abo blood group system. importance of abo system abo compatibility between donor cell and patient...
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ABO Blood Group SystemABO Blood Group System
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Importance of ABO system
ABO compatibility between donor cell and patient serum is the essential foundation of pre-transfusion testing
It is the only system with expected antibodies Whether they are IgG or IgM, ABO antibodies can
activate complement readily– This means that incompatibilities can cause life threatening
situations (transfusion reactions)
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ABO antigensABO antigens
Biochemical & Genetic ConsiderationsBiochemical & Genetic Considerations
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ABO and H ABO and H Antigen Genetics Genetics Genes at three separate loci control the occurrence and location of
ABO antigens. The presence or absence of the A, B, and H antigens is controlled
by the H and ABO genes. The presence or absence of the ABH antigens on the red blood
cell membrane is controlled by the H gene. The presence or absence of the ABH antigens in secretions is
indirectly controlled by the Se gene. H H Antigen The H gene codes for an enzyme that adds the sugar fucose to the
terminal sugar of a precursor substance (PS) The precursor substance (proteins and lipids) is formed on an
oligosaccharide chain (the basic structure)
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Type I and Type Type I and Type II Precursors Precursors There are two potential precursors substances for ABH antigens
Type I and Type II
Both are comprised of identical sugars but the linkage of the terminal sugars differs in the two types
Type I precursor has a terminal galactose linked to a subterminal N-acetylgluosamine in a 1-3 linkage. These same sugars combine in a 1-4 linkage in type II precursor.
ABH Ags on red cells are derived from Type II chains whereas the ABH Ags in plasma are made from both types I & II precursors
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RBC Precursor Structure
Glucose
Galactose
N acetylglucosamine
Galactose
Precursor Substance (stays the
same)
RBC
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Formation of the H antigen
Glucose
Galactose
N-acetylglucosamine
Galactose
H antigen
RBC
Fucose
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H antigen The H antigen is the foundation upon which A and B
antigens are built. A and B genes code for enzymes that add a sugar to the
H antigen A and B Antigen The “A” gene codes for an enzyme (transferase) that
adds N-acetylgalactosamine to the terminal sugar of the H antigen “1-3 N-acetylgalactosaminyltransferase”
The “B” gene codes for an enzyme that adds D-galactose to the terminal sugar of the H antigen “ 1-3 D-galactosyltransferase”.
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Formation of the A antigen
Glucose
Galactose
N-acetylglucosamine
Galactose
RBC
Fucose N-acetylgalactosamine
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Formation of the B antigen
Glucose
Galactose
N-acetylglucosamine
Galactose
RBC
FucoseGalactose
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Genetics The H antigen is found on the RBC when you have the Hh or
HH genotype, but NOT from the hh genotype The A antigen is found on the RBC when you have the Hh,
HH, and A/A, A/O, or A/B genotypes The B antigen is found on the RBC when you have the Hh,
HH, and B/B, B/O, or A/B genotypes.
The O alleleThe O allele – Why do Group O individuals have more H antigen than
the other groups?– The O gene is a silent allele. It does not alter the structure of
the H substance….that means more H antigen sites.
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Group O Group A
Many H antigen sites
Most of the H antigen sites in a Group A individual have been
converted to the A antigen
Fewer H antigen
sites
A
A A
AA
Group O Group A
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Other ABO conditions
Bombay Phenotype (Oh) Inheritance of hh The h gene is an amorph and results in little or no
production of L-fucosyltransferase Very rare
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Bombay The hh causes NO H antigen to be produced Results in RBCs with no H, A, or B antigen (patient types as O) Bombay RBCs are NOT agglutinated with anti-A, anti-B, or
anti-H (no antigens present) Bombay serum has strong anti-A, anti-B and anti-H,
agglutinating ALL ABO blood groups What blood ABO blood group would you use to transfuse this
patient?? Another Bombay
– Group O RBCs cannot be given because they still have the H antigen
– You have to transfuse the patient with blood that contains NO H antigen
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ABO Antibodies
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ABO antibodies
RBC PhenotypeFrequency(%) Serum Ab
A43Anti-B
B9Anti-A
AB4--------
O44 Anti-A,B
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ABO antibody factsABO antibody facts• Complement can be activated with ABO antibodies (mostly IgM, some
IgG)• High titer: react strongly (4+)
Anti-A, Anti-B, Anti-A,B
Clinically Significant
Yes
Abs class
IgM, less IgG
Thermal range
4 - 37
HDNB
Yes
Transfusion Reactions
ExtravascularIntravascular
YesYes
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The Rhesus (Rh) Blood Group system
Rh Genetics: Rh Genetics: The genes that control the system are autosomal codominant located on the short arm of chromosome 1.
D antigen – 85%d antigen – 15%C antigen – 70%c antigen – 80%E antigen – 30%e antigen – 98%
The presence or absence of D Ag determines if the person is Rh+ or Rh-
Rh PositiveRh Positive
Rh NegativeRh Negative
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Rh Deleted : Rh Deleted : Red cells that express no Ags at the C & E loci (D)
Number of D Ags greatly increase Anti-D IgG Abs can agglutinate these cells
RH null: individual that appears to have no Rh antigens ( -, -, -)
Must use autologous blood products– No D, C, c, E, e antigens present on the RBC membrane
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Rh antibodies
Rh AbsClinically Significant
Yes
Abs class
IgG
Thermal range
4 - 37
HDNB
Yes
Transfusion Reactions
ExtravascularIntravascular
YesNo
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Usually related to D antigen exposure and the formation of anti-D
Usually results from D negative female and D positive male producing and offspring.
– The baby will probably be D positive. 1st pregnancy not effected, the 2nd pregnancy and
on will be effected-results in still birth, severe jaundice, anemia related to HDN.
To prevent this occurrence the female is administered RH-IG.
Hemolytic disease of the Newborn (HDN)
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Rh factor can cause complications in some pregnancies.
Mother is exposed to Rh antigens at the birth of her Rh+ baby.
First pregnancy
PlacentaRh+ antigens
Rh factor
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Anti-Rh+ antibodies
Possible subsequent pregnancies
Mother makes anti-Rh+ antibodies.
During the mother’s next pregnancy, Rh antibodies can cross the placenta and endanger the fetus.
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Weak D PhenotypeWeak D Phenotype Most D positive RbC’s react macroscopically with Reagent anti-
D at immediate spin– These patients are referred to as Rh positive– Reacting from 1+ to 3+ or greater
HOWEVER, some D-positive rbc’s DO NOT react (do NOT agglutinate) at Immediate Spin using Reagent Anti-D. These require further testing (37oC and/or AHG) to determine the D status of the patient.
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Cross-matching involves mixing a sample of the recipient's serum with a sample of the donor's red blood cells and checking if the mixture agglutinates, or forms clumps.
If agglutination is not obvious by direct vision, blood bank technicians usually check for agglutination with a microscope. If agglutination occurs, that particular donor's blood cannot be transfused to that particular recipient.
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Blood group testSample is fresh blood or EDTA blood (anticoagulant)
Put 10 µ of anti A on one side of a slide and put 10 µ of anti B on the other side
Put 10 µ of blood tested in each side and mix the blood with the reagent added.
results:
+ A & + B = AB
+ A & - B = A
- A & + B = B
-A & - B = O
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