Blood Groups

2nd Year MBBS

2020
 Blood Group

• Knowledge
•  List the different types of the human blood grouping
•  Define the O-A-B Blood Types
•  Describe the Rhesus (Rh) Antigen system and Rh Incompatibility
•  Define blood transfusion, indications, blood products, incompatibility
and complications
• Skills
•  Explain the clinical importance of blood grouping and Rh

Refrences
• Textbook of Medical Physiology, Guyton & Hall, 13th edition ) C H A P T E R 3 6, PAGE 455)
• Ganong’s Review of Medical Physiology, 24th edition C H A P T E R 3 1, PAGE 560)
 Blood groups, Blood typing
and blood transfusion
• Experiments with blood transfusions, the
transfer of blood or blood components into
a person's blood stream, have been carried
out for hundreds of years

• Many patients have died and it was not until

1901, when the Austrian Karl Landsteiner
discovered human blood groups, that blood
transfusions became safer

• He discovered the ABO Blood Group System

in 1901, For this discovery he was awarded
the Nobel Prize in 1930.
 Landsteiner’s law
• ABO system based on
• Ag =Agglutinogens
• Ab=Agglutinins
• Reaction between Ag and Ab =Agglutination

• If an antigen is present on the surface of RBC, the corresponding

antibody is absent in Plasma.
• Conversely ,if an antigen is absent , the corresponding antibody is
present in Plasma.
• The law holds good for the ABO system but not for the Rh system.
O-A-B Blood Types Blood Types
AA or AO = Type A
There are 3 alleles or genes for blood BB or BO = Type B
type: type A, B, & O genes.there are 6 OO = Type O
possible combinations. genotypes, AB = Type AB

http://learn.genetics.utah.edu/units/basics/blood/types.cfm
ABO blood group antigens present on red blood cells
and IgM antibodies present in the serum
What do co-dominant genes mean?
6 Possible Blood group Genotypes

Parent A-dominat B-dominant O-recessive

Allele

A AA AB AO

B AB BB BO

O AO BO OO
 Why do we have Anti-A or Anti-B
Antibodies???
•They are not present in the newborn
•They develop in the first years of life

•Exposure to plant, bacterial, viral antigens provokes this response

•Viruses transmitted from respiratory tracts of humans to other

humans drag along various antigens including ABO blood group
antigens. This Prime the newborn’s immune system.

•The "A“ and "B" antigens are also produced by some other plants
and microorganisms. Thus, individuals who do not recognize one
or more of these antigens as "self" will produce antibodies against
the plant or microbial antigens.
 Unique to the
ABO blood
groups is the of
Determination
presence
blood in
groups
the plasma of
preformed
antibodies
called
agglutinins.
Slide technique

Appear within
2 months and
reach peak
levels between
8-10 years of
age.
 Average Percents…
• Type O—46%
• Type A—40%
• Type B—10%
• Type AB—4%
 The Rhesus (Rh) Antigen System

•This is a system of Ag normally present in Rhesus monkeys RBCs

in which they were first discovered.

•There are 6 variaties , Antigen D has the strongest antigenic effect

•RBCs that are "Rh positive" express the antigen designated D

•85% of population are Rh(or D) +ve & 15% are Rh(or D) -ve , If it
is present, the blood is RhD, if not it's RhD negative.

•Rh antigens are transmembrane proteins with loops exposed at the

surface of red blood cells.

•They appear to be used for the transport of carbon dioxide and/or

ammonia across the plasma membrane.
 Rh Blood Group and Rh Incompatibility
A person with Rh- blood does not have Rh
antibodies naturally in the blood plasma
•Production of D-Antibodies in the Rh –ve recipient requires
previous exposure to the D antigen (in utero or by transfusion)

Blood Alleles
Genotype
Type Produced

RR R
Rh positive
Rr R or r

Rh negative rr r
 Allo-immune hemolytic
anemia
1. Incompatible ABO blood transfusion

Donor Blood Recipient

Goup A Group O

(cells contain A antigen) (cells contain neither A or B antigen)

Plasma contains Anti-A and Anti-B
(iso-antibody)

Agglutination
Hemolysis
 Allo-immune hemolytic
anemia
2. Incompatibilities with in the Rh blood group system
Incompatible blood transfusion

DONOR RECIPIENT

(not previously transfused or pregnant)

Rh +ve Rh-ve (i.e. RBC’s do not contain Rh antigen)
(RBC’s contain Rh antigen) Plasma contains no Rh antibodies
\ NO agglutination
to macrophage system for degradation
in usual way but Rh+ve cells
Later (months, years) act as foreign antigens
Transfusion
of Rh +ve blood Formation of
anti-Rh antibodies stimulated
Agglutination
and hemolysis
 Allo-immune hemolytic
anemia
2. Incompatibilities with in the Rh blood group system
Hemolytic Disease of the New born (HDN)

First Pregnancy Rh+ve fetus in Rh-ve mother-no antibodies present.

\Healthy Baby

Gradual elimination
Rh+ve
fetal rbc’s
by macrophage system
into mother
Fetal circulation (Rh-ve)
Iso-immunisation

Placenta maternal
blood sinus Anti-Rh antibodies
Damaged formed (IgG type)
Uterus Maternal chorionic villus Trophoblast
circulation
 Allo-immune hemolytic
anemia
2. Incompatibilities with in the Rh blood group system
Hemolytic Disease of the New born (HDN)

Subsequent pregnancies

Uterus Maternal anti-Rh antibodies IgG type

Placenta

Pass placental barrier

Enter fetal circulation and destroy fetal red cells

(agglutination and hemolysis)
 Hemolytic Disease of Newborns (HDN)
or Erythroblastosis Fetalis
• Father--Rh+ve blood
• Mother is Rh–ve
• Child could be Rh +ve.
• 1st pregnancy--if the baby is Rh +ve, then there are no complications.
• However, the mother will start to develop antibodies against the Rh
factor
• Second pregnancy, if the child is Rh +ve, the mother’s antibodies can
cross the placenta and start to attack the fetus’ blood cells, causing
hemolysis.
• Hemolysis--breakdown of RBC and the release of hemoglobin into the
plasma which can damage organs.
• This is called erythroblastosis fetalis, can cause severe anemia, jaundice
possibly death.
Prevention of Erythroblastosis Fetalis
– anti-D antibody is also administered to Rh-negative women
who deliver Rh-positive babies to
– Injection of anti-Rh antibodies given soon after every
delivery, abortion also anti-D antibody is administered to
starting at 28 to 30 weeks of gestation.
– prevent sensitization of the mothers to the D antigen &
inactivates fetal Rh antigens so mother’s immune system
doesn’t respond
 Importance of Determination of Blood
Groups

1. In blood Transfusion (avoid incompatibility)

2. In Marriage ( avoid erthroblastosis fetalis)
3. Medicolegal importance
– In cases of disputed paternity: to exclude paternity
but not prove it,
– Other tests for proving paternity: determination of
HLA (human leukocyte antigen)& DNA examination
 What is blood transfusion?
A blood transfusion is the infusion of whole blood or a blood
component such as plasma, red blood cells, or platelets into
the patients venous circulation.
Purpose of blood Transfution therapy
To restore intravascular volume with
whole blood or albumin.

To restore the oxygen capacity of

blood by replacing red blood cells.

To replace clotting factor and

correction of anemia
 What is blood transfusion?
A blood transfusion is the infusion of whole blood or a blood
component such as plasma, red blood cells, or platelets into
the patients venous circulation.
Indications of blood Transfution therapy
- Hemorrhage more than 20% loss
- severe anemia
- hemophilia
- thrompocytopenias, purpura
- leukopenia
- erthroblastosis fetalis
- hypoproteinaemia
- leukemia
- severe infections-gamma globulins
Blood Products and Blood Typing
 Blood Transfusions
•People with TYPE O blood are called
Universal Donors, contain no RBC Ag.
Universal Donor

•People with TYPE AB blood are called O

Universal Recipients, contain no plasma AB

•It is essential that the recipient’s plasma A B

should not contain AB against donor’s RBC
Ag; the AB of the plasma donor has no effect
on recipient RBCs as it will be diluted much
with recipient plasma. AB
Rh +  Can receive Rh +ve or –ve Universal Recipient
Rh -  Can only receive Rh -ve
 CROSS MATCHING TESTS

• Simple pretransfusion compatibility test

• The red cells and the plasma of the donor and recipient
blood are separated by centrifugation.
• Major side cross match: donor red cell are then treated
with recipient plasma.
• Minor side cross match or double cross matching: the
donor plasma is tested against the red cells of the
recipient.
Complications of Blood Transfusion

1. Incompatibility
2. Anaphylactic Reaction
3. Infection
1. Bacterial
2. Viral Hepatitis & AIDS
4. Circulatory overload & hyperkalemia in
massive blood transfusion
 Incompatible blood
transfusion
1. Hemolytic jaundice
1. Acute Hemolytic Transfusion Reactions
2. Delayed Hemolytic and Serologic Transfusion Reactions
2. Severe pain-block of capillaries by agglutinated clumps
3. Chest pain & dyspnea (Transfusion-Related Acute Lung
Injury)
4. Fever, chills (Febrile Nonhemolytic Transfusion Reaction
5. Hypotension-generalised vasodilatation-histamine
6. Hyperkalemia
7. Acute Renal failure
8. Allergic Reactions-Anaphylactic Reaction
9. Posttransfusion Purpura
 Red blood cell compatibility table

Recipient Donor
O- O+ A- A+ B- B+ AB- AB+
O-   
O+      
A-      
A+            
B-      
B+            
AB-            
AB+                        
 BLOOD PRODUCTS AND SUBSTITUTES
• Packed RBC
• Platelet concentrate
• WBC concentrate
• Fresh frozen Plasma
• Freeze Dried Plasma
• Albumin
• Immunoglobulins
• Plasma substitutes