Blood Groups

Blood Groups
 Discovered by Landsteiner
 Awarded Nobel Prize

 Blood group Systems

ABO System Rh System

Other Systems:
Lewis System MN system
Luthern System
 Agglutinogens
 Refers to Antigens present on the cell
membrane of RBC
 A & B – are complex oligosaccharides
 Also present in saliva, gastric juice, etc
(Secretors)
 Agglutinogens 1st appear during the 6th
wk of life
 Agglutinins
 Refers to antibodies against
agglutinogens Anti A() & Anti B()
 present in the plasma
 are globulins of IgM type
 cannot cross the placenta
 concentration at birth is nil
 begins to form within few months after
birth
 Blood Grouping System
 Depending upon the type of agglutinogen present
or absent on the RBC
 Major Blood Group system
 Classical ABO blood grouping & Rh blood

grouping
 Minor Blood Group system
 MNS blood group system & P blood group

 Familial Blood group system

Kell, Duffy, Lutheran, Lewis, Deigo, Kidd, etc

 Landsteiner’s Law
 If an agglutinogen is present on the
RBC, corresponding agglutinin will be
absent
 If the agglutinogen is absent

corresponding Agglutinin will be present

Exception to the 2nd part is Rh System -
Rh-ve people will not have Rh
Antibodies
 Blood Group Agglutinogen and
Agglutinin
Blood group Ag Ab
A A B
B B A
AB A, B NIL
O NIL A, B
Blood Group Agglutinogen and
Agglutinin
 Determination of blood groups
Agglutination No Agglutination
Blood group Antisera A Antisera B

A Agglutination NIL

B NIL Agglutination

AB Agglutination Agglutination
O NIL NIL
Inheritance of ABO Blood
Group
 Genetically inherited as Mendelian
dominant pattern

Blood group Genotype

A AA, AO
B BB, BO
AB AB
O OO
 BLOOD GROUP - INHERITENCE
♀ ♂
A B
AO BO
Offspring AB AO BO OO
Bld Group AB A B O
 Rh Blood Group
 Discovered by Landsteiner & Weiner (1940)
 RBC of Rhesus Monkey –injected into Rabbit –
Rabbit forms antibody - which causes
Agglutination of Rhesus RBC
 Rabbit Serum – Human RBC – Agglutination –
Rh + (85%)
 No agglutination occurs in 15% and these are
called Rh-ve (negative)
 Rh antigen
 The Rh Antigens are C,D,E
 D antigen more antigenic
 No naturally occurring antibodies
(does not obey 2nd part of
Landsteiner’s law)
 Not found in other tissues except RBC
 Rh antibody – Anti D
 The antibodies belong to IgG type
(ABO system antibodies belong to IgM type)
 Can cross the placenta

 Rh-ve persons develop antibodies only when

they are exposed to

 Rh+ve blood by transfusion or

 By entry of Rh+ve blood from a Rh+ve fetus

INHERITANCE OF Rh Antigen
 Inherited as dominant gene D
 Rh + ve - DD or Dd
 Rh – ve - dd
 Rh + ve - 85%
 Rh – ve - 15%
 Haemolytic Disease of
New born
 As a result of Rh incompatibility between
mother and fetus
 Because Rh antibody are IgG type - can
cross the placental barrier
 Seen when Mother is Rh -ve,
Father is Rh +ve
Developing fetus is Rh+ve
 Mechanism of HDN
 Entry of Rh+ve fetal RBC into Rh – ve mother’s
circulation during first pregnancy at the time of
labor
 Production of Rh antibodies by Mother. Once
formed Rh antibodies persist for a long period
 During 2nd pregnancy – Rh antibody from
mother enters the Rh –ve fetal circulation- Fetal
RBC agglutination - Rh incompatibility reaction
during 2nd pregnancy
Manifestations of HDN
 Erythroblastosis fetalis
 Icterus gravis neonatorum
 Kernicterus
 Hydrops fetalis
 Erythroblastosis fetalis
In the new born the following are seen
 Appearance of large number of blast cells

in periphery
 Attempts to rapidly replace the hemolysed

RBC
 Liver & Spleen are enlarged

 Anaemia occurs due to excessive

haemolysis of RBC
Icterus gravis neonatorum
 Jaundice may occur within 24 hours of
birth - & it is fatal
 Due to excessive destruction of RBC
 Liver & Spleen are enlarged
Kernicterus
 Neurological syndrome
 BBB poorly developed – excessive
bilirubin enter brain tissue
 Affects basal ganglia
 Causes disturbance of motor activities
Hydrops fetalis
 Fetus is grossly edematous
 Occurs when haemolysis is very severe
 If it occurs – infant dies within a few
hours
 Or death of fetus in-utero
 Prevention
 Proper counseling before marriage between Rh –
ve lady and Rh + ve male
 Immediately after 1st delivery –injection of Rh
antibody (anti D) to mother
 These antibody will destroy Rh+ve cells which
entered from fetus into the mother
 This prevents mother from producing active
antibodies (anti D)
 Treatment
 Replacement of Rh+ve blood of the
new born with Rh-ve blood
 Baby’s blood is removed slowly from
IVC and replaced by equal amount of
Rh-ve blood
 Exchange transfusion
 ABO incompatibility
 ABO incompatibility rarely produce
hemolytic disease of newborn
 Anti A & Anti B antibodies are of

IgM - Cannot cross the placenta

 Uses of Blood Grouping
 In Blood Transfusion
 In Pregnancy
 In Disputed Paternity
 In Medico legal cases
 Susceptibility to diseases
 O Group -Duodenal Ulcer

 A Group -Carcinoma of Stomach,

Pancreas, Salivary gland, Diabetes mellitus

 In Disputed Paternity
 It is possible to prove that a person
could not have been the father, but
not that he is/was the father
 If the child is AB group the father

cannot be O group (Irrespective of

Mother’s group) and vice versa
BLOOD TRANSFUSION
Animal to Human Transfusion

Early lamb blood transfusion

 Indications for blood
transfusion
 To restore Blood volume
Hemorrhage, Surgery
 To improve O2 carrying capacity
Anaemia, CO Poisoning
 To correct Bleeding Disorder
Hemophilia
 Exchange Transfusion-Rh Incompatibility
 Criteria for Donor
 Age - 18-60 yrs
 Hb & PCV within normal limits
 Should be free from AIDS, Syphilis,
Jaundice, Hepatitis, etc
 Should not be pregnant/lactating
 Frequency-Once in 6 months
 Donor & Recipient
 Universal Donor O group persons have no
agglutinogen and so can be given to anyone.
 Universal Recipient AB group persons have no
agglutinins and so can receive any type of blood

 The above are no longer valid as complications can

be produced by Rh and other sub groups.
 In case of extreme emergency O-ve blood should
be used
 Compatibility between Blood
groups
Donor’s Recipient’s Group (Antibody)
Group A B AB O
(Antigen) (AntiB) (AntiA) (Nil) (Anti A
& Anti
B)
O    

A  X  X
B X   X
 Precautions to be observed
during blood transfusion
 Absolute indication
 Cross matching should be done
 Rh+ blood should never be transfused to Rh-
person
 Donor’s blood should always be screened for
diseases
 Blood transfusion - at slow rate
 Careful watch on recipient’s condition (10-15
min) after starting transfusion
 Proper aseptic measures
 Cross matching
 Major cross matching
Recipient’s Serum + Donor’s Cell
Plasma agglutinin of Donor gets diluted in
Recipient’s Plasma
 Minor Cross matching

(Done during multiple transfusions)

Recipient’s Cell + Donor’s Serum
 Types of Transfusion
 Autologous Transfusion Patient’s own blood is
withdrawn 3-4 weeks before any elective surgery
and can be reinfused during surgery.
 Blood Substitutes can be Transfused
Plasma, Colloids (Dextran), Crystalloids (Glucose,
saline)
 Blood Component Can be Transfused
 Packed cell (RBC) - Anaemia
 Platelet concentrate –Thrombocytopenia
 WBC - Infection
 Clotting factor - Hemophilia
 Advantages of blood
component transfusion
 Can be given to a number of people
 Avoid circulatory overload
 Donor need not loose all components
 Can be stored for a long time
 Easy Transportation
Plastic Blood Bags and Component Separation
 Blood Storage
 One unit = 450ml of blood
 Stored at 4°C for 4 weeks
 Preservatives used:
 Acid-citrate-dextrose (ACD Solution)

 Citrate-Phosphate-Dextrose-Adenine

(CPD-A Solution)
 ACD mixture
 450ml blood + 120 ml ACD mixture
 ACD Mixture ( in 100 ml distilled water)
 Acid citrate – 0.45g

 Tri sodium citrate – 1.32 g - anticoagulant

 Dextrose – 1.47 g - For energy &

Maintaining Na-K pump
 Effect of storage on blood
cells
 Cold storage decreases cell metabolism
 Decreases active transport of ions
 Cell loses K+, Plasma K+ Increases
 So transfusion of stored blood can lead to
the death of the patient due to
hyperkalemia
 Blood stored for more than 24 hrs contain
no viable WBC and platelet
 Mismatched transfusion
reactions
 Agglutination of Donor’s RBC in recipient
circulation
 Tissue Ischaemia (in lungs, heart, etc)
 Haemolysis – Haemolytic Jaundice
 Renal vasoconstriction
 Haemoglobinuria- Renal tubular damage –
Acute Renal Shut down- uraemia
 Circulatory shock
 Hazards of (Matched) blood
transfusion
Circulatory Over load Transmission of blood-
 Hypervolemia due borne infections
 AIDS, Viral hepatitis,
to rapid transfusion
 Rate of transfusion Malaria, Syphilis
1ml/Kg body wt/hr
 Hazards of (Matched) blood
transfusion
Allergic reactions Pyrogenic reaction
 Skin rashes &  Fever and chills

Asthma  ??Due to destruction of

leucocytes and
platelets
 Hazards of (Matched) blood
transfusion
Hyperkalaemia Hypocalcaemia
 May occur after  Produces Tetany

excessive  Because citrate

transfusion cannot be
 Due to leakage of metabolized fully (in
K+ from RBC into rapid transfusion)
plasma
 Hazards of (Matched) blood
transfusion
Haemosiderosis Thrombophlebitis
 Due to iron  At the site of

overload venepuncture
 Excessive iron

deposited in liver,
Air embolism
heart & endocrine
 Entry of air into
organs – produces
damage blood
 Hazards of Blood transfusion
 Mismatched transfusion reactions
 Matched transfusion reactions
 Circulatory over load

 Transmission of blood borne infections

 Pyrogenic reaction & Allergic reactions

 Hyperkalaemia & Hypocalcaemia

 Haemosiderosis

 Thrombophlebitis

 Air embolism
 Rh Incompatibility
 Rh –ve blood given to a Rh + ve person –
takes 2-4 months for antibodies to develop.
By this time donor’s RBCs would have been
destroyed.
 But when 2nd time Rh +ve blood is transfused
–severe reactions occur
 In a girl – during pregnancy incompatibility
leads to ERYTHROBLASTOSIS FOETALIS
 Sample Questions
 What are the various blood group system, how
are they identified/established. Add a note on
uses of blood grouping.
 Hemolytic disease of the new born
 Erythroblastosis Foetalis
 Indications fro blood transfusion
 Hazards of blood transfusion
 Cross matching
 Landsteiner’s law