Bio Lab: RH System

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Bio Lab
Rh System
2nd semester
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RH system
What RH blood group system means .
2- The inheritance of RH- system by two closely linked genes
RHD and RHCE which located on chromosome 1 .
3- The importance of RH- system because RHD antibody of RH-
system can cause disease called Erythroblastosis fetalis .
4- What Erythroblastosis fetalis means and how it is occur in first
and second pregnancy .

RH- System
RH blood types ( Rhesus factor-first discovery in monkys) were discovered in 1940 by Karl
Landsteiner and Alexander Wiener . Like the ABO system , the RH system is defined on the basis of
antigens that are present on erythrocyte surfaces .
Rh factor is a protein found on most peoples RBCs .

Inheritance :
The RH locus is located on the long arm of chromosome 1 . It contains two
closely linked genes RHD and RHCE . ( Table 1 ) . RH D gene codes for a
single protein which contains the RH D antigen

Inheritance of Blood Types

These charts show the possible blood type results for offspring.
Mothers's Type
Blood Type
O A B AB
O O O, A O, B A, B
Fathers' A O, A O, A O, A, B, AB A, B, AB
Type B O, B O, A, B, AB O, B A, B, AB
AB A, B A, B, AB A, B, AB A, B, AB
Mother's Type
Rh Factor
Rh + Rh -
Rh + Rh +, Rh + Rh +, Rh -
Father's Type
Rh - Rh +, Rh - Rh -

Person with the DD or Dd genotype have the RH antigen ( D antigen) on

their erythrocytes and are termed RH-Positive . ( Figure 1) .
The recessive homozygotes , with genotype dd , are RH-Negative and
do not have the RH antigen .
Frequency in population RH Positive 85% , RH_Negative 15% .

Importance of RH system :
1. RH D antigen is the most immunogenic red cell antigen after A and B
antigen .
2. RH D antibody can cause hemolytic transfusion reactions and
hemolytic disease of newborn or erythtoblastosis fetalis .


Unlike the ABO system , in which antibodies normally are formed in

response to antigens presented by other organisms , anti RH antibody
production requires a stimlus by the human RH antigen itself . An RH-
Negative person does not begin to produce anti-RH antibodies unless he or
she is exposed to the RH antigen , usually through an incompatible blood
transfusion or during pregnancy .
Other important antigens in the Rh system are C, c , E , and e . These antigens
are not usually tested for in routine blood typing tests , however , testing for
the presence of these antigens is useful in paternity testing and when a
technologist tries to identify unexpected Rh antibodies or find matching blood
for a person with antibodies to one or more of these antigens .

Blood donors and blood recepients must have compatible blood types .
( Table 1: Blood compatibility chart ) illustrates how people with different blood types can
receive or donate blood . An A- person , for example , can receive either O- or A- , and
can donate to people with AB+ , AB- , A+ or A- blood . An O-person can donate blood to
people with any type , and is termed a Universal donor . An AB+person can receive blood
of any type , and is termed Universal recepient .

Table (1)
RH-Maternal-fetal incompatibility :
Results when an RH-Positive man and RH-Negative women produce

RH-Positive children. Since RH+ father can have either a DD or Dd
genotype , there are 2 mating combination possible .
If the mans genotype is DD , all of their children will be RH-Positive
and will have RH antigens on their erythrocytes . If the man is a
heterozygote , with genotype Dd , half of their children will be
RH-Positive , on average .

RH-Maternal-fetal incompatibility :
RH-Mother RH+father Children

1- dd ( homozygous ) DD Dd Dd all RH+ all at risk
2- dd ( heterozygous ) Dd Dd Dd dd dd . 1 RH+ : 1 RH-
Only the RH+ children ( Dd ) are likely to have medical complications . When
both the mother and her fetus are RH-Negative ( dd ) the birth will be normal .

Erythroblastosis fetalis ( Hemolytic Disease of Newborn HDN)
Type of anemia in which the RBCs of afetus are destroyed in a

maternal immune reaction resulting from ablood group incompatibility
between the fetus and its mother . This incompatibility arises when the
fetus inherits a certain blood factor gene from the father that is absent in
the mother .

In the First Pregnancy with RH Positive child :
This usually isn’t a problem, because very few of the fetus RBCs cross the
placental barrier during pregnancy .
At birth, or after an abortion or miscarrage RH positive RBCs from the baby enter
the mothers blood stream . The mother immune system recognizes the cells as foreign
and develops anti RH+ antibodies against them .

Figure (9)

In Subsequent Pregnancy with RH Positive baby :
There is the risk that it will develop RH disease , anti RH antibodies in mother system
can cross the placenta, bind antigen on RBCs of fetus and fetus RBCs are killed or hemolysis
The resulting anemia may be so profound that the fetus may die in uterus . Reacting to the
anemia, the fetal bone marrow may release Erythroblasts ( immature nucleated RBCs ) into the
fetal peripheral circulation, causing Erythroblastosis fetalis.
In the fetus bilirubin, a breakdown product of RBCs accumulates, damaging the brain
and turning the skin and whites of the eyes yellow, lead to jaundice

Peripheral blood film of fetus with Rh-Hemolytic disease of newborn showing

large numbers of :
Erythroblasts ( immature nucleated red blood cells )
Polychromasia.
Creneated cells.

Symptoms :
1. Newborn jaundice
2. Anemia
3. Heart failure
4. Enlarged Liver and Spleen .
5. Generalized swelling
6. Respiratory distress
7. The infant may be stillborn or die after birth .

Preventing Hemolytic Disease of Newborn (HDN):
RH negative mother is givin injections of anti-RH D antibodies D gamma globulin

called ( Rhogam ) around the 28 th week of pregnancy and again with in 72 hours after
the delivery of the RH Positive baby . This must be done for the first and all subsequent
pregnancies .
The injected antibodies quickly agglutinate any fetal red blood cells as they enter the
mother’s blood before they stimulate production of anti- RH antibodies .

ABO Hemolytic Disease of Newborn : :
ABO incompatibility disease is almost always limited to babies with A or B antigens

whose mothers have type O blood . Approximately one third of these babies show
evidence of the mothers antibodies in their blood stream but only a small percentage
develop symptoms of ABO incompatibility disease .
Group A and group B mothers usually have only IgM ABO antibodies .
The majority of case of ABO HDN are caused by immune IgG antibodies in group O
mothers . ( IgG which cross placenta while IgM cannot cross the placenta ) .
In contrast to Rh HDN , ABO disease may be found in the first pregnancy and may or
may not affect subsequent pregnancies . Examination of the blood film of infants cells
shows auto-agglutination and spherocytosis . Polychromasia and erythroblastosis .

22

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This Document has been modified with Flexcil app (Android) https://www.fexcil.

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Inheritance of Blood Types

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Person with the DD or Dd genotype have the RH antigen ( D antigen) on

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Unlike the ABO system , in which antibodies normally are formed in

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Results when an RH-Positive man and RH-Negative women produce

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

RH-Mother RH+father Children

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Erythroblastosis fetalis ( Hemolytic Disease of Newborn HDN)

Type of anemia in which the RBCs of afetus are destroyed in a

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

In the First Pregnancy with RH Positive child :

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

In Subsequent Pregnancy with RH Positive baby :

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Peripheral blood film of fetus with Rh-Hemolytic disease of newborn showing

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Preventing Hemolytic Disease of Newborn (HDN):

RH negative mother is givin injections of anti-RH D antibodies D gamma globulin

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

ABO Hemolytic Disease of Newborn : :

ABO incompatibility disease is almost always limited to babies with A or B antigens

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

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