Blood Groups & Rhesus System

What are the different blood groups?

The differences in human blood are due to the
presence or absence of certain protein
molecules called antigens and antibodies.

The antigens are located on the surface of the

red blood cells and the antibodies are in the
blood plasma.

Individuals have different types and

combinations of these molecules.
.
• The blood group you belong to depends on
what you have inherited from your parents.

• There are more than 20 genetically

determined blood group systems known
today, but the AB0 and Rh systems are the
most important ones used for blood
transfusions.
• Not all blood groups are compatible with each
other.
• Mixing incompatible blood groups leads to
blood clumping or agglutination, which is
dangerous for individuals.

– Nobel Laureate Karl Landsteiner was

involved in the discovery of both the AB0
and Rh blood groups.
 AB0 blood grouping system

• According to the AB0 blood group system

there are four different kinds of blood
groups: A, B, AB or 0
 Blood group A
• If you belong to the blood group A, you have
A antigens on the surface of your red blood
cells and B antibodies in your blood plasma.
 Blood group B
• If you belong to the blood group B, you have
B antigens on the surface of your red blood
cells and A antibodies in your blood plasma.
 Blood group AB
• If you belong to the blood group AB, you have
both A and B antigens on the surface of your red
blood cells and NO A or B antibodies at all in
your blood plasma.
 Blood group 0
• If you belong to the blood group 0 (null), you
have neither A or B antigens on the surface of
your red blood cells but you have both A and B
antibodies in your blood plasma.
 Rh factor blood grouping system
• Many people also have a so called Rh factor
on the red blood cell's surface.
• This is also an antigen (Antigen D) and those
who have are called Rh+. (D positive)
• Those who haven't are called Rh-( D
negative)
• A person with Rh- blood does not have Rh
antibodies naturally in the blood plasma (as
one can have A or B antibodies, for instance).
• A person with Rh- blood can develop Rh
antibodies in the blood plasma if he or she
receives blood from a person with Rh+ blood,
whose Rh antigens can trigger the production of
Rh antibodies.
• A person with Rh+ blood can receive blood from a
person with Rh- blood without any problems.
 Blood group notation
• According to above blood grouping systems,
you can belong to either of following 8 blood
groups:
• Rh+B (B+) Rh-B (B-)

• Rh+AB (AB+) Rh-AB (AB-)

• Rh+0 (O+) Rh-0 (O-)

• Rh+A (A+) Rh-A (A-)

 Blood typing – how do you find out to
which blood group someone belongs?
• 1.You mix the blood with three different
reagents including either of the three
different antibodies, A, B or Rh antibodies.
• Then you take a look at what has happened. In
which mixtures has agglutination occurred?

• The agglutination indicates that the blood has

reacted with a certain antibody and therefore is
not compatible with blood containing that kind of
antibody.

• If the blood does not agglutinate, it indicates that

the blood does not have the antigens binding the
special antibody in the reagent.
 Effect of blood clumping or agglutination

• For a blood transfusion to be successful, AB0 and

Rh blood groups must be compatible between the
donor blood and the patient blood.

• If they are not, the red blood cells from the

donated blood will clump or agglutinate.

• The agglutinated red cells can clog blood vessels

and stop the circulation of the blood to various
parts of the body.
• The agglutinated red blood cells also
crack/hemolyse and its contents leak out in
the body causing Jaundice

• The red blood cells contain hemoglobin

which becomes toxic when outside the cell.

• This can have fatal consequences for the

patient.
• The A antigen and the A antibodies can bind
to each other in the same way that the B
antigens can bind to the B antibodies.

• This is what would happen if, for instance, a B

blood person receives blood from an A blood
person.

• The red blood cells will be linked together, like

bunches of grapes, by the antibodies.
 Blood transfusions – who can receive
blood from whom?
• Of course you can always give A blood to
persons with blood group A, B blood to a
person with blood group B and so on.

• But in some cases you can receive blood with

another type of blood group, or donate blood
to a person with another kind of blood group.
 Cont.
• The transfusion will work if a person who is
going to receive blood has a blood group that
doesn't have any antibodies against the donor
blood's antigens.

• But if a person who is going to receive blood

has antibodies matching the donor blood's
antigens, the red blood cells in the donated
blood will clump.
• People with blood group 0 Rh - are called
"universal donors" and people with blood
group AB Rh+ are called "universal
receipients."
 The appropriate use of
blood and blood products

1. The appropriate use of blood and blood

products means the transfusion of safe blood
products only to treat a condition leading to
significant morbidity or mortality that cannot
be prevented or managed effectively by other
means.

.
• 2. Transfusion carries the risk of adverse
reactions and transfusion-transmissible
infections.

Plasma can transmit most of the infections

present in whole blood and there are very
few indications for its transfusion.
3. Blood donated by family/replacement donors
carries a higher risks of transfusion-
transmissible infections than blood donated by
voluntary non-remunerated donors.

• Paid blood donors generally have the highest

incidence and prevalence of transfusion-
transmissible infections.
4. Blood should not be transfused unless it has
been obtained from appropriately selected
donors, has been screened for transfusion
transmissible infections and tested for
compatibility between the donor’s red cells
and the antibodies in the patient’s plasma,
in accordance with national requirements
5. The need for transfusion can often be
avoided by:
• The prevention or early diagnosis and
treatment of anaemia and conditions that
cause anaemia
• The correction of anaemia and the
replacement of depleted iron stores before
planned surgery
• The use of simple alternatives to
transfusion, such as intravenous
replacement fluids
 Blood Transfusion hazards

Blood transfusion can be a life-saving

intervention.

• However, like all treatments, it may result in

acute or delayed complications and carries the
risk of transfusion-transmissible infections,
including HIV, hepatitis viruses, syphilis,
malaria parasites and Chagas disease.
• The transfusion of red cell products carries
a risk of serious haemolytic transfusion
reactions especially if incompatible.

• Any blood product can become

contaminated with bacteria and very
dangerous if it is manufactured or stored
incorrectly.
 The safety and effectiveness of transfusion
depend on two key factors:
1.A supply of blood and blood products that
are safe, accessible at reasonable cost and
adequate to meet national needs
2.The appropriate clinical use of blood and
blood products.
• Blood is an expensive, scarce resource.
Unnecessary transfusions may cause a
shortage of blood products for patients in
real need.

• For instance, blood is often unnecessarily

given to raise a patient’s haemoglobin level
before surgery or to allow earlier discharge
from hospital
 Blood safety
• The quality and safety of all blood and blood
products must be assured throughout the process
from the selection of blood donors through to
their administration to the patient. This requires:

• 1. The establishment of a well-organized blood

transfusion service with quality systems in all
areas.
2. The collection of blood only from voluntary
non-remunerated donors , low-risk
populations and rigorous procedures for donor
selection.

3. The screening of all donated blood for

transfusion-transmissible infections.
• 4. Good laboratory practice in all aspects of blood
grouping, compatibility testing, component
preparation, storage and transportation of blood
and blood products.

• 5. A reduction in unnecessary transfusions through

the appropriate clinical use of blood and blood
products, and the use of simple alternatives to
transfusion, wherever possible
 PRINCIPLES OF CLINICAL
TRANSFUSION PRACTICE
 Transfusion is only one part of the patient’s
management.

 Prescribing should be based on national

guidelines on the clinical use of blood, taking
individual patient needs into account.

 Blood loss should be minimized to reduce the

patient’s need for transfusion.
• The clinician should be aware of the risks of
transfusion-transmissible infections in the
blood products that are available for the
individual patient.

• Transfusion should be prescribed only when

the benefits to the patient are likely to
outweigh the risks.
• The patient with acute blood loss should
receive effective resuscitation (intravenous
replacement fluids, oxygen, etc.) while the
need for transfusion is being assessed.

• The patient’s haemoglobin value, although

important, should not be the sole deciding
factor in starting transfusion.
The clinician should record the reason for
transfusion clearly.

A trained person should monitor the

transfused patient and respond immediately if
any adverse effects occur.

This decision should be supported by the need

to relieve clinical signs and symptoms and
prevent significant morbidity or mortality
Blood products and
components
• Blood product -Any therapeutic substance prepared
from human blood

• Whole blood -Unseparated blood collected into an

approved container containing an anticoagulant-
preservative solution

• Blood component (Blood products)

1. A constituent of blood, separated from whole
blood, such as: Red cell concentrate ,Red cell
suspension, Plasma Platelet concentrates
 2. Plasma or platelets collected by apheresis

3. Cryoprecipitate, prepared from fresh frozen

plasma: rich in Factor VIII and fibrinogen

Plasma derivatives- Human plasma proteins

prepared under pharmaceutical manufacturing
conditions, such as:
 Albumin
 Coagulation factor concentrates
 Immunoglobulins
Apheresis: a method of collecting plasma or
platelets directly from the donor, usually by
a mechanical method
 Whole blood
A 500mls whole blood donation contains:

 450 ml donor blood (plasma, and all cells) and 63

ml anticoagulant-preservative solution
Blood Cell Indices
 Haemoglobin approximately 12 g/ml
 Haematocrit 35%–45% (RBC concentration)
 No functional platelets
 No labile coagulation factors (V and VIII)
• Unit of issue for 1 donation, also referred to as a
‘unit’ or ‘pack’ increases Hb by 1g/dl

• Infection risk -Not sterilized, so capable of

transmitting any agent present in cells or
plasma which has not been detected by routine
screening for transfusion-transmissible
infections, including HIV-1 and HIV-2, hepatitis
B and C,
 Storage

 Between +2°C and +6°C in approved blood bank

refrigerator, fitted with a temperature chart and
alarm

 During storage at +2°C and +6°C, changes in

composition occur resulting from red cell
metabolism

 Transfusion should be started within 30 minutes of

removal from refrigerator
 Indications
• Red cell replacement in acute blood loss
with hypovolaemia

• Exchange transfusion

• Patients needing red cell transfusions where

red cell concentrates or suspensions are not
available
 Contraindications
• Risk of volume overload in patients with
Chronic anaemia
• Incipient cardiac failure

Administration
• Must be ABO and RhD compatible with the
recipient
• Never add medication to a unit of blood
• Complete transfusion within 4 hours of
commencement
RED CELL CONCENTRATE (‘Packed red
cells’, ‘plasma-reduced blood’
Description
• 150–200 ml red cells from which most of the
plasma has been removed
• Haemoglobin approximately 20 g/100 ml
(not less than 45 g per unit)
• Haematocrit 55%–75%

• Unit of issue is 1 donation

 Indications
• Replacement of red cells in anaemic
patients
• Use with crystalloid replacement fluids or
colloid solution in acute blood loss
Administration
• Same as whole blood
• To improve transfusion flow, normal saline
(50–100 ml) may be added using a Y-
pattern infusion set
 RED CELL SUSPENSION
• 150–200 ml red cells with minimal residual
plasma to which ±100 ml normal saline,
adenine, glucose, mannitol solution (SAG-M) or
an equivalent red cell nutrient solution has been
added
• Haemoglobin approximately 15 g/100 ml (not
less than 45 g per unit)
• Haematocrit 50%–70%
• Unit of issue 1 donation
• Indications: Same as red cell concentrate

Contraindications
• Not advised for exchange transfusion of
neonates. The additive solution may be
replaced with plasma, 45% albumin or an
isotonic crystalloid solution, such as normal
saline
 PLATELET CONCENTRATES
• Prepared from whole blood donation
• Single donor unit in a volume of 50–60 ml of
plasma .
should contain:
• At least 5.5 x 109 platelets
• <1.2 x 109 red cells
• <0.12 x 109leucocytes
 May be supplied as either:
• Single donor unit: platelets prepared from
one donation or
• Pooled unit: platelets prepared from 4 to 6
donor units ‘pooled’ into one pack to
contain an adult dose of at least 240 x 10 9
platelets
 Storage
• Up to 72 hours at 20°C to 24°C (with
agitation) unless collected in specialized
platelet packs validated for longer storage
periods; do not store at 2°C to 6°C

• Longer storage increases the risk of

bacterial proliferation and septicaemia in
the recipient
 Indications
Treatment of bleeding due to:
 Thrombocytopenia (hereditary or acquired) such
as in bone marrow failure
 Platelet function dysfunction
Prophylaxis in patients with platelet counts
⊱10,000/μL

Contraindications
 Not generally indicated for prophylaxis of
bleeding in surgical patients, unless known to
have significant pre-operative platelet deficiency
(less than 50,000/μL)
 Contraindications
• Idiopathic autoimmune thrombocytopenic
purpura (ITP)
• Thrombotic thrombocytopenic purpura (TTP)
• Untreated disseminated intravascular
coagulation (DIC)
• Thrombocytopenia associated with septicaemia,
until treatment has commenced or in cases of
hypersplenism
• Heparin-induced thrombocytopenia (stop
heparin)
• Hemolytic uremic syndrome (HUS)

• N/B. In case of life-threatening conditions,

platelet transfusions can be done in these
conditions
 Dosage
• 1 unit of platelet concentrate/10 kg body weight:
in a 60 or 70 kg adult, 4–6 single donor units
containing at least 240 x 109 platelets should
raise the platelet count by 20–40 x 109/L

• Increment will be less if there is:

• Splenomegaly
• Disseminated intravascular coagulation
• Septicaemia
 Administration
 After pooling, platelet concentrates should be infused
as soon as possible, generally within 4 hours of
preparation, because of the risk of bacterial
proliferation

 Must not be refrigerated before infusion as this

reduces platelet function

 4–6 units of platelet concentrates (which may be

supplied pooled) should be infused through a fresh
standard blood administration set
• Should be infused over a period of about 30
minutes
• Do not give platelet concentrates prepared
from RhD positive donors to an RhD negative
female with childbearing potential
• Give platelet concentrates that are ABO
compatible, whenever possible
 Complications
• Febrile non-haemolytic and allergic
urticarial reactions are not uncommon,
especially in patients receiving multiple
transfusions
 PLATELET CONCENTRATES (collected
by plateletpheresis)
• Volume 150–300 ml

• Platelet content 150–500 x 109, equivalent to 3–10

single donations

• Platelet content, volume of plasma and leucocyte

contamination depend on the collection procedure
 Dosage
• Unit of issue is1 pack containing platelet
concentrates collected by a cell separator device
from a single donor

• 1 pack of platelet concentrate collected from a single

donor by apheresis is usually equivalent to 1
therapeutic dose.

• Storage/indications and administration same as

platelet concentrate from whole plasma
 FRESH FROZEN PLASMA
• Pack containing the plasma separated from one whole
blood donation within 6 hours of collection and then
rapidly frozen to –25°C or colder
• Contains normal plasma levels of stable clotting
factors, albumin and immunoglobulin
• Factor VIII level at least 70% of normal fresh plasma
level
• Usual volume of pack is 200–300 ml
 Storage
• At –25°C or colder for up to 1 year
• Before use, should be thawed in the blood
bank in water which is between 30°C to
37°C. Higher temperatures will destroy
clotting factors and proteins

• Once thawed, should be stored in a

refrigerator at+2°C to +6°C
 Indications
Replacement of multiple coagulation factor
deficiencies: e.g.
• Liver disease
• Warfarin (anticoagulant) overdose
• Depletion of coagulation factors in patients
receiving large volume transfusions
• Disseminated intravascular coagulation (DIC)
• Thrombotic thrombocytopenic purpura (TTP)