ABO and Rh
Blood
Grouping
BY
DR.ARPITA SANKHWAR
Contents
• Introduction of blood
• Composition of blood
• Cells and functions of blood cells
• Abo system of blood groups
• Landsteiner's law
• Abo antigen
• Abo antibodies
• Bombay antigen
• Rh antigen
• Abo inheritance
• Determination of blood groups
• Blood transfusion
• Blood transfusion reactions
• Applied aspects
• Conclusion
• References
BLOOD
9/3/20XX Presentation Title 3
9/3/20XX
Human Blood Groups
Red cell membranes have
antigens (protein / These antigens are unique
glycoprotein) on their to the individual
external surfaces
Recognized as foreign if
transfused into another More than 30 such
individual to promote antigen systems
agglutination of red cells discovered
if combine with antibody
Presence or absence of
these antigens is used to
classify blood groups
Major blood groupings system
• ABO blood grouping system
• Rh (CDE) blood grouping system
CLASSIFICATION
Minor blood grouping system
• MNS blood groups
• P blood groups
Familial blood groups system
• Only in few families ex. Kell, Duffy, Lutheran
• Lewis, Deigo, Kidd etc.
ABO Blood Groups
• Most well known & clinically important blood
group system.
• Discovered by Karl Landsteiner in 1900
• First to be identified.
• Most significant for transfusion.
• ABO blood group consist of two antigens (A &
B) on the surface of the RBCs.
• Two antibodies in the plasma (anti-A & anti-B)
Development at birth
• All the ABH antigens develop as early as day
37 of fetal life.
• Red cell of newborn carry 25-50 % of
number of antigenic sites found on adult
RBC.
• A or B antigen expression fully developed at
2-4 yrs of age and remain constant
throughout life
Expression of ABO
Antigens
• ABO blood group antigens are
regarded as RBC antigens.
• They are expressed on a wide
variety of human tissues and are
present on most epithelial and
endothelial cells.
• Present both on red blood cells
and in secretions.
Anti-A and anti-B antibodies
• Newborn, appear in the first years of life (4- 6 months usually),
• Reach adult level at 5-10 years of age,
• Decreases in elderly.
• Naturally occurring
• Do not need any antigenic stimulus .
• Immunocompetent person react to these antigens by producing
antibodies to those absent from their own system.
• Usually IgM, which are not able to pass through the placenta to
the fetal blood circulation.
ABO antigens & corresponding antibodies
• 'Landsteiner's law :
the plasma contains
natural antibodies to
A or B, if these
antigens are absent
from the red cells of
that person.
Inheritance of • Follows Mendelian principles
ABO Blood • Blood group antigens are “codominant”- if the gene is
inherited, it will be expressed.
Groups • There are three allelic genes -A, B & O
• Two genes inherited, one from each parent.
• Individual who is A or B may be homozygous or
heterozygous for the antigen.
• Heterozygous: AO or BO
• Homozygous: AA or BB
• Phenotype is the actual expression of the genotype, ie,
group A
• Genotype are the actual inherited genes which can
only be determined by family studies, ie, AO.
ABO and H Antigen Genetics
• Genes at three separate loci control the
occurrence and location of ABO antigens
• Presence or absence of the ABH antigens on the
red cell membrane is controlled by the H gene
• Presence or absence of the ABH antigens in
secretions is indirectly controlled by the Se gene
• H gene – H and h alleles (h is an amorph)
• Se gene – Se and se alleles (se is an amorph)
• ABO genes – A, B and O alleles
RBC precursor substance
H Antigen
• The H gene codes for an enzyme
(fucosyltransferase) that adds the sugar
fucose to the terminal sugar of a precursor
substance
• The precursor substance (proteins and
lipids) is formed on an oligosaccharide
chain (the basic structure)
• The H antigen is the foundation upon
which A and B antigens are built
• A and B genes code for enzymes that add
an immunodominant sugar to the H
antigen
• Immunodominant sugars are present at the
terminal ends of the chains and confer the
ABO antigen specificity
A and B Antigen
• The “A” gene codes for an enzyme (transferase) that adds
Nacetylgalactosamine to the terminal sugar of the H antigen.
• The “B” gene codes for an enzyme that adds D-galactose to the
terminal sugar of the H antigen
• D-galactosyltransferase
Formation of the A AND B antigen
Secretor Status
• A, B, H substances are found in all body secretions (except CSF) in
80% of individuals
• Ability to secrete these substances is determined by the presence of
secretor gene (Se) in either homozygous (SeSe) or heterozygous
(Sese) state.
Characteristics of Bombay
Phenotype
• First reported by Bhende et al in Bombay in 1952.
• Frequency estimated to be about 1 in 7600 in
Bombay.
• Absence of H, A & B antigens. No agglutination
with anti-A, anti-B or anti-H
• Presence of anti-H, anti-A and anti-B in the serum
• No A, B or H substances present in saliva
• Incompatible with any ABO blood groups,
compatible with Bombay phenotype only
• A recessive mode of inheritance (identical
phenotypes in children but not in parents).
Rh (D) Antigen
• Rh is a blood group system with many
antigens, one of which is D.
• Rh refers to the presence or absence of the D
antigen on the red blood cell.
• Unlike the ABO system, individuals who lack
the D antigen do not naturally produce anti-D.
• Production of antibody to D requires
exposure to the antigen.
• The D antigen is very immunogenic, i.e.,
individuals exposed to it will very likely make
an antibody to it.
• For this reason, all individuals are typed for D,
if negative must receive Rh (D) negative blood.
• Rh antigens are an integral part of the red cell membrane.
• They are protein in nature with an active phospholipid component
• Rh antigens do not exist in the soluble form and, therefore are not excreted in body
fluids.
• Unlike ABO antigens, Rh antigens are present only on red blood cells. These antigens
are not found on other blood cells including platelets and leukocytes
• A very potent antigen (50% may form antibody to exposure)
• Frequency in Indian population
• 92-95% Rh positive
• The most important patient population to consider is females of child-bearing age.
Rh Antibodies
• All Rh antibodies are immune in nature,
developed after immunizing event
• React at 37oC and require anti globulin test to
demonstrate the reaction
• Most are IgG in nature and therefore can cross
the placenta
• Generally, do not fix complement and cause
extravascular hemolysis
Rh typing
• Normal typing for Rh antigens only
includes typing for Rh (D).
• The result of this typing determines the
Rh status of the cells (Rh - positive or Rh -
negative).
• It is recommended to use two
monoclonal anti-D sera from two
different manufacturers labeled as D1
and D2, especially to confirm all Rh
negatives.
Practical aspects of ABO
grouping
• Routine ABO grouping must include both cell &
serum testing as each test serves as a check on
the other
• Test should be done at room temperature or
lower; testing at 37oC weakens the reactions
• Tubes, slides should be dry and labeled properly
• Serum should always be added before adding
cells
• Results should be recorded immediately after
observation
• Hemolysis is interpreted as positive result.
BLOOD TRANSFUSION
Blood Transfusions: One of the primary reasons blood groups are essential is their
critical role in blood transfusions.
1. Blood must be compatible between the donor and recipient to prevent life-threatening reactions.
2. Matching the ABO and RhD (Rhesus) blood groups is crucial to ensure a safe transfusion.
3. A mismatch can result in a severe immune response, leading to complications and even death.
COMPLICATIONS OF BLOOD TRANSFUSION
• Acute hemolytic transfusion reactions occur if donated blood cells are attacked by matching
host antibodies.
• Shock-like symptoms, fever, hypotension, and
• Disseminated intravascular coagulation from immune system mediated endothelial damage.
• Transfusion reactions are also associated with acute renal failure.
• Lung injury , due to pulmonary edema from fluid overload
• Contaminated with bacteria, it may induce septic shock in the patient.
Pregnancy and Rh Incompatibility
Rh factor (positive or negative) is another vital aspect of blood groups.
ERYTHROBLASTOSIS FETALIS- RH incompatibility between a pregnant Rh-
negative mother and a Rh-positive fetus can lead to hemolytic disease of the newborn
(HDN), a condition where the mother's immune system attacks the baby's red blood
cells.
This can result in severe health issues for the baby, emphasizing the importance of blood
group testing during pregnancy.
In severe cases, it can result in anemia, jaundice, and, in extreme cases, can lead to
serious complications or even death for the newborn.
Applied aspect
1.Organ Transplants: Blood group compatibility is also critical for organ transplantation.
1. Matching the donor and recipient's blood types helps minimize the risk of organ rejection and
improves the chances of a successful transplant.
2.Forensic Science: Blood groups can be used in forensic science for identifying
individuals involved in criminal activities or accidents.
Blood left at a crime scene can be tested for blood type, potentially helping to solve crimes.
3.Anthropological Studies: Blood groups have been used in anthropological studies to
understand human migration patterns and genetic diversity among populations.
They can provide insights into the history and evolution of different human groups.
1.Blood Donation: Knowledge of one's blood group is essential for blood donors. Blood
banks rely on blood type information to ensure that donated blood is compatible with
the needs of recipients.
This helps save lives in emergency situations, surgeries, and for individuals with chronic medical
conditions requiring regular transfusions.
2.Research and Genetics: Blood groups are a part of human genetics and can be used in
genetic studies to trace ancestry and inheritance patterns.
They also play a role in understanding the inheritance of other genetic traits.
• Blood groups and disease association.
• The ABO blood groups have a profound influence on
haemostasis.
• They exert major quantitative effects on plasma levels of von
Willebrand factor and factor VIII. Increased association of
myocardial infarction, ischemic stroke, and venous
thromboembolism is seen with blood groups A and AB possibly
through functional ABO glycol transferases modulation of
thrombosis.
• A higher risk of cerebral venous thrombosis has been reported
in non-O groups.
• Significant association of ABO groups with the prevalence of
preeclampsia has been reported, where AB group was found to
be associated with an increased risk of 2.1-folds.
• Preliminary studies suggested an association of ABO
system with malignancies.
• A positive correlation has been shown between blood
group A with chronic hepatitis-B infection and
pancreatic cancer;[16] and blood group B with ovarian
cancer.
• Protection against falciparum malaria can be achieved
with group O by reducing rosette formation.
• Blood group O increases the severity of infection in
Vibrio cholerae strains (O1 El Tor and O139)
conclusion
• Currently, our knowledge on blood groups goes beyond the usual
tests of agglutination and transfusion to the better understanding
of RBC antigens in light of their association with multiple diseases
and the scope of use of this knowledge to modulate the disease
processes.
• In this context, the role of adequate understanding of screening,
typing, and cross-matching apart from awareness on evolving
trends, for every clinician, may not be overemphasized.
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