is incompletely understood.…”