BLOOD GROUPS, TYPING & MATCHING

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Blood Groups, Blood Typing Blood
Transfusions
By Dr. K. Ambreesha Assit. Professor, Department
of Physiology MNR College Hospital Sangarddy
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Contents

• Blood Groups Various types
• Agglutinins and agglutinogens
• 3. Land Steiners law
• 4. Cross matching
• Erythroblastsis fetalis
• 6. Blood transfusion and transfusion reactions
• 7. Importance of blood Grouping

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History
In the year of 1901 Karl Land Steiner discovered
the classical ABO system and was given Nobel
Prize in 1930.
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1. The most important Blood
Group systems are
1. ABO system 2. Rh system 3. MNS system
Less important blood group systems
1. Lutheran 2. Kell 3. Lewis 4. Duffy 5. Bombay,
etc..
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2. Land Steiners law

• If an agglutinogen is present on red cells of
  blood, the corresponding agglutinin must be
  absent from the plasma.
• If the particular antigen is absent, the
• corresponding antibody must be present.
• Note The 2nd law is a fact, but not must .
• Ex. Absence of Rh antigen is
  not accompanied by
• the presence of anti-Rh
  antibody.

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A. Classical ABO System
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Classical ABO System
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Classical ABO System
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Classical ABO System
Blood Type Antigens (Agglutinogens) on Red Blood Cells Antibodies (Agglutinins) in Plasma
A A Anti-B
B B Anti-A
AB A B None
O Neither Anti-A Anti-B
Note A has 2 sub units A1 and A2
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Percentage of Distribution of ABO Blood Groups
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Formation of the A antigen
B. Inheritance of ABO System
RBC
Glucose
Galactose
N-acetyl glucosamine
Galactose
N-acetylgalactosamine
Fucose
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3. Basis of ABO Blood Group
ABO agglutinogens

• The fructose containing H ag is the basic ag
  found
• in all individuals
• In case of ag A, N acetyl galactosamine as
  terminal
• sugar on H ag
• In ag B the terminal sugar is galactose
• In AB persons both transferases are present
  while in
• O group none of the enzymes present.

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Formation of the B antigen
RBC
Glucose
Galactose
N-acetylglucosamine
Galactose
Galactose
Fucose
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4. How an individual gets his/her Blood Group
Gene received from parents Group of of offspring Genotype
AA A AA
AO A AO
BB B BB
BO B BO
AB AB AB
OO O OO
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ABO agglutinins

• These are natural antibodies and belongs to Ig M
  and so do not cross the placental barrier.
• These are called cold agglutinins because they
  react better between 5-20c
• They appear after birth due to exposure to A and
  B antigens, which may enter the body along with
  food or bacteria

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Blood Typing/grouping/matching
Note Typing is done on the basis of
agglutination
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Major and Minor Cross matching of blood
Donors Blood
Patients blood
Minor Cross matching
Plasma
Major Cross matching
RBCs
Patients Plasma Donors RBCs Major
Cross-Match
Donors Plasma Patients RBCs Minor
Cross-Match
TASK Mix and place a drop of plasma or RBC onto
slide/test tube Observe for
Agglutination or Hemolysis.
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Compatibility between the donors cells and
recipients serum
Anti- Body
Receive From
Donate To





Type
Antigen
A
A
A or O
A or AB
Anti - B
B
Anti - A
B
B or AB
B or O
UniversalReceiver
Neither
AB
A B
AB,A,B,O
AB
UniversalDonor
O
None
Both
O
O,A,B,AB
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RBC Compatibility
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6. Effects of ABO Incompatible blood transfusion

1. Immediate effects Fever, chills nausea,
   vomiting, chest pain, back pain and rigor
2. Delayed effects Jaundice, cardiac shock and
   renal shut down

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II. Rh Blood group system

• Landsteiner and Weiner discovered this group in
  1940.
• 7. Rh factor
• Rh factor is an ag present in RBC
• First discovered in Rhesus monkey so
• named as Rh factor
• The person having D ag are called Rh ve and
  without D ag are called Rh- ve
• Importance Erythroblastosisfetalis is the
  condition occur because of Rh incompatibility

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Rh Blood group system Group
Rh Rh-
O 38.5 6.5
A 34.3 5.7
B 8.6 1.4
AB 4.3 0.7
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Rh agglutinins

• These are called warm abs as they react better at
  body temp 37c
• 2. The Rh abs belongs to Ig G group and can
  enter the fetal circulation through placenta.

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Rh
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Exercise-1
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Rh group-applied aspect

• Transfusion reactions

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Haemolytic disease of new born HDN
About 1 in 10 pregnancies involve an Rh-negative
mother and an Rh-positive father
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Hemolytic Disease of Newborn

• Rh antibodies attack fetal blood
• causing severe anemia

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3. The HDN is associated with the following
features

• Haemolytic anaemia
• b. Erythro blastosis fetalis
• Due to excess destruction of RBSs there is an
  increased production of RBSs not only from the
  bone marrow but also from liver and spleen
• Due to rapid destruction, blast cells are
  released into the circulation called EBF.

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Blood film of a fetus affected by HDN showing
increased number of normaoblasts
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• C. Kernicterus Due to haemolysis excess
  bilirubin is formed. This causes jaundice. The
  excess bilirubin enters the brain and causes
  permanent damage
• D. Hydrops fetalis The fetus
• may develop oedema of all the
• organs leading to the intra uterine
• death.

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• Prevention
• By marriage counseling
• Rh-ve mother with Rh ve fetus should be
  administered anti-D abs at 28th and 34th weeks of
  gestation
• Rh-ve mother with Rh ve fetus-anti D abs are
  given immediately after 1st delivery within 48h.
  to neutralize the ags that would have entered the
  mothers blood

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• 8. Treatment of HDN
• Erythroblastosisfetalis
• Exchange transfusion
• 1. Is replacement of newborn babys
• blood with Rh- ve blood.
• 2. Babys Rh ve blood is removed
• slowly an about 400ml of Rh-ve is
• infused is called exchange
• transfusion

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• III. MNS System
• In 1921,Landsteinerand Levine discovered this
  blood group
• They are used in medico legal cases like parent
  dispute etc.,
• 9. Medico-legal Importance
• 1. Any red stain on a clotting may be claimed
  to be a supposed victim
• 2. Therefore it is first confirmed that it is
  really a human blood
• 3. Blood Group of extracted sample can be then
  prove or disprove the claim of the victim
• 4. In doubtful cases DNA finger printing would
  help.

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• IV. Bombay Blood Group
• This is the rare blood group in which H ag is
  absent, Since there is no H ag there is no ag A
  or ag B on RBC.
• However, the plasma contains anti- A, anti-B and
  anti-H abs.
• As a result , such a person can receive blood
  only from person having Bombay blood group

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• Importance of Blood Groups
• To avoid transfusion reactions of blood
• Medico legal cases like disputed parented age
  and to find out the criminals
• Research purposes as some blood groups are
  associated with a high incidence of certain
  disease
• For matching the tissues during organ
  transplantation
• For preventing development of HDN

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• Blood Transfusion

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• Transfusion The 1st blood transfusion was made
  in 1667 by Dr. Jean Baptiste. Sheep blood was
  transfused to a 15 yr old boy.

• Transfusion is done to restore blood volume
  when there is
• a decrease in blood volume.
• Ex. Hemorrhage, burns ,dehydration, severe
  anaemia and
• surgery

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Blood Substitutes

• When the required blood group is not available
  we give blood substitutes
• Ex Packed RBCs, Platelet conc., plasma,
  saline, volume expanders, Albumin and clotting
  factor concentrate
• Collection of Blood About 350-500ml of blood
  depending on the Hb level

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Effect of storage

• Blood is stored in siliconized bottles in blood
  banks at 4c
• An anticoagulant ACD / CPD is used for preventing
  clotting
• 10. Blood undergoes the following changes
• during storage
• Increases in Na, decrease in Kwith net
  increase in water
• As a result the cell swells and is susceptible
  to
• haemolysis, after 20 days most of RBC get lysed.

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Precautions of transfusion

• Select healthy donor for transfusion
• Matching and typing should be done
• Before we use the blood, it should be warmed to
  the normal body temp.
• Transfusion should be done at a slower rate
• Whole blood transfusion
• Autologous transfusion
• Blood doping

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Treatment

• Stop transfusion immediately on signs of
  incompatibility
• 2. To suppress reaction, corticosteroids and
  Antihistamines are also administered
• 3. If anuria is present, dialysis is given till
  the kidney function is recovered
• 4. Anaemia may be treated suitably
• 5. Osmotic dieresis should be induced
•  

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Give Blood and Save lives !!
Thank you
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BLANKS

• A new born with blood group B ve is having
  Erythroblastosis fetalis, Which is the most
  appropriate line of treatment exchange
  transfusion with Bve
• The person is known as universal donor if he/she
  belongs to blood group O
• Major crossmatching is tested between donors
  cells and recipient plasma
• The person is universal recipient if he or she
  belongs to blood groupAB
• One of the most lethal effects of transfusion
  reaction is acute Kidney shutdown
• Erythroblastosisfoetalis is the mother is Rh-ve
  and fetus is Rh ve

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Essay

• Name the various blood groups? Describe its
  importance? Add a note on transfusion reactions?
• 2. What is the physiological basis of blood
  groups and how they determined? Give an account
  of the significance of Rh factor?

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Short notes

• Transfusion reactions
• 2. Erythroblastosisfetalis
• 3. ABO system
• 4. Rh factor

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Ultra short notes

• Name the different blood groups and describe how
  an individual gets his/ her blood group?
• 2. What is Rh factor? What is its importance?
• 3. What are the effects of incompatible blood
  transfusion?
• 4. Explain the basis of ABO blood grouping?
• 5. Describe the medico legal importance of blood
  groups?

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• 6. What is cross matching and mis-matching?
• 7. Mention the other types of blood grouping
  other than ABO system?
• 8. What is treatment of Erythroblast sis fetalis?
• 9. What are the changes that occur in stored
  blood? What is the significance of these changes?
• 10. What are the disadvantages of prolonged
  storage of blood in blood banks?
•