B io Factsheet
September 2001
Number 93
The ABO Blood Group System
By
studying this Factsheet you should gain a knowledge of:
the nature of the ABO blood group system and its importance;
the pattern of inheritance of the ABO blood group system;
a brief historical perspective on ABO groups and transfusion.
Definitions
Antigen: Any substance that when introduced into, or present in, the
tissues or blood causes the formation of antibodies and only reacts
with its specific antibodies.
Blood group: The type or specification of an individuals blood according
to the presence or absence of specific agglutinogens on the red cells.
Blood transfusion: The introduction of blood from one person (the
donor) into the circulation (veins) of another person (the recipient). A
blood transfusion is performed when the recipient has suffered considerable
blood loss, perhaps as a result of serious injury or as a result of surgery.
It is important that the blood of the recipient has compatible blood groups
with the blood of the donor.
Antibody: A protein produced by certain cells of the body in the
presence of a specific antigen. The antibody combines with that antigen
to inhibit, neutralise or destroy it.
Agglutinogen: An antigen located on the surface plasma membrane of
red blood cells (erythrocytes) which determines the blood group of the
individual. Agglutinogens are genetically determined.
Incompatibility: When the agglutinogens on the red cells in the donor
blood react with the agglutinins in the recipients blood. If this happens
then the red cells in the transfusion will agglutinate (clump together). This
may cause serious problems or death if the clumped cells block coronary
vessels to the heart muscle (causing heart attack or cardiac arrest) or if
they block the glomeruli of the kidneys (causing kidney failure), or if they
block cerebral vessels (causing stroke and death of certain brain tissues).
The clumped red cells also swell and rupture, releasing haemoglobin into
the blood; this is called haemolysis.
Agglutinin: A specific antibody in blood plasma capable of causing
the clumping of red blood cells or bacteria or particles such as viruses.
They are sometimes called isoantibodies to distinguish them from
immune antibodies which appear after an immune response. The
agglutinins appear soon after birth and are present in plasma throughout
life.
Agglutination: The clumping together of blood cells or microorganisms,
usually due to an antigen-antibody reaction.
The ABO blood group system
This is based on two agglutinogens referred to as A and B. Individuals whose
erythrocytes develop only agglutinogen A are said to have blood type A.
Those whose erythrocytes develop only agglutinogen B are said to have
blood group B. Some individuals, who have erythrocytes which develop both
agglutinogen A and B, are said to have blood group AB. Those individuals
who manufacture neither agglutinogen are said to have blood group O.
The blood group agglutinins, a and b, are present in the plasma of the
individuals. Blood group A plasma contains agglutinin b, blood group B
plasma contains agglutinin a, blood group AB does not contain either
agglutinin and blood group O contains both agglutinins a and b. Table 1
illustrates the ABO blood group system.
Table 1. The ABO blood group system
Type A
Blood group
A
Type B
AB
Type O
Type AB
neither
Agglutinogen on red blood cell
Agglutinin in plasma
agglutinin b will clump
the B agglutinogen
people from group A
can't receive blood from
B or AB but can receive
blood from A or O
agglutinin a will clump the
A agglutinogen people
from group B can't receive
blood from A or AB but
can receive blood from B
or O
neither
does not contain a or b
agglutinin can receive
blood from A, B, AB and
O
a+b
agglutinin a and b will clump
the A and B agglutinogen
people from group O can't
receive blood from A, AB and
B but can only receive blood
from O
Bio Factsheet
The ABO Blood Group System
People who have type AB blood have neither agglutinin and so have been
called universal recipients since they can receive blood from any of the
ABO groups.
Exam Hint:- Depending on which specification is being followed,
examiners may ask questions testing recall knowledge about the
ABO blood group system or they may set data interpretation questions
relating to the ABO system. It is not unknown for data interpretation
questions to be set on other blood group systems, such as the Rhesus
system and the MNO system. To answer these, the student should
remember that the biological principles governing the ABO system
and other blood group systems are similar. Some specifications
require candidates to develop historical perspectives of the subject,
but these will probably only be relevant in essay type answers.
The term universal means in all possible circumstances and so these
terms have fallen into disuse because they take no account of other blood
groups, such as the rhesus groups, which must be considered before
transfusion.
Fig 1 illustrates how incompatible red cells and plasma agglutinins clump
together.
Fig 1. Agglutinated (clumped) red cells
Students sometimes ask the question why do some people carry natural
antibodies against another persons red cell antigens? The answer lies in
the fact that the antigenic substances A and B are not confined to human
cells but occur in many other organisms, including gut-dwelling bacteria and
other bacteria that the body encounters. People are thus continually exposed
to these antigens during everyday life and so develop antibodies against
them when they are foreign to the body, or do not produce the antibodies
when they are not foreign. For instance, people who contain the A antigen
on their cell membranes will not produce a antibody when they come into
contact with bacterial A antigen. They will however, develop b antigen if
they come into contact with bacterial B antigen, since this is recognised as foreign.
agglutinogen on
red cell surface
binds with
specific
agglutinin
in plasma
Blood transfusion
Blood transfusion has been attempted many times during history, either as
experimental transfusions between mammals of the same or different species,
or between humans in an attempt to save life. Samuel Pepys (1633 1703),
in his famous diary, described several transfusions that he had witnessed.
Such transfusions were risky and usually resulted in the death of the
recipient.
red blood cells
bound together
Before blood is transfused , even if donor and recipient groups are known,
it must be tested against the recipients blood to ensure that no unforeseen
factors are causing agglutination. A drop of the recipients serum can be
placed on a slide and mixed with a drop of the donor blood if it remains
clear then there is no agglutination. If it becomes granular then the cells
have been agglutinated.
Landois (1875) discovered that when the red cells of an animal, for example,
a lamb, were mixed with the serum of another animal, for example, a dog,
and incubated at 37oC they were haemolysed within 2 minutes.
Exam Hint :- Students frequently become confused and write that the
agglutinins in the donated blood plasma will agglutinate the recipients
red cells. This does not happen because these agglutinins become
greatly diluted when the donated blood is transfused into the much
larger blood volume of the recipient.
The ABO blood group system was the first system to be discovered, by
the German immunologist Dr Carl Landsteiner in 1901. He was fortunate
because his laboratory staff expressed all four blood groups, so that when
he mixed red cells from each of his staff with serum from each of his staff
he was able to determine all four groups.
Samples of blood can be typed by testing them, by mixing single drops of
blood with drops of known antisera on glass slides to establish whether
agglutination occurs or not. A knowledge of blood types can be important
in linking suspects to crimes, in disproving paternity and as part of
anthropological studies to establish a relationship between races.
Remember:- Serum is the fluid left after blood has clotted. It is the same
as plasma but without the clotting proteins, such as fibrinogen
Inheritance of the ABO blood groups
The agglutinins (antigens) are an integral part of the red cell membrane and
of plasma membranes of all cells of the body. The multiple allele gene
regulating the development of these antigens possesses three alleles,
designated IA, IB and IO. IA and IB are co-dominant and both cause the
development of their antigen (A or B). The allele IO does not produce any
recognisable effect and can be considered to be recessive. Any individual
will contain two of these alleles on corresponding loci on a pair of
homologous chromosomes. The individual may be homozygous (both alleles
the same) or heterozygous (has dissimilar alleles). There are thus six possible
genotypes which govern the development of the four ABO blood types.
These are shown in Table 2.
Once Landsteiner had discovered the ABO system it was possible to
perform blood transfusion with a greater degree of success, but transfusions
had to be direct from person to person. During the First World War (1914
1918) the use of blood anticoagulants such as citrate was discovered. This
meant that bloods could then be stored without clotting, and so regular
indirect transfusion became possible.
When transfusion is performed it is important that the recipient plasma
agglutinins do not clump and haemolyse the red cells in the donation. The
compatible transfusions are:
type A blood contains b agglutinin and so can receive only types A
and O blood.
type B blood contains a agglutinin and so can receive only types B
and O blood.
type AB blood does not contain a or b agglutinin and so can receive
types A, B, AB and O blood.
type O blood contains both agglutinins a and b and so can only
receive O blood.
Table 2. The inheritance of ABO blood groups.
Blood group
Type A
Type B
Note that type O blood contains neither A or B cells and so can be transfused
into any person. For this reason, people who are group O have been called
universal donors.
Type AB
Type O
Possible genotypes % Frequency in British
population
IAIA, IAIO
B B
B O
II, II
A B
I I
O
I I
42
9
3
46
Bio Factsheet
The ABO Blood Group System
The frequencies of ABO groups vary in different populations around the
world, for reasons that are not clear. Group B has a high frequency in the
indigenous populations of Central Asia but has a lower frequency in Europe.
3. A husband, who is blood group A, suspects that his wifes third child
has been fathered by another man. His own first two children possess
blood groups O and AB. The third, suspect child, is blood group B.
Are the husbands suspicions justified? Explain your answer.
4
Exam Hint:- use the accepted symbols for the three alleles, these are
IA, IB and IO. If asked to show a genetic cross, then label the parents,
gametes and offspring clearly.
Answers
1.
The following genetic cross shows the possible results of crossing a
heterozygous group A individual with a heterozygous group B person:
Parents
Group A
IA
Offspring
Possible alleles available
Parent 1
Parent 2
Impossible phenotypes in
offspring blood groups
Group B
IAIO
Gametes
Blood
group
cross
IB I O
IB
IO
IO
AxA
IA, IO
IA, IO
B, AB;
AB x B
IA,IB
IB,IO
O;
AB x O
IA,IB
IO
AB,O;
IA IO
I BI O
I AI B
IOIO
AxB
IA,O
IB,IO
none impossible;
group
A
group
B
group
AB
group
O
OxO
IO
IO
A,B,AB;
5
There is a 1 in 4 chance of a particular blood group appearing in the offspring.
2. (a)
Practice Questions
1. The multiple allele inheritance system of the ABO blood group system
contains the codominant alleles IA and IB and the recessive allele IO. The
table below shows possible crosses between people of certain ABO
groups, the alleles they can contribute and the phenotypes of offspring
which could not be produced as a result of this cross. Complete the
table by writing in the alleles and blood group phenotypes in the
empty boxes.
Genotype
Agglutinogen
Blood group/phenotype
MM
M;
NN
N;
MN
M+N
MN;
3
Blood
group
cross
Possible alleles available
Parent 1
Parent 2
Impossible phenotypes in
offspring blood groups
(b) (i) there would be no adverse effect/no agglutination;
because there are no related antibodies in the plasma;
AxA
(ii) the immune system of the body may have become sensitised
to the foreign red (M or N) cells;
thus, with the second transfusion, agglutination could occur;
2
AB x B
AB x O
3. both parents must contain an IO allele because they have a child with
group O/genotype OO;
one parent must contain an IA allele and one parent a IB allele since they
have a child with group AB/genotype AB;
father is blood group A and so must have genotype IAIO;
mother must have genotype IBIO and so could bear a child of group B/
genotype IBIO,
the IB allele coming from the mother and the IO allele from the father;
thus the fathers suspicions are not justified (no mark)
max 4
AxB
OxO
5
2. In the MN blood group system the two codominant alleles are called
M and N. M regulates the production of agglutinogen M and N regulates
the production of agglutinogen N. These are on the red cell surfaces.
No related antibodies occur in the plasma in this blood group system.
(a) Complete the following table to show the genotypes, agglutinogens
and phenotypes of the three possible MN blood groups.
Genotype
Agglutinogen
Blood group/phenotype
Acknowledgements:
This Factsheet was researched and written by Martin Griffin
Curriculum Press, Unit 305B, The Big Peg, 120 Vyse Street, Birmingham. B18 6NF
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ISSN 1351-5136
3
(b) (i) If blood of one of these groups was transfused into a person
with another of these groups, what, if anything would happen?
Explain your answer.
2
(ii) If the same transfusion was repeated a few months later, what,
if anything would happen? Explain your answer.
2
