Blood Grouping PDF

# Blood Grouping ## Contents * Introduction * Blood Group Systems * ABO Blood Group System * Rh Blood Group System * Blood Transfusion * Introduction * Precautions * Adverse Effect of Blood Transfusion * Exchange Transfusion * Rh Incompatibility * Other Blood Group System...

# Blood Grouping ## Contents * Introduction * Blood Group Systems * ABO Blood Group System * Rh Blood Group System * Blood Transfusion * Introduction * Precautions * Adverse Effect of Blood Transfusion * Exchange Transfusion * Rh Incompatibility * Other Blood Group System * Blood Transfusion ## Introduction * A blood group is also called a Blood Type. * Classification of blood is based on the presence or absence of inherited antigenic substances on the surface of red blood cells (RBCs). * Blood group systems * ABO blood group system * Rh blood group system * These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system. ## ABO Blood Group System * The ABO blood group system is the most important blood type system (or blood group system) in human blood transfusion. * ABO blood types are also present in some other animals for example rodents and apes such as chimpanzees, bonobos and gorillas. * Determination of ABO blood groups depends upon the immunological reaction between antigen and antibody. * Antigens are also called agglutinogens because of their capacity to cause agglutination of RBCs. ## Importance of Blood Groups 1. In blood transfusion. 2. In preventing hemolytic disease (Rh incompatibility between mother and fetus) 3. In paternity disputes (to determine the father) 4. In medicolegal cases 5. In knowing susceptibility to disease: * Group O: duodenal cancer. * Group A: carcinoma of stomach, pancreas & salivary glands. ## History * Karl Landsteiner discovered the ABO Blood Group System in 1901. * Adriano Sturli and Alfred von Decastello who were working under Landsteiner discovered type AB a year later in 1902. * Landsteiner was awarded the 1930 Nobel Prize in Physiology or Medicine for his work. * Janský is credited with the first classification of blood into the four types (A, B, AB, O) in 1907, which remains in use today. * Reuben Ottenberg successfully transfused blood between two people at Mount Sinai Hospital in New York. He was the first person to record pre-transfusion testing for blood compatibility in a clinical setting. Later in 1954, he was the first to be awarded with Karl Landsteiner Award. ## Landsteiner Rule If an antigen is present on a patient's red blood cells (RBCs), the corresponding antibody will NOT be present in the patient's plasma under 'normal conditions'. ## Based on the presence or absence of antigen A and antigen B, blood is divided into four groups: 1. A 2. B 3. AB 4. O * Blood having antigen A belongs to 'A' group. This blood has B-antibody in the serum. * Blood with antigen B and a-antibody belongs to 'B' group. * If both the antigens are present, blood group is called 'AB' group and serum of this group does not contain any antibody. * If both antigens are absent, the blood group is called 'O' group and both a and B antibodies are present in the serum. ## Antigen and Antibody Present in ABO Blood Group | ABO Group | Antigen Present | Antigen Missing | Antibody Present | |---|---|---|---| | A | A | B | Anti-B | | B | B | A | Anti-A | | O | None | A and B | Anti-A&B | | AB | A and B | None | None | ## ABO Blood Groups * **Type A:** Cannot have B or AB blood. Can have A or O blood. * **Type B:** Cannot have A or AB blood. Can have B or O blood. * **Type AB:** Can have any type of blood. Is the universal recipient. * **Type O:** Can only have O blood. Is the universal donor. ## Principle of Blood Grouping * Blood grouping is done on the basis of agglutination. * Agglutination means the collection of separate particles like RBCs into clumps or masses. * Agglutination occurs if an antigen is mixed with its corresponding antibody, which is called isoagglutinin, i.e., occurs when A antigen is mixed with anti-A or when B antigen is mixed with anti-B. ## Importance of ABO Groups in Blood Transfusion * During blood transfusion, only compatible blood must be used. * The one who gives blood is called the 'donor', and the one who receives the blood is called 'recipient'. * While transfusing the blood, antigen of the donor and the antibody of the recipient are considered. * The antibody of the donor and antigen of the recipient are ignored mostly. * Thus, RBC of 'O' group has no antigen, and so agglutination does not occur with any other group of blood. So, 'O' group blood can be given to any blood group persons, and the people with this blood group are called 'universal donors'. * Plasma of AB group blood has no antibody. This does not cause agglutination of RBC from any other group of blood. * People with AB group can receive blood from any blood group persons. So, people with this blood group are called 'universal recipients'. ## Blood Groups Compatibility | Recipient | 0- | 0+ | B- | B+ | A- | A+ | AB- | AB+ | |---|---|---|---|---|---|---|---|---| | AB+ | | | | | | | | **X** | | AB- | | | | | | | **X** | **X** | | A+ | **X** | **X** | | | | **X** | **X** | **X** | | A- | **X** | **X** | | | **X** | **X** | **X** | **X** | | B+ | **X** | **X** | **X** | **X** | | | **X** | **X** | | B- | **X** | **X** | **X** | **X** | | | **X** | **X** | | 0+ | **X** | **X** | | | | | | | | 0- | **X** | **X** | | | | | | | ## Blood Type Compatibility | Blood Type | Gives | Receives | |---|---|---| | A+ | A+, AB+ | A+, A-, O+, O- | | O+ | O+, A+, B+, AB+ | O+, O- | | B+ | B+, AB+ | B+, B-, O+, O- | | AB+ | AB+ | Everyone | | A- | A+, A-, AB+, AB- | A-, O- | | O- | Everyone | O- | | B- | B+, B-, AB+, AB- | B-, O- | | AB- | AB+, AB- | AB-, A-, B-, O- | ## In mismatched transfusion, the transfusion reactions occur between donor's RBC and recipient's plasma. * So, if the donor's plasma contains agglutinins against recipient's RBC, agglutination does not occur because these antibodies are diluted in the recipient's blood. ## Blood Compatibility * A diagram of the blood types: O (universal donor) can give blood to A, B, AB. A can give to A, AB. B can give to B, AB. AB can give to AB. ## Transfusion Reactions Due to ABO Incompatibility * Transfusion reactions are the adverse reactions in the body, which occur due to transfusion error that involves transfusion of incompatible (mismatched) blood. * The reactions may be mild causing only fever and hives (skin disorder characterized by itching) or may be severe leading to renal failure, shock, and death. ## Rh Blood Group System * The Rh blood group system is one of thirty-five current human blood group systems. * It is the most important blood group system after ABO. * Rh blood group system consists of 50 defined blood-group antigens, among them there are six common types of Rh antigens. * Each of which is called an Rh factor. These types are designated C,D, E, c, d, and e. * The type D antigen is widely prevalent in the population and considerably more antigenic than the other Rh antigens. * Anyone who has this type of antigen is said to be Rh positive, whereas a person who does not have type D antigen is said to be Rh negative. * This antigen was discovered by Karl Landsteiner and Alexander Wiener in 1940. * It was first discovered in Rhesus macaque and hence the name 'Rh factor'. ## Rh Incompatibility * **Erythroblastosis fetalis** * Mother Rh negative and fetus Rh positive. * RBCs from the fetus can go into the mother's bloodstream through the placenta. * Rh negative mothers' immune system treats the Rh positive fetal cells as a foreign substance and makes antibodies against them. * Theses anti Rh antibodies may cross the placenta into the fetus where they destroy the fetus's circulation RBCs. ## Erythroblastosis fetalis ("Hemolytic Disease of the Newborn") * Erythroblastosis fetalis is a disease of the fetus and newborn child characterized by agglutination and phagocytosis of the fetus's red blood cells. * In most instances of erythroblastosis fetalis, the mother is Rh negative and the father Rh positive. The baby has inherited the Rh-positive antigen from the father, and the mother develops anti-Rh agglutinins from exposure to the fetus's Rh antigen. In turn, the mother's agglutinins diffuse through the placenta into the fetus and cause red blood cell agglutination. ## 2. Rh incompatibility between mother and fetus * a diagram illustrating the progression of the disease ## Result * a diagram showing the breakdown of the placenta ## Prevention of Erythroblastosis Fetalis * Prophylactic treatment is passive immunization of the mother with anti-Rh agglutinins (Rhogam) shortly after delivery of the first baby. * It prevents sensitization in the Rh negative mother by neutralizing the Rh agglutinins in the mother. * Anti-D antibody is also administered to the expectant mother starting at 28 to 30 weeks of gestation. ## Symptoms and signs in the fetus: * Enlarged liver spleen, or heart * Fluid buildup in the fetus' abdomen seen via ultrasound. ## Symptoms and signs in the newborn: * Anemia that creates the newborn's pallor (pale appearance). * Jaundice or yellow discoloration of the newborn's skin, sclera, or mucous membrane. * Enlargement of the newborn's liver and spleen. * Severe edema of the entire body. * Dyspnea or difficulty breathing. ## Other Blood Group System * Thirty-five major blood group systems were recognized by the International Society of Blood Transfusion (ISBT) in October 2012. * In addition to the ABO antigens and Rhesus antigens, many other antigens are expressed on the red blood cell surface membrane. ## Other blood groups include * Auberger groups * Diego group * Bombay group * Duffy group * Lutheran group * P group * Kell group * I group * Kidd group * Sulter Xg group * Kidd group * Duffy group ## Blood Transfusion * Blood transfusion is generally the process of receiving blood products into one's circulation intravenously. * Transfusions are used for various medical conditions to replace lost components of the blood. * Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, white blood cells, plasma, clotting factors, and platelets. * Blood transfusion is the process of transferring blood or blood components from one person ( the donor) into the bloodstream of another person ( the recipient). * Richard Lower pioneered the first blood transfusion from animal to human in 1665 at the Royal Society. * In 1840 Dr. Blundell performed the first successful whole blood transfusion to treat haemophilia. ## Before a blood transfusion is given, there are many steps taken to ensure quality of the blood products, compatibility, and safety to the recipient. * Blood transfusions typically use sources of blood: one's own (autologous transfusion), or someone else's (allogeneic or homologous transfusion). * The latter is much more common than the former. * Using another's blood must first start with donation of blood. * Blood is most commonly donated as whole blood intravenously and collecting it with an anticoagulant. ## Processing and Testing Of Blood * Donated blood is usually subjected to processing after it is collected, to make it suitable for use in specific patient populations. * Collected blood is then separated into blood components by centrifugation: red blood cells, plasma, platelets, albumin protein, clotting factor concentrates, cryoprecipitate, fibrinogen concentrate and immunoglobulins (antibodies). * All donated blood is tested for infections like HIVs, Hepatitis B, Hepatitis C, Syphilis. * All donated blood is also tested for ABO and Rh groups, along with the presence of any red blood cell antibodies. * Pathogen Reduction treatment done. ## Conditions When Blood Transfusion Is Necessary * Anemia * Hemorrhage * Trauma * Burns * Surgery ## Precautions to Be Taken Before The Transfusion of Blood * Donor must be healthy, without any diseases like: * Sexually transmitted diseases such as syphilis * Diseases caused by virus like hepatitis, AIDS, etc. * Only compatible blood must be transfused. * Both matching and cross-matching must be done. * Rh compatibility must be confirmed. ## Precautions to Be Taken While Transfusing Blood * Apparatus for transfusion must be sterile. * Temperature of blood to be transfused must be same as the body temperature. * Transfusion of blood must be slow. The sudden rapid infusion of blood into the body increases the load on the heart, resulting in many complications. ## Adverse Effect of Blood Transfusion * Transfusions of blood products are associated with several complications, many of which can be grouped as immunological or infectious such as: * Acute hemolytic reaction * Delayed hemolytic reaction * Allergic reaction * Post-transfusion purpura * Transfusion associated acute lung injury * HIV * Hepatitis C ## Exchange Transfusion * Is the procedure which involves removal of patient's blood completely and replacement with fresh blood or plasma of the donor. * Also known as replacement transfusion. * It is an important in life-saving procedure carried out in conditions such as severe jaundice, sickle cell anemia, erythroblastosis fetalis, etc. ## References * Guyton-Physiology-11th edition * Essentials of Medical Physiology, 6th Edition By K Sembulingam ## Any Questions?