11

BLOOD GROUPS & BLOOD GROUPS & TYPES TYPES

22

HISTORICALHISTORICAL 1919thth CENTURY: Boer War CENTURY: Boer War Massive deaths of people:Massive deaths of people:

Many infectionsMany infections Severe blood lossSevere blood loss

Attempts to transfuse blood began.Attempts to transfuse blood began. They had confusing results.They had confusing results. Some people recovered fully.Some people recovered fully. Others died.Others died.

33

WHY? WHY? WHY?WHY? WHY? WHY? Either all should die Either all should die Or all should live.Or all should live. Why this difference?Why this difference? This question haunted a This question haunted a

researcher called researcher called Karl Karl Landsteiner.Landsteiner.

He worked hard to find out He worked hard to find out why.why.

44

KARL LANDSTEINER, NOBEL KARL LANDSTEINER, NOBEL LAUREATE, 1930.LAUREATE, 1930.

1868

1943

55

KARL LANDSTEINERKARL LANDSTEINER Wondered about this phenomenon.Wondered about this phenomenon. Studied this extensively.Studied this extensively. Discovered Blood Groups and types Discovered Blood Groups and types

single handedly.single handedly. Framed the Landsteiner’s Law in Framed the Landsteiner’s Law in

1904.1904. Continued to research on Blood Continued to research on Blood

groups and types till his death in groups and types till his death in 1943.1943.

66

LANDSTEINER’S LAWLANDSTEINER’S LAW1.“If an agglutinogen is present in

the red cells of a blood, the corresponding agglutinin must be absent from the plasma.”

2. “If an agglutinogen is absent in the red cells of a blood, the corresponding agglutinin must be present in it’s plasma.”

77

LANDSTEINER’S LAW: LANDSTEINER’S LAW: APPLICABILITYAPPLICABILITY

The first law is applicable to all The first law is applicable to all groups and types of blood.groups and types of blood.

It is a logical conclusion.It is a logical conclusion. The second part is a fact, but not The second part is a fact, but not

necessarily true always.necessarily true always. It is a fact for ABO Blood groups.It is a fact for ABO Blood groups. The Rh, M,N and other groups or The Rh, M,N and other groups or

types do not follow the second types do not follow the second part of the Landsteiner’s Law.part of the Landsteiner’s Law.

88

ABO BLOOD GROUPSABO BLOOD GROUPS

The most common type of The most common type of blood grouping in use.blood grouping in use.

99

AGGLUTINOGENSAGGLUTINOGENS Also called antigens. These agglutinogens are present

on the outer surface of the Erythrocyte membranes.

They are antigenic and have epitopes or antigenic determinants, which are glycoproteins.

In ABO groups, three types of agglutinogens can be present.

1010

AGGLUTINOGENS (Contd)AGGLUTINOGENS (Contd) Some individuals will have Some individuals will have

Erythrocytes with an agglutinogen Erythrocytes with an agglutinogen called as “A”.called as “A”.

Others have one called “B”Others have one called “B” The third type of agglutinogen is non The third type of agglutinogen is non

antigenic and it is called “H”antigenic and it is called “H” H doesn’t cause production of H doesn’t cause production of

antibodies.antibodies. So those having H antigen are called So those having H antigen are called

O group individuals.O group individuals.

1111

A AND B, INDIVIDUALSA AND B, INDIVIDUALS Those having the Those having the A agglutinogenA agglutinogen

on their erythrocytes are called on their erythrocytes are called A blood group people.A blood group people.

Those having theThose having the B agglutinogen B agglutinogen are called the B blood group are called the B blood group people.people.

1212

Some have both the Some have both the A and B A and B agglutinogensagglutinogens on their on their erythrocytes and they are called erythrocytes and they are called AB type.AB type.

Others have Others have neither A nor B neither A nor B agglutinogensagglutinogens. They have the . They have the non antigenic H on their RBCs non antigenic H on their RBCs and are called O group people.and are called O group people.

AB & O INDIVIDUALSAB & O INDIVIDUALS

1313

AGGLUTININSAGGLUTININS The antibodies to the agglutinogens The antibodies to the agglutinogens

are called Agglutinins.are called Agglutinins. These are present naturally in ABO These are present naturally in ABO

groups.groups. They are always present in the They are always present in the

plasma of the individual.plasma of the individual. There are two types of agglutinins in There are two types of agglutinins in

the ABO blood system:the ABO blood system: Anti A or Anti A or αα: Alpha: Alpha Anti B or Anti B or ββ: Beta: Beta

1414

AGGLUTININS (Contd)AGGLUTININS (Contd) The A group people have the Beta or

anti B agglutinin in their plasma. Similarly the B group people have the

Alpha or Anti-A agglutinin in their plasma.

The AB group of people have no agglutinins in their plasma.

The O group people have both Alpha and Beta types of agglutinins in their plasma.

1515

ABO BLOOD GROUPSABO BLOOD GROUPSGROUPGROUP AGGLUTINOGEN/S AGGLUTINOGEN/S

ON RBCON RBCAGGLUTININ/S AGGLUTININ/S

IN PLASMAIN PLASMAAA AA ββ

BB BB αα

ABAB Both A & BBoth A & B NoneNone

OO Neither A nor BNeither A nor B Both Both αα and and ββ

1616

1717

ABO BLOOD GROUP TESTABO BLOOD GROUP TEST Why test?Why test? To determine the blood To determine the blood

groups.groups. How is the test done?How is the test done? The erythrocytes of the The erythrocytes of the

patient are exposed to the two patient are exposed to the two different types of anti sera.different types of anti sera.

1818

Antisera are solutions containing the Antisera are solutions containing the respective agglutinins.respective agglutinins.

Anti A agglutinin is present in Antisera AAnti A agglutinin is present in Antisera A Anti sera B contains Beta agglutinin or Anti sera B contains Beta agglutinin or

anti B agglutinin.anti B agglutinin. In this test the patients erythrocytes are In this test the patients erythrocytes are

exposed separately to both these exposed separately to both these antisera.antisera.

Agglutination is seen in one or more of Agglutination is seen in one or more of the solutions.the solutions.

ABO BLOOD GROUP TESTABO BLOOD GROUP TEST

1919

AGGLUTINATIONAGGLUTINATION Agglutination or clumping is seen Agglutination or clumping is seen

whenever the respective whenever the respective agglutinogens and agglutinins are agglutinogens and agglutinins are mixed.mixed.

Agglutinogen A + Agglutinin Alpha = Agglutinogen A + Agglutinin Alpha = Agglutination.Agglutination.

Agglutinogen B + Agglutinin Beta = Agglutinogen B + Agglutinin Beta = Agglutination.Agglutination.

Both agglutinogens + Both antisera = Both agglutinogens + Both antisera = Agglutination.Agglutination.

No agglutinogens = No agglutination.No agglutinogens = No agglutination.

2020

If there is agglutination with antisera A, the blood group of the individual will be A.

If there is agglutination with antisera B, the blood group of the individual is B.

If there is agglutination with both the antisera, then the blood group is AB.

If there is no agglutination with either of the two antisera, then the person is of the group O.

ABO BLOOD GROUP TESTABO BLOOD GROUP TEST

2121

By doing this test we can By doing this test we can determine the blood group of determine the blood group of individuals.individuals.

Knowing one’s blood group helps Knowing one’s blood group helps us in times of need. If a patient is us in times of need. If a patient is of Group A, he can receive blood as of Group A, he can receive blood as transfusion from group A or group transfusion from group A or group O individuals. He cannot receive it O individuals. He cannot receive it from Group B or Group AB people.from Group B or Group AB people.

ABO BLOOD GROUP TESTABO BLOOD GROUP TEST

2222

Why? Why? Because the agglutinogens in Because the agglutinogens in

the donor’s blood can the donor’s blood can agglutinate with the agglutinate with the agglutinin in the recipient’s agglutinin in the recipient’s blood and cause hemolysis. blood and cause hemolysis.

This is called transfusion This is called transfusion mismatch and can be fatal.mismatch and can be fatal.

ABO BLOOD GROUP TESTABO BLOOD GROUP TEST

2323

UNIVERSAL DONOR & UNIVERSAL DONOR & RECEPIENTSRECEPIENTS

The blood group O can be given to The blood group O can be given to any other of the ABO group any other of the ABO group persons and so is called the persons and so is called the “Universal Donor”“Universal Donor”

The blood group AB persons lack The blood group AB persons lack agglutinins and so can receive agglutinins and so can receive blood from any of the ABO group blood from any of the ABO group persons. So this AB group is called persons. So this AB group is called as the “Universal Recipient” as the “Universal Recipient”

2424

2525

DONATIONS…DONATIONS… AA Blood group person can donate Blood group person can donate

blood to A and AB groups.blood to A and AB groups. BB Blood group person can donate Blood group person can donate

blood to B and AB groups.blood to B and AB groups. ABAB Blood group person can Blood group person can

donate blood only to AB group.donate blood only to AB group. O O blood group person can donate blood group person can donate

blood to O, A, B and AB groups.blood to O, A, B and AB groups.

2626

2727

ABO BLOOD GROUP TEST: ABO BLOOD GROUP TEST: SUMMARYSUMMARY

RED CELLS

ANTISERA ALPHA

ANTISERA BETA

A AGGLUTINATION

NO AGGLUTINATIO

NB NO AGG. AGGLUTINATIO

NAB AGGLUTINATIO

NAGGLUTINATIO

NO NO

AGGLUTINATION

NO AGGLUTINATIO

N

2828

CROSS MATCHINGCROSS MATCHING This is a test done just This is a test done just

before the blood is before the blood is transfused.transfused.

It helps rule out other group It helps rule out other group mismatches.mismatches.

It has two parts: It has two parts: MajorMajor & & Minor Minor cross matching.cross matching.

2929

MAJOR CROSS MATCHINGMAJOR CROSS MATCHING The effects of the recipient’s The effects of the recipient’s

serum agglutinins on the serum agglutinins on the donors erythrocytes.donors erythrocytes.

This is called major because This is called major because about 300 ml of the Blood cells about 300 ml of the Blood cells of the donor are sent into the of the donor are sent into the circulation of the recipient.circulation of the recipient.

Donor’s Erythrocytes+ Donor’s Erythrocytes+ Recipient’s plasma= ?Recipient’s plasma= ?

3030

MINOR CROSS MATCHINGMINOR CROSS MATCHING The Effect of the donor’s serum The Effect of the donor’s serum

agglutinins on the recipient’s agglutinins on the recipient’s erythrocytes.erythrocytes.

This is called minor because these This is called minor because these agglutinins get diluted by the agglutinins get diluted by the larger volume of the recipient’s larger volume of the recipient’s plasma.plasma.

Donor’s Serum + Recipient’s Donor’s Serum + Recipient’s ErythrocytesErythrocytes

3131

PERCENTAGE OF BLOOD PERCENTAGE OF BLOOD GROUPSGROUPS

WESTERN POPULATION

42

9

46

3

ABOAB

3232

PERCENTAGE OF BLOOD PERCENTAGE OF BLOOD GROUPSGROUPS

ASIAN POPULATION

25

2545

5

ABOAB

3333

Rh TYPING: INTRODUCTION

It is the second most important typing of blood.

These blood groups were originally discovered in Rhesus monkeys

Rh is another type of agglutinogen.

It is also present on the outer surface of the erythrocytes.

3434

Rh Positive and Negative Rh Positive and Negative peoplepeople

People who have the Rh People who have the Rh agglutinogen on their RBC agglutinogen on their RBC membranes are called membranes are called Rh Positive.Rh Positive.

Those who do not have the Rh Those who do not have the Rh agglutinogen are called agglutinogen are called Rh Negative Rh Negative people.people.

Rh-ve peopleRh-ve people do not NATURALLY do not NATURALLY carrycarry the corresponding the corresponding Anti-Rh Anti-Rh antibodyantibody..

3535

DISTRIBUTION OF Rh DISTRIBUTION OF Rh TYPESTYPES

CAUCASIAN POPULATION15

85

Rh+veRh-ve

3636

DISTRIBUTION OF Rh DISTRIBUTION OF Rh TYPESTYPES

ORIENTAL POPULATION

95

5

Rh+veRh-ve

3737

Rh or D Agglutinins Rh or D Agglutinins Anti-D agglutinins or antibodies Anti-D agglutinins or antibodies do not do not

occur naturally.occur naturally. They are produced by the Immune They are produced by the Immune

systems as and when it is exposed to systems as and when it is exposed to the D antigens.the D antigens.

So these Anti D agglutinins are found So these Anti D agglutinins are found only in some of the Rh Negative only in some of the Rh Negative people.people.

Those who have been Those who have been exposed to the exposed to the Rh or D antigenRh or D antigen

3838

Exposure to Antigens: How?

The Rh+ve people will never The Rh+ve people will never manufacture Anti D antibodies.manufacture Anti D antibodies.

Only Rh – ve individuals can Only Rh – ve individuals can develop these Agglutinins.develop these Agglutinins.

When these Rh-ve people receive When these Rh-ve people receive Rh+ve blood by mistake, they get Rh+ve blood by mistake, they get exposed to the antigen.exposed to the antigen.

Then they will develop the Then they will develop the antibody.antibody.

3939

In case of an In case of an Rh-ve womanRh-ve woman, if , if she is married to an she is married to an Rh+ve manRh+ve man, , she can conceive an she can conceive an Rh+ve childRh+ve child..

In this case, the D antigen In this case, the D antigen present on the erythrocytes of present on the erythrocytes of the fetus does not go into the the fetus does not go into the maternal circulation maternal circulation throughout throughout the pregnancy the pregnancy (due to the Feto-(due to the Feto-Placental barrier)Placental barrier)

Exposure to Antigens: Exposure to Antigens: How?How?

4040

During the delivery of the baby, During the delivery of the baby, some some blood of the fetus spillsblood of the fetus spills over into the maternal circulation.over into the maternal circulation.

The maternal circulation is The maternal circulation is exposed to the exposed to the D antigensD antigens from from the fetal erythrocytes.the fetal erythrocytes.

The maternal circulation The maternal circulation slowly slowly develops Anti D antibodiesdevelops Anti D antibodies..

The first child is howeverThe first child is however spared spared..

Exposure to Antigens: Exposure to Antigens: How?How?

4141

ERYTHROBLASTOSIS FETALISERYTHROBLASTOSIS FETALIS

The second child in such a woman, if The second child in such a woman, if also Rh+ve, can develop a disease also Rh+ve, can develop a disease called as called as Erythroblastosis fetalisErythroblastosis fetalis..

This is due to the This is due to the Anti D antibodies Anti D antibodies developed in the mother.developed in the mother.

These antibodies These antibodies traverse through traverse through the placentathe placenta, enter the fetal , enter the fetal circulation and cause circulation and cause agglutinationagglutination of the erythrocytes of the fetus.of the erythrocytes of the fetus.

4242

PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF ERYTHROBLASTOSIS FETALISERYTHROBLASTOSIS FETALIS

PLACENTA

MATERNALCIRCULATION

FETAL CIRCULATION

Anti-D Antibodies Agglutination of RBCs

HemolysisHemoglobin in Plasma

Bilirubin

Jaundice

Blocks RenalTubules

Renal Failure Kernicterus

4343

NORMAL JAUNDICED

4444

Rh+ve children of an Rh-ve mother If it is of severe nature, bilirubin

may enter te brain to cause “kernicterus”

The fetus may become groosly edematous (swollen).

This is called “Hydrops fetalis” Such fetuses may die in utero or

hours after preterm or term birth

ERYTHROBLASTOSIS FETALIS or ERYTHROBLASTOSIS FETALIS or ICTERUS GRAVIS NEONATORUMICTERUS GRAVIS NEONATORUM

4545

ERYTHROBLASTOSIS:ERYTHROBLASTOSIS:PREVENTIONPREVENTION

All pregnant women to be tested All pregnant women to be tested for Rh.for Rh.

If any are If any are Rh-veRh-ve, their husbands , their husbands also to be tested for Rh.also to be tested for Rh.

The first baby’s blood to be The first baby’s blood to be tested for Rh.tested for Rh.

If Rh+ve, then the mother to be If Rh+ve, then the mother to be givengiven Rhogam injection Rhogam injection within within 24 24 hrshrs after delivery. after delivery.

4646

TREATMENT OF TREATMENT OF ERYTHROBLASTOSISERYTHROBLASTOSIS

EXCHANGE TRANSFUSION.EXCHANGE TRANSFUSION. The entire blood of the fetus is The entire blood of the fetus is

replaced by O Rh-ve blood.replaced by O Rh-ve blood. This is done in small installments.This is done in small installments. Once it is done, slowly the baby Once it is done, slowly the baby

will recover, as erythropoiesis will recover, as erythropoiesis occurs while these O –ve cells die.occurs while these O –ve cells die.

4747

EXCHANGE TRANSFUSION EXCHANGE TRANSFUSION

NOMAD:2006: BP:BldgpsINOMAD:2006: BP:BldgpsI 4848

AFTER SUCCESSFUL THERAPYAFTER SUCCESSFUL THERAPY

4949

USES OF BLOOD GROUPSUSES OF BLOOD GROUPS CLINICAL:CLINICAL:

For transfusion of bloodFor transfusion of blood To prevent Erythroblastosis fetalisTo prevent Erythroblastosis fetalis

MEDICOLEGAL:MEDICOLEGAL: Determination of suspected parentageDetermination of suspected parentage Can say whether one could or could Can say whether one could or could

not have been the father of a child.not have been the father of a child. DNA fingerprinting is more specific.DNA fingerprinting is more specific.

GENETIC STUDIES: EPIDEMIOLOGY.GENETIC STUDIES: EPIDEMIOLOGY.

5050

INCOMPATIBLE INCOMPATIBLE TRANSFUSIONS CAUSE…TRANSFUSIONS CAUSE…

MILD REACTIONS SUCH AS:MILD REACTIONS SUCH AS: Chills and rigorsChills and rigors FeverFever Inapparent Hemolysis.Inapparent Hemolysis. Post transfusion Jaundice. Post transfusion Jaundice. Severe transfusion reactions.Severe transfusion reactions.

5151

SEVERE TRANSFUSION SEVERE TRANSFUSION REACTIONSREACTIONS

Violent Backaches.Violent Backaches. Tightness in the chest.Tightness in the chest. Jaundice.Jaundice. Oliguria.Oliguria. Renal Shutdown/Failure.Renal Shutdown/Failure. AnuriaAnuria DeathDeath