Blood Groups and Blood

Transfusion

Dr.Ahmed Alsabih
 Objectives;
Intended learning outcomes (ILOs)
After reviewing the PowerPoint presentation and the associated
learning resources, the student should be able to:
❑ Describe the ABO and Rhesus blood group systems
❑ Recognize agglutinins in the plasma
❑ Describe grouping, cross-matching & typing with anti-sera
❑ List precautions taken in preparing blood for transfusion and
storage of blood
❑ Define autologous transfusion and list its advantages
❑ Describe transfusion reactions.
❑ Define hemolytic disease of newborn, describe its pathophysiology
and outline its prevention
 Learning Resources

Guyton and Hall, Textbook of Medical

Physiology; 13th Edition; Unit VI-Chapter
36.
 Blood Typing
❑ RBC surfaces are marked by genetically determined antigens
- Agglutinogens or isoantigens

❑ Blood is typed (grouped) based on surface antigens

❑ At least 30 common antigens and 100s of rare antigens have been

found on the surfaces of human blood cells
❑ The ABO and Rhesus (Rh) systems of antigens are of major clinical
importance as they are associated with transfusion reactions
when mismatched
❑ Other antigens are less likely to cause reactions; however, they
are of forensic importance (establish parentage).
 Karl Landsteiner
❑ 1901: was the first to discover
the ABO blood agglutinins &
classified blood groups
accordingly.

❑ 1930: awarded the Nobel

Prize in Physiology & Medicine
for his discovery

❑ 1937: With Alexander S.

Wiener, he identified the Rh
factor.
 Blood Typing
ABO blood group:

A and B antigens are found in:

- Most cells: RBCs, WBCs and platelets
- In secretions: saliva, sweat, semen
- They are glycoproteins, complex oligosaccharides that
differ in their terminal sugar

• RBCs with A antigen = Type A blood

• RBCs with B antigen = Type B blood
• RBCs with neither antigens = Type O blood
• RBCs with both antigens = Type AB blood

• Detection of A and B antigens in dried blood stains is of

forensic importance
 ABO Blood Group Frequency

Blood group % Distribution

O 47%
A 41%
B 9%
AB 3%

Frequency of ABO has ethnic variation

 Genetic Determination of ABO Antigens
Genotypes Blood Types Agglutinogens
OO O -
OA or AA A A
OB or BB B B
AB AB A and B

❑ Two genes (one maternal and one paternal in origin), one on each of the two paired chromosomes
number 9, determine the O-A-B blood type.
❑ These genes can be any one of three types but only one type on each of the two chromosomes
number 9: type O, type A, or type B.
❑ The type O gene is either functionless or almost functionless, so that it causes no significant type O
agglutinogen on the cells. Conversely, the type A and type B genes do cause strong agglutinogens on
the cells.
❑ The type A and type B genes are co-dominant. This meant that if a person inherited one type A gene
and one type B gene, their red cells would possess both the A and B antigens
 ABO Blood Group Inheritance

Mother/Father OO AA, AO BB, BO AB

OO O O, A O, B A, B

AA, AO O, A O, A O, A, B, AB A, B, AB

BB, BO O, B O, A, B, AB O, B A, B, AB

AB A, B A, B, AB A, B, AB A, B, AB
 The Question of Paternity
❑ Blood types cannot be used to prove paternity.
❑ Blood types can disprove paternity.
❑ Noura blood (type A) and Fahad blood (type B) Have a baby (blood
type O) Can Fahad be the father?
Phenotype Possible
Genotype

Noura: A AA or AO
Fahad :B BB or BO
Baby: O OO
Rh factor (D):
Blood Typing
❑ There are eight different Rh agglutinogens, three of
which (C, D, and E) are common

❑ Rh factor (antigen) are a complex system of antigens

with Mendelian inheritance Cc, Dd, Ee

❑ Rh factor (antigen) was first discovered in blood of

Rhesus monkey. Rh factors only detectable on RBCs

❑ C, D & E antigens (D is the most immunogenic)

• RBCs with D protein = Rh+

• RBCs without D protein = Rh–
Locus of alleles responsible
of ABO system is on
85% of caucasians, 95% of black Americans, long arm of chromosome 9
while Rh locus is on
99% of chinese and nearly 100% of black
chromosome 1
Africans are Rh+
❑ Plasma contains isoantibodies or agglutinins
(IgM) to the A or B antigens not found in the Agglutinins
blood:
– anti-A antibody reacts with antigen A.
– anti-B antibody reacts with antigen B.

❑ Anti-A and Anti-B antibodies are not present

at birth. Two to 8 months after birth, an infant
begins to produce agglutinins. A maximum
titer is usually reached at 8 to 10 years of age,
and this gradually declines throughout the
remaining years of life.

❑ Normal plasma contains no anti-Rh (anti-D)

antibodies.
LANDSTEINER's LAW:
❑ Anti-Rh antibodies (IgG) develop only in Rh- 1. If an agglutinogen is present on red blood cell
blood type and only with exposure to the membrane ,the corresponding agglutinin must be
absent in the plasma.
antigen:
2. If an agglutinogen is absent on red blood cell
– transfusion of positive blood. membrane, then corresponding agglutinin must be
– during a pregnancy with a positive blood present in the plasma.
3. This law is only applicable to ABO blood grouping
type fetus. system.
 Agglutinins
❑ Anti-Rh antibodies (IgG) develop only in Rh- blood type and only with exposure
to the antigen:
– transfusion of positive blood.
– during a pregnancy with a positive blood type fetus.

❑ Anti-Rh antibodies are not spontaneously formed in Rh– individuals.

❑ However, if an Rh– individual receives Rh+ blood, anti-Rh antibodies form.

❑ Anti-Rh agglutinins develop slowly (2-4 months). Once produced they persist
for years and can produce serious transfusion reaction during 2nd transfusion.

❑ This immune response occurs to a much greater extent in some people than in
others. With multiple exposures to the Rh factor, an Rh-negative person
eventually becomes strongly "sensitized" to Rh factor.
 Agglutinins

Genotypes Blood Types Agglutinogens Agglutinins

OO O - Anti-A &
Anti-B
OA or AA A A Anti-B
OB or BB B B Anti-A
AB AB A+B -
 ABO Blood Typing

• With ABO, person makes antibodies (agglutinens; IgM) against factors

(agglutinogens) he/she does NOT have on his/her cells
Blood Typing and Agglutination
 ABO Blood Typing
Blood Type A B AB[1] O[2]

Agglutinogens (antigen
A B A&B (neither)
proteins) Present

Makes Agglutinins
B A (neither) A&B
(antibodies) Against

May Receive Blood From: A, O B, O A, B, AB, O O

May Give Blood To: A, AB B, AB AB A, B, AB, O

Present or Present or Present or Absent Present or

Rh Factor Absent Absent (AB+ or AB-) Absent
(A+ or A-) (B+ or B-) (O+ or O-)

[1] Universal Recipient [2] Universal Donor

Blood Antigens Antibodies Can give Can receive
Group blood to blood from

AB

O
Blood Antigens Antibodies Can give Can receive
Group blood to blood from

AB A and B None AB AB, A, B, O

A A anti-B A and AB A and O

B B anti-A B and AB B and O

O None anti-A and AB, A, B, O O

anti-B
 Rh Blood Types
Blood Type Rh+ Rh-

Agglutinogen D (antigen proteins)

Present Absent
Present or Absent

Makes Agglutinins (antibodies) Against

No Yes[1]
Agglutinogen

May Receive Blood From: Rh+ or Rh- Rh-[2]

May Give Blood To Without Reaction[2]: Rh+ Rh+ or Rh-

Genotype DD or Dd dd

[1] Only makes antibodies (agglutinens) after exposure to Rh+ blood cells (via transfusion or during birth
process)
[2] Transfusion of Rh- individual with Rh+ blood results in production of anti-D agglutinens; sensitizes person to
Rh factor and may result in anaphylaxis if exposed a second time. Erythroblastosis fetalis arises when Rh- mother
has been exposed to Rh+ blood and is carrying Rh+ child.
 Universal Donor; Suitable for all?
Universal donor:
❑ Blood group O, Rh negative.
❑ May be given in emergency to patients with either A, B, AB
and Rh negative or positive blood groups.
❑ Antibody concentrations may be high, so may not be suitable
if large volume of blood required.

Universal recipient:
❑ People with type AB blood are called “universal recipients”
since have no antibodies in plasma.
 Importance of Blood Groups
❑ In blood transfusion.

❑ In preventing hemolytic disease (Rh incompatibility).

❑ In paternity disputes.

❑ In medico-legal cases.

❑ In knowing susceptibility to disease

❑ Group O- duodenal cancer
❑ Group A- Carcinoma of stomach, pancreas & salivary
glands
 Blood Transfusion
Indications of blood transfusion:

1. Acute hemorrhage.
2. Sever anemia (if Hb decreased below 7 g/dL).
3. Erythroblastosis fetalis: in this case exchange transfusion (all
blood is changed) is done.
4. To supply a necessary elements e.g. platelets, packed RBCs,
and some clotting factors.
 Requirements Prior to Blood Transfusion
• Typing (grouping) of the recipient: determining red cell antigens in blood
- ABO typing
- Rh typing

• Cross-matching:
Donor’s cells + Recipient's serum

• Antibody Screening:
– Hepatitis B and C virus
– Antibody to HIV
– HIV Antigens
– Syphilis
– Cytomegalovirus
 Typing and Cross-Matching Blood
❑ Typing involves testing blood
with known antisera that
contain antibodies anti-A, anti-B
or anti-Rh.

❑ Cross-matching is mixing of
donor cells with recipient’s
serum.

❑ Mixing of incompatible blood

causes agglutination (visible
clumping):
❑ formation of antigen-
antibody complex that sticks
cells together (agglutination
reaction).
ABO Blood Grouping (Typing) in Laboratory Using Anti-sera

Group Anti-A Anti-B

A Agglutination Nil

B Nil Agglutination

AB Agglutination Agglutination

O Nil Nil
 Transfusion Reactions
❑ Incompatible blood transfusions
– Mixing of incompatible blood causes the formation of antigen-
antibody complexes between recipient’s plasma antibodies and
“foreign proteins; antigens” on donated RBC's (agglutination)
– Donated RBCs become leaky and burst → diminished oxygen-
carrying capacity
– Clumped cells impede blood flow
– Ruptured RBCs release free hemoglobin into the bloodstream →
circulating hemoglobin precipitates in the kidneys and causes kidney
damage and renal failure

❑ Problems are caused by incompatibility between donor’s cells and

recipient’s plasma
• Why do donor antibodies not attack recipient RBCs
• Donor plasma is too diluted to cause problems
Symptoms and Signs of Transfusion Reactions
❑ Pain at site of infusion
❑ Dyspnea
❑ Nausea
❑ Flushing
❑ Hypotension
❑ Oliguria or Anuria (renal failure )
❑ Chest Pain Back Pain
❑ Chills
❑ Shock
❑ Fever
Serious Hazards of Blood Transfusion
Complications of Blood Transfusion
 Question

Transfusion reaction occurs between which of the following?

- Donor’s plasma agglutinins against the red cell antigens of the recipient
- Donor’s red cell antigens against plasma agglutinins of the recepient
- Both

Explain
Hemolytic Disease of Newborn
❑ During birth, there is often a leakage
of the baby's red blood cells into the
mother's circulation.

❑ If the baby is Rh-positive (having

inherited the trait from its father) and
the mother Rh-negative, these red
cells will cause her to develop
antibodies (IgG class) against the RhD
antigen unless she receives an anti-D
injection soon after first delivery or
abortion.

❑ Anti-D binds to fetal red blood cells

and remove them from body before
she reacts

❑ In 2nd child, hemolytic disease of the

newborn may develop causing
hemolysis of the fetal RBCs → anemia
and jaundice.
 Hemolytic Disease of Newborn
❑ Hemolytic anemia:
– If severe:
treated with exchange
transfusion: Replace baby
blood with Rh-ve RBC
(several times)

❑ Hydrops fetalis (death in

utero)

Prevalence of Disease
1st Pregnancy: 0%
❑ Kernicterus (yellow, 2nd Pregnancy: 3
jaundice baby) 3rd Pregnancy: 10%
 Fetal Incompatibility
❑ Most anti-A or anti-B antibodies are of the IgM class and
these do not cross the placenta.

❑ Thus, an Rh−/type O mother carrying an Rh+/type A, B, or

AB foetus is resistant to sensitization to the Rh antigen.

❑ Her anti-A and anti-B antibodies destroy any fetal cells

that enter her blood before they can stimulate anti-Rh
antibodies in her.
 Prevention of Hemolytic Disease of Newborn
Rh immune globulin (RhIg) or Rhogam or anti-D:

❑ Shortly after each birth of an Rh-positive baby, the

mother is given an injection of anti-Rh antibodies.

❑ These antibodies destroy any Rh+ fetal cells that got

into the maternal circulation before they can
stimulate an active immune response in the mother.

❑ The routine administration of such treatment to Rh -

ve mothers after the delivery of Rh+ve baby has
reduced the incidence of disease by >90%.

❑ Fetal Rh typing from amniocenthesis, and treatment

with small dose of Rh immune serum will prevent
sensitization during pregnancy.
 Objectives;
Intended learning outcomes (ILOs)
After reviewing the PowerPoint presentation and the associated
learning resources, the student should be able to:
❑ Describe the ABO and Rhesus blood group systems
❑ Recognize agglutinins in the plasma
❑ Describe grouping, cross-matching & typing with anti-sera
❑ List precautions taken in preparing blood for transfusion and
storage of blood
❑ Define autologous transfusion and list its advantages
❑ Describe transfusion reactions.
❑ Define hemolytic disease of newborn, describe its pathophysiology
and outline its prevention
Thank You