Abstract: Objective This survey aims to comprehensively and systematically analyze the positive rate of unexpected red cell antibodies and the distribution characteristics of specific antibodies in the Chinese population. This study aims to provide data support for screening unexpected antibodies and for determining the spectrum of cell antigen composition in China. Methods Research literature on unexpected antibodies in hospitalized patients and blood donors across 31 provinces and municipalities in China was searched in PubMed, CNKI, Wanfang Data, and other authoritative databases from 1981 to December 2023. The literature was screened according to inclusion and exclusion criteria, data extraction was performed, and a quality assessment was conducted. Results The positive rate of unexpected red cell antibodies in hospitalized patients was 0.47%. The rate in blood donors was 0.10%. The rate in hospitalized mothers was 0.71%. The rate in blood transfusion patients was 1.22%, and the rate in pregnant women was 0.91%. The positive rate in blood transfusion/pregnancy was 1.15%. The proportion of specific antibodies in hospitalized patients is in the following order: Rh>MNS>Lewis>Kidd>Duffy>Xg>ABO subtype>I>Diego>P>Kell>Lutheran>H; the proportion of specific antibodies in blood donors is in the following order: MNS>Rh>Lewis>P>ABO subtype>I>Kell>Kidd>Diego>Duffy>Lutheran>H; the proportion of specific antibodies in pregnant and postpartum women is in the following order: Rh>MNS>Lewis>Kidd>P>H>Duffy>I>Diego. The composition proportion of specific antibodies in hospitalized patients is in the following order: anti-E>anti-M>anti-D>anti-Ec>anti-Le^a>anti-C>anti-c>anti-Jk^a>anti-Ce>anti-Le^b, the composition proportion of specific antibodies in blood donors is in the following order: anti-M>anti-E>anti-P1>anti-D>anti-Le^a>anti-Le^b>anti-C>anti-N>anti-I>anti-A1; the composition proportion of specific antibodies in pregnant and postpartum women is in the following order: anti-E>anti-M>anti-D>anti-C>anti-Le^a>anti-Ec> anti-EC>anti-P1. Conclusion The positive rate of unexpected antibodies in hospitalized patients in China is significantly higher than that in blood donors, and the distribution characteristics of specific antibodies vary among different populations and regions.

Key words: Red cell, Unexpected red cell antibodies, Specific antibodies, Blood groups