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146 PART II Blood Groups and Serologic Testing

SUMMARY CHART
 ABO frequencies: group O, 45%; group A, 40%; group
B, 11%; group AB, 4%.
 ABO blood group system has naturally occurring anti-
bodies that are primarily IgM.
 ABO genes, like those of most other blood groups, are
inherited in a codominant manner.
 ABH-soluble antigens are secreted by tissue cells and
are found in all body secretions. The antigens secreted
depend on the person’s ABO group.
 ABO reverse grouping is omitted from cord blood test-
ing on newborns because their antibody titer levels are
generally too low for detection.
 ABO RBC antigens can be glycolipids, glycoproteins,
or glycosphingolipids; ABO-secreted substances are
glycoproteins.
 L-fucose is the immunodominant sugar responsible for
H specificity.
 N-acetylgalactosamine is the immunodominant sugar
responsible for A specificity.
 D-galactose is the immunodominant sugar responsible
for B specificity.
 The hh genotype is known as the Bombay phenotype,
or Oh, and lacks normal expression of the ABH
antigens.
 Group O persons have the greatest amount of H sub-
stance; group A1B persons contain the least amount of
H substance.
 Approximately 80% of individuals inherit the A gene
phenotype as A1; the remaining 20% phenotype as A2
or weaker subgroups.
 Approximately 1% to 8% of A2 persons produce anti-
A1 in their serum.
 Glycoproteins in secretions are formed on type 1 pre-
cursor chains.
 The ABH antigens on RBCs are formed on type 2 pre-
cursor chains.
 Forward and reverse grouping normally yield strong
(3+ to 4+) reactions.
 Group A persons have anti-B in their serum; group
B persons have anti-A in their serum; group AB per-
sons have neither anti-A nor anti-B in their serum;
group O persons contain both anti-A and anti-B in
their serum.
 Approximately 78% of the random population inherit
the Se gene and are termed secretors; the remaining
22% inherit the se gene and are termed nonsecretors.
 The Se gene codes for the production of
L-fucosyltransferase.

Review Questions 4. The immunodominant sugar responsible for blood group

A specificity is:
1. An ABO type on a patient gives the following reactions: a. L-fucose.
b. N-acetyl-D-galactosamine.
Patient Cells With Patient Serum With c. D-galactose.
Anti-A Anti-B A1 cells B cells d. Uridine diphosphate-N-acetyl-D-galactose.

4+ 4+ Neg Neg 5. What ABH substance(s) would be found in the saliva of

a group B secretor?
What is the patient’s blood type? a. H
a. O b. H and A
b. A c. H and B
c. B d. H, A, and B
d. AB
6. An ABO type on a patient gives the following reactions:
2. The major immunoglobulin class(es) of anti-B in a group
A individual is (are): Patient Cells With Patient Serum With
a. IgM. Anti-A Anti-B Anti-A1 A1 cells B cells
b. IgG.
c. IgM and IgG. 4+ 4+ Neg 2+ Neg
d. IgM and IgA.
The reactions above may be seen in a patient who is:
3. What are the possible ABO phenotypes of the offspring a. A1 with acquired B.
from the mating of a group A to a group B individual? b. A2B with anti-A1.
a. O, A, B c. AB with increased concentrations of protein in the
b. A, B serum.
c. A, B, AB d. AB with an autoantibody.
d. O, A, B, AB
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7. Which of the following ABO blood groups contains the
least amount of H substance?
a. A1B
b. A2
c. B
d. O
8. You are working on a specimen in the laboratory that
you believe to be a Bombay phenotype. Which of the fol-
lowing reactions would you expect to see?
a. Patient’s cells + Ulex europaeus = no agglutination
b. Patient’s cells + Ulex europaeus = agglutination
c. Patient’s serum + group O donor RBCs = no
agglutination
d. Patient’s serum + A1 and B cells = no agglutination
9. An example of a technical error that can result in an
ABO discrepancy is:
a. Acquired B phenomenon.
b. Missing isoagglutinins.
c. Cell suspension that is too heavy.
d. Acriflavine antibodies.
10. An ABO type on a patient gives the following reactions:
Patient Cells
With Patient Serum With
Anti-A Anti-B A1 cells B cells O cells Autocontrol
4+ Neg 2+ 4+ 2+ Neg
These results are most likely due to:
a. ABO alloantibody.
b. Non-ABO alloantibody.
c. Rouleaux.
d. Cold autoantibody.
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