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Antibodies against antigens in the Lutheran system are not often encountered. The antigen-antibody reaction produces small and loose agglutinates in a characteristic mixed-field appearance. The antigens are poorly developed at birth. Allo anti-Luᵃ has not been implicated in transfusion reactions and only rarely as causing mild hemolytic disease of the fetus and newborn (HDFN). Allo anti-Luᵇ has been implicated in mild to moderate transfusion reactions and mild HDFN.