The ABO Blood Group System & Rh Blood Group System

1. __________most important of all blood group in transfusion practice.

2. Only ___________ in which individuals have antibodies in their serum
to antigens that are absent from their RBCs.
3. _________ was the most frequent cause of death in fiscal year
4. FY 2009, there were four reports of fatal hemolytic transfusion reactions due
to _________
5. ____________ is defined as using known sources of
commercial antisera (anti-A, anti-B) to detect antigens on an individual’s RBCs
6. ____________ is defined as detecting ABO antibodies in the
patient’s serum by using known reagent RBCs, namely A1 and B cells.
7. ________ are the most common blood types,
8. ________ is the rarest
9. _________ These antibodies have been described as naturally occurring because they are
produced without any exposure to RBCs.
10. The ABO antibodies are predominantly _____ and they activate complement and react at room
temperature or colder.
11. _______produce strong direct agglutination reactions during ABO testing.
12. The production of ABO antibodies is initiated at ________
13. but titers are generally too low for detection until the individual is ___________
14. most antibodies found in _______ are of maternal origin.
15. Antibody production peaks when an individual is between ___________and declines later in life
16. ABO antibodies can cause ________ if the wrong ABO group is transfused; this can result in the
patient dying
17. _______is more effective at detecting weakly expressed A and B antigens than reagent anti-A or
anti-B.
18. __________ demonstrated that an individual inherits one ABO gene from each parent and that
these two genes determine which ABO antigens are present on the RBC membrane.
19. One position, or locus, on each ________ is occupied by an A, B, or O gene
20. The ________ is considered an amorph
21. _______is an autosomal recessive trait with the inheritance of two O genes that are
nonfunctional.
22. The designations group _______ refer to phenotypes,
23. whereas __________ denote genotypes.
24. The formation of __________results from the interaction of genes at three separate loci (ABO,
Hh, and Se).
25. These genes do not actually code for the production of antigens but rather produce specific
________ that add sugars to a basic precursor substance
26. _____ are formed from the same basic precursor material (called a paragloboside or glycan) to
which sugars are attached in response to specific enzyme transferases elicited by an inherited
gene
27. __________ is actually the precursor structure on which A and B antigens are made.
28. The H and Se genes are closely linked and located on ______
29. In contrast to ABO genes, which are located on ________
30. The _______ are not part of the ABO system; however, their inheritance does influence A and B
antigen expression.
31. ______ they do not produce H substance and therefore the A and B genes cannot be expressed
32. _____ results in rbcs with no H, A or B, antigen (patient type as O)
33. _______ serum has no strong anti- A and anti-B and anti-H
34. ________ must be inherited to form the ABO antigens on the RBCs,
35. and the _______ must be inherited to form the ABO antigens insecretions.
36. The expression of A and B antigens on the RBCs is fully developed by _______ of age and
remains constant throughout life
37. Individuals who are blood group O inherit at least __________ (genotype HH or Hh) __________
38. H gene elicits the production of an enzyme called ________
39. which transfers the sugar L-fucose to an __________ on the terminal galactose of type 2 chains
40. ________is the sugar responsible for H specificity
41. The term ________has been used to refer to the phenotype that lacks normal expression of the
ABH antigens because of the inheritance of the hh genotype.
42. In the formation of blood group A, the A gene (AA or AO) codes for the production
of_____________, which transfers
43. _________ (GalNAc) sugar to the H substance. This sugar is responsible for A specificity (blood
group A
44. Individuals who are blood group B inherit a B gene (BB or BO) that codes for the production of
________
45. Which attaches ______ (Gal) sugar to the H substance previously placed on the type 2 precursor
substance through the action of the H gene.14 This sugar is responsible for B specificity
46. The demonstration of ____ substances in saliva is evidence for the inheritance of an A gene, B
gene, H gene, and Se gene.
47. The term _______ refers only to secretion of A, B, and H soluble antigens in body fluids.
48. ____________ are associated with unexpected reactions in the reverse grouping due to weakly
reacting or missing antibodies.
49. Obtaining the patient’s history may resolve this type of discrepancy, such as a newborn sample
that would not have ABO antibodies in the serum until the child was __________ of age.
50. elderly individual, or the diagnosis indicates ________ , then the best way to resolve this
discrepancy is to enhance the weak or missing reaction in the serum
51. RESOLUTION OF COMMON GROUP 1 DISCREPANCIES
- performed by incubating the patient serum with reagent __________ at room temperature for
approximately _______or by adding one or two drops more plasma or serum to the test.
52. centrifugation, the serum-cell mixtures can be incubated at ______________
53. __________ associated with unexpected reactions in the forward grouping due to weakly
reacting or missing antigens.
54. RESOLUTION OF COMMON GROUP 2 DISCREPANCIES
- The agglutination of weakly reactive antigens with the reagent antisera can be enhanced by
incubating the test mixture at room temperature for up to ____ which will increase the
association of the antibody with the RBC antigen.
55. incubate the text mixture at _________
56. The acquired B antigen arises when bacterial enzymes modify the immunodominant blood
group A sugar (N-acetyl-D-galactosamine) into D-galactosamine, which is sufficiently similar to
the group B sugar (D-galactose) and ______ with anti-B antisera
57. ___________ between forward and reverse groupings are caused by protein or plasma
abnormalities and result in rouleaux formation or pseudoagglutination, attributable to:
58. RESOLUTION OF COMMON GROUP 3 DISCREPANCIES
- Rouleaux is a stacking of erythrocytes that adhere in a_______, giving the appearance of
agglutination.
59. accomplished by washing the patient’s RBCs several times with _______
60. serum is ________ by an equal volume of saline. In trueagglutination, RBC clumping will still
remain after the addition of saline.
61. Cord blood samples received in the laboratory can also pose a problem in ABO testing, since
cord cells may be contaminated with a substance called___________ , which may cause the red
cells to aggregate.
62. Washing cord cells _________ with saline should alleviate spontaneous rouleaux due to
Wharton’s jelly. This substance is a viscous mucopolysaccharide material present on cord blood
cells, and thorough washing should result in an accurate ABO grouping.
63. _________ between forward and reverse groupings are due to miscellaneous problems and
have the following causes:
64. RESOLUTION OF COMMON GROUP 4 DISCREPANCIES
- Potent cold autoantibodies can cause spontaneous agglutination of the patient’s cells. These
cells often yield a positive direct _________
65. To resolve this discrepancy, the patient’s RBCs could be incubated at _______ for a short period,
then washed with saline at 37°C three times and retyped. If this is not successful in resolving the
forward type, the patient’s RBCs can be treated with 0.01 M dithiothreitol (DTT) to disperse
IgM-related agglutination.
66. As for the serum, the reagent RBCs and serum can be warmed to______ , then mixed, tested,
and read at 37°C. The test can be converted to the __________ if necessary.
67. The H gene codes for an enzyme that adds the sugar _____ to the terminal sugar of a _________
68. The precursor substance (proteins and lipids) is formed on an _________ (the basic structure)
69. ____________ are presents the terminal ends of the chains and confer the ABO antigen
specificity

The Rh Blood Group System

1. The term _______ refers to a specific red blood cell (RBC) antigen (D) and to a complex
blood group system currently composed of over 50 different antigenic specificities
2. Rh-specific antigens reside on ________ versus the carbohydrate antigens ABO and Hh
3. _____ is the second most important blood group system in terms of transfusion, as the Rh
system antigens are very immunogenic
4. Once present, they can produce significant ____________ (HDFN) as well as hemolytic
transfusion reactions
5. _______ indicates that an individual’s red blood cells possess one particular Rh antigen, the
D antigen, on their red blood cells.
6. _____ indicates that the red blood cells lack the D antigen.
7. _________ reported on an antibody made by guinea pigs and rabbits when they were
transfused with Rhesus macaque monkey RBCs which agglutinated 85% of human RBCs, was
named Rh after the Rhesus monkey.
8. _________ is a blood group system with many antigens, one of which is D.
9. ______refers to the presence or absence of the D antigen on the red blood cell.
10. The ______ is very immunogenic, ie, individuals exposed to it will very likely make an
antibody to it.
11. 3 different nomenclatures
12. Rh as a primary cause of hemolytic disease of the fetus and newborn (HDFN, also
called______________ ) and a significant cause of hemolytic transfusion reactions.
13. 1940s__________ were investigating antigens found on human RBCs, including the newly
defined Rh antigen. They postulated that the antigens of the system were produced by
three closely linked sets of alleles.
14. Fisher and Race named the antigens of the ____________
15. Now it is known that “d” represents the absence of________ ; however, the term continues
to be utilized with Fisher-Race terminology as a placeholder
16. According to the_________ , each person inherits a set of Rh genes from each parent (i.e.,
one D or d, one C or c, and one E or e)
17. Because ______ were thought to be codominant, each inherited gene expresses its
corresponding antigen on the RBC
18. An individual’s Rh phenotype is reported as_____ rather than CDE because Fisher
postulated that the C/c locus lies between the D/d and E/e loci
19. The person expressing no Rh antigens on the RBC is said to be ______, and the phenotype
may be written as —/—.
20. ______ is designated by the presence or absence of Rh antigens: D, C, c, E, e
21. _________ believed there was one gene responsible for defining Rh that produced an
agglutinogen containing a series of blood factors.
22. According to_______ , this Rh gene produced at least three factors within an agglutinogen.
23. _____ actually represent the presence of a single haplotype composed of three different
antigens : R= D antigen , C= indicated by 1’, E= indicated 2’
24. Genetics and serology
25. Shorthand
26. Presence or absence of a given antigen
27. This system has no genetic basis, nor was it proposed based on a theory of Rh inheritance,
but it simply demonstrates the presence or absence of the antigen on the RBC.
28. Five major antigens
29. Another gene important to Rh antigen expression is RHAG, and it resides on ______
30. _________ RhAG is termed a coexpressor and must be present for successful expression of
the Rh antigens
31. When mutations in the RHAG gene occur, it can result in _____ or significantly altered RhD
and RhCE proteins, affecting antigen expression
32. Termed_____ pseudogene or RHDψ.