ABO

October 15,2019 LECTURE

HISTORY
• 1900 - Karl Landsteiner discovered the ABO Blood group system of antigens
• He classified an individuals erythrocytes into 4 types:
A, B, AB, & O
• Only 2 antigens ( A & B ) were needed to explain the 4 blood groups
• The blood groups are named for the antigens on the surface of the red cells
• Ex. ( Group A individuals have the “A” antigen )

General Character of ABO Antigens

ABO antigens are widely distributed & are located on red cells, lymphocytes(adsorbed from
plasma), platelets(adsorbed from plasma), most epithelial and endothelial cells, and
organs such as the kidneys.
Soluble forms of the ABO blood groups sys. antigens can also be synthesized and secreted by
tissue cells. As a result, these antigens are found in association with cellular membranes
and as soluble forms.

Soluble antigens are detected in secretions and all body fluids except CSF.
• ABO antigens which are intrinsic to the red cell memberane, exist as either glycollipid or
glycoprotein molecules, whereas the soluble forms are primarily glycoproteins
• Are detectable at 5 to 6 weeks in utero
• Newborns possess fewer antigen copies per red cell compared with adults
• The specificity of A and B antigen is defines by immunodominant sugars:
• N-acetylgalactosamine (A antigen)
• D-galactose (B antigen)

Antibodies of the ABO Blood Group

• Naturally occuring = as a result of unavoidable exposure to group specific substances
(bacteria, plants, & pollen) in the environment
• Usually absent in the neonatal sera. They increase in strength between 3 to 6 months of
age, reaching a maximum at 5 to 10 years.
• As a person ages, the titer tend to decrease
• Titer may also be weak in immuno deficient individuals

Landsteiner’s Law
• In normally healthy adults & in children above the age of 3-6 months, the serum always
contain anti-A if the RBC lack A antigen, and it contains anti-B if the RBC lack the B antigen.
• Interaction between Antigen and antibody leads to agglutination
• The antigen is called agglutinogen
• The antibody is called agglutinin
 *base sa marieb too! Table 10.3 P. 377*

GENERAL CONSIDERATIONS
• Gene-ultimate unit of heredity found in chromosomes
• Chromosomes - exist in pairs, genes tend to occupy certain positions in chromosomes
• Gene that occupies the same site in the partner chromosome is called allelomorphic gene or
allele
• If 2 genes are the same, they are homozygous
• If different, they are heterozygous
• One character of gene = has the ability to manifest their presence. The offspring takes in
characterisitic from either parent.

• Genotype - the sum total of genetic characteristics in an individual only detected through
family studies or molecular tests (DNA-based assays)
• Phenotype - genetic characteristics of an individual which are immediately manifested and
detected by serologic testing/ blood typing (hemagglutination)

Inheritance of the ABO Blood Groups:

• Antigens are inherited in accordance to Mendelian laws and are the result of 3 allelic genes
A, B & O
• Each individual inherits 2, one from each parent
• The O gene does not produce a product and is therefore believed to be amorphic
• A & B genes are co-dominant, O is recessive & not expressed in the presence of either A or
B genes
• AB is always heterozygous
• O is always homozygous
• A & B may either be homozygous or heterozygous

BLOOD GROUPING
• 1. Cell Grouping / Forward Typing or Direct Blood Grouping
• Can be done on a slide or in a test tube at room temperature
• Done by mixing unknown RBC with known typing sera
• Use of commercial reagents, Anti-A (Blue) & anti-B (yellow)
• Ingredients are mixed in a slide with applicator stick and then tilted back and forth &
observed over a 2 minute period for agglutination
• Longer periods of incubation should be avoided because the effects of drying may be
interpreted as agglutination. (Pseudoagglutination)
• 2. Serum Testing / Reverse Testing
• Patient’s serum is tested with suspensions of known group A & B cells
• Done to crosscheck the result of forward typing
• To test the reactivity of anti-A and anti-B typing reagents
Practical Significance of the ABO Blood Group:
• 1. BLOOD TRANSFUSION - to provide maximum benefit to the recepient
• Indications for Transfusion:
• Most common reason is decrease in blood volume
• Often used for treating anemia or to supply recepient with some other constituent of
whole blood besides red cells.

Compatibility Testing or Crossmatching

• Done to prevent transfusion reactions
• A. Major Crossmatch
- recepient’s serum + donor’s RBC
- (to find out whether recepient’s serum has antibodies that would react with donor’s
antigen)
• B. Minor Crossmatch
- recepient’s RBC + donor’s serum
-(detects antibodies in the donor that may be capable of destroying the recepient’s RBC)
• RESULT : presence of agglutination or hemolysis indicates INCOMPATIBILITY

The Agglutination Process in Transfusin Reaction

• When bloods are mismatched so that anti-A or anti-B agglutinis are mixed with RBC
containg A & B agglutinogens respectively.
Red cells agglutinate - cells clump & cause plugging of small blood vessels throughout
the circulatory system
• During the ensuing few hours to few days the phagocyte WBC & RES destroy the
agglutinated cells releasing Hemoglobin into the plasma

Hemolysis in Transfusion Reaction:

• Mismatched recepients & donor bloods - immediate hemolysis of blood occur in the
circulating blood - antibodies cause lysis of RBC by activating the complement system - this
in turn releases proteolytic enzymes that rupture cell membranes
• Immediate intravascular hemolysis is far less common than agglutination, because not only
does there have to be a very high titer of antibodies for this to occur but also a different type
of antibody is required, mainly the IgM antibodies called hemolysins
• However, even agglutination eventually leads to hemolysis because the phagocytic WBC &
the RES rupture the agglutinated cells within a few hours after agglutination has taken
place.

• Transfusion reaction - manifested by fever, chills, nausea, vomitting and general toxicity
• Most lethal effect - acute renal failure

• 2. Provide serological evidence for use in Forensic Medicine:

• A. Paternity Exclusion
• Typing can only prove that the man is not the father, not that he is the father
of the child.
• 1st Law of Inheritance
- Factors A & B can’t be present in a child unless present in 1 or both
parents
 • 2nd Law
- A parent of group AB can’t have a child of group O
• 3rd Law
- A parent of group O can’t have a child of group AB
• B. Blood Stain Determination
• In cases of homicide & other crimes of violence, it is important to determine
the ABO group represented in a blood stain.
• Blood stain on a non-absorbed material (glass,stone,leather) & absorbent
material (cloth)
• Method used for establishing the ABO group is Reverse Typing.
When blood dries, erythrocyte degenerates making direct grouping
impossible. However, the natural blood group antibodies of the ABO
system usually can be detected for considerable periods of time after the
stain has formed.