BLOOD GROUPS,BLOOD

TRANSFUSION AND RHESUS

FACTOR
BY

DR.MUDASSAR
 HISTORY OF BLOOD GROUPS

•Experiments with blood transfusions have

been carried out for hundreds of years.

•Many patients have died & it was not until

1901,when Austrian Karl Landsteiner
               discovered human blood groups, that blood
transfusions became safer.

• He found that mixing blood from two

individuals can lead to blood clumping. The
clumped RBCs can crack and cause toxic
reactions. This can be fatal.

 
•Karl Landsteiner discovered that blood clumping was an
immunological reaction which occurs when receiver of
a blood transfusion has antibodies against the donor
blood cells.

•Karl Landsteiner's work made it possible to determine

blood types and thus paved the way for blood
transfusions to be carried out safely.

•For this discovery he was awarded the Nobel Prize in

Physiology or Medicine in 1930.
LANDSTEINER’S LAW

IF AN ANTIGEN (AGGLUTINOGEN) IS PRESENT IN

RBC, ITS CORRESPONDING ANTIBODY
(AGGLUTININ) MUST BE ABSENT FROM PLASMA.

Ifa person has antigen A , he cannot have , A

antibody
DIFFERENT BLOOD GROUPS

 
• Differences in human blood are due to the presence or
absence of certain protein molecules called antigens &
antibodies.
                                                    

• Antigens are located on the surface of the RBC’S &

antibodies are in blood plasma.

• Individuals have different types and combinations of

these molecules.  

 
• Blood group you belong to depends on what you have
               

inherited from your parents.

•There are more than 20 genetically determined blood
group systems known today

• The AB0 and Rhesus (Rh) systems are the most

important ones used for blood transfusions.

• Not all blood groups are compatible with each other.

•Mixing incompatible blood groups leads to blood

clumping or agglutination, which is dangerous for
individuals.
ABO blood grouping system

According to the ABO blood

typing system there are four
different kinds of blood types:

A, B, AB or O (null).

 
AB0 blood grouping system
Blood group A
If you belong to the blood group
               A, you have A antigens on the
surface of your RBCs and B
antibodies in your blood plasma.

              
Blood group B
If you belong to the blood
 
group B, you have B antigens
on the surface of your RBCs
and A antibodies in your blood
plasma.
              
Blood group AB
               If you belong to the blood group
AB, you have both A and B
antigens on the surface of your
RBCs and no A or B antibodies
               at all in your blood plasma.

 
Blood group O
If you belong to the blood group O
(null), you have neither A or B
antigens on the surface of your RBCs
but you have both A and B antibodies
in your blood plasma.
 ABO INHERITANCE AND GENETICS
•
•The ABO gene is autosomal (the gene is not on either sex
chromosomes)

• The ABO gene locus is located on the chromosome 9.

• A and B blood groups are dominant over the O blood group

• A and B group genes are co-dominant

• Each person has two copies of genes coding for their ABO blood group
(one maternal and one paternal in origin)
 GENOTYPE.

Genetic make-up of a cell, an organism & an individuals.

PHENOTYPE

Physical appearance & biochemical characteristics of

organism as determine by both genetic make-up &
environment.
Expression of a specific trait such as blood type, stature or
skin according to genetic make-up & environment.
Possible Blood group Genotypes

Parent A B O
Allele
A

O
 Possible Blood group Genotypes

Parent A B O
Allele

A AA AB AO

B AB BB BO

O AO BO OO
The ABO blood groups

• The most important in assuring a safe blood transfusion.

• The table shows the four ABO phenotypes ("blood groups") present in
the human population and the genotypes that give rise to them.

Blood Antigens
Antibodies in Serum Genotypes
Group on RBCs

A A Anti-B AA or AO
B B Anti-A BB or BO
AB A and B Neither AB
O Neither Anti-A and anti-B OO
Why group A blood must never be given to a
group B person?  
                             
                      
                     
                 
                        
                      
                 
                         

                         

•Giving someone blood from the wrong ABO group

   
                               

could be fatal.                                  

                            

                          
     

                                 
•The anti-A antibodies in group B attack group A
                 

cells and vice versa.

 The Rhesus (Rh) System

• Well, it gets more complicated here, because there's another

antigen to be considered - the Rh antigen.

•Rh antigens are transmembrane proteins with loops exposed

at the surface of red blood cells.

• They are named for rhesus monkey in which they were first
discovered.

• RBCs that are "Rh positive" express the antigen designated D.

• 85% of the population is RhD positive, the other 15% of the

population is running around with RhD negative blood.
Do you know which blood group you
belong to?

According to above
blood grouping systems,
you can belong to either
of following 8 blood
groups:
Blood transfusions – who can
receive blood from
whom?
              
People with blood group O
are called "universal
donors" and people with
 
blood group AB are called
"universal receivers."
Blood Antigens Antibodies Can give Can
Group blood to receive
blood from

AB

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

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

A A B A and AB A and O

B B A B and AB B and O

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

Difference Between Rh & ABO system

In ABO system antibody(agglutinin)are responsible

for causing transfusion reactions which develop
spontaneously while in Rh system spontaneous
agglutination never occur.
MISMATCHED BLOOD TRANSFUSION
 BLOOD TRANSFUSION
Blood transfusion is the process of receiving blood
products into one's circulation intravenously.

Transfusions are used in a variety of 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
asRBC’S,WBC’S, plasma, clotting factors and platelets.
 COMPATIBILITY TESTING
Beforea recipient receives transfusion, compatibility testing
between donor & recipient blood done.

Firststep before transfusion is to Type and Screen the

recipient's blood.

1. Typing of recipient's blood determines the ABO and Rh

status.

2. Sampleis then Screened for any alloantibodies that may

react with donor blood.
 INDICATIONS OF BLOOD TRANSFUSION

Hemorrhage
Anemia
Burns

BLOOD SUSTITUTES

Human plasma
Colloids (albumin)
Sodium chloride solution
 EARLY COMPLICATIONS

ACUTE HEMOLYTIC REACTION

In intravascular hemolysis,
incompatible transfused red cells react with the recipient’s
red cell antibodies, resulting in complement activation and
the generation of cytokines.

FEBRILEHEMOLYTIC REACTION
ALLERGIC REACTIONS
JAUNDICE
Cardiac shock
Acute kidney failure
Anemia

Discomfort

Lung dysfunction
Bacterial contamination
Viral infections
Volume overload
 EARLY SYMPTOMS

Bloody urine
Chills

Fainting or dizziness
Fever

Flank pain or back pain

Rash
 LABORATORY TESTS
Bilirubin
CBC
Coombs' test
Hematocrit
Hepatoglobin
Hemoglobin
RBC count
Serum creatinine
Serum hemoglobin
Urinalysis
 TREATMENT

Antihistamine drugs can treat itching and rash.

The pain reliever, can reduce fever and discomfort.

Corticosteroids(such as prednisone or dexamethasone) can

reduce the immune response.

Fluids given through a vein (intravenous) and other

medications may be used to treat or prevent kidney failure
and shock.
CATEGORY 1: MILD REACTIONS

Signs Symptoms Possible Cause Immediate Management

Urticaria/rash Pruritis (itching) Allergic 1.Stop transfusion

2.Assess patient
3.An antihistamine may
be required
4.Transfusion may be
restarted if no other
signs/symptoms are
present
CATEGORY 2: MODERATELY SEVERE REACTIONS

Signs Symptoms Immediate Management

Flushing Anxiety
1.Stop transfusion and maintain
Urticaria Pruritis IV line with N Saline
Rigors Palpitations
2.Patient may require
Fever Mild dyspnoea
antihistamine and/or paracetamol

Restlessnes Headache

Tachycardia
 HEMOLYTIC DISEASE OF NEW BORN
ERYTHROBLASTOSIS FETASIS

 Father Rh positive.
 Mother Rh negative.
 Fetus Rh positive.

• Mother develops anti-Rh agglutinis from exposure to

fetus’s Rh antigen.

• In turn the mothers agglutinins diffuse through the placenta

into the fetus and cause red blood agglutination
 CLINICAL PICTURE

Jaundiced erythroblastic anemic newborn.

RBC with nucleated blastic forms.

Mental impairment in the children because of precipitation

of bilirubin in neuronal cells damaging motor areas
permanently resulting in condition called
KERNICTURUS.
 TREATMENT

Replace neonatal blood with Rh NEGATIVE BLOOD

PREVENTION:
Anti- D antibody administration to the
Rh negative mother.
A transplant of a tissue or whole organ from one part of the
same animal to another part is called an AUTOGRAFT.

 From one identical twin to another, an ISOGRAFT.

 Fromone human being to another or from any animal to

another animal of the same species, an ALLOGRAFT.

 From a lower animal to a human being or from an animal or

one species to one of another species, a XENOGRAFT.
PREVENTION OF GRAFT REJECTION BY
SUPPRESSING THE IMMUNE SYSTEM

 Ifthe immune system were completely suppressed, graft

rejection would not occur.

T cells are mainly important for killing grafted cells, their

suppression is much more important than suppression of
plasma antibodies.

 Some of the therapeutic agents used for this purpose include.

1. Glucocorticoid hormones (or drugs with glucocorticoid-like
activity) suppress the growth of lymphoid tissue, therefore
decrease formation of antibodies and T cells.

2. Various drugs that have a toxic effect on the lymphoid

system block formation of antibodies and T cells, especially
azathioprine.

3. Cyclosporine which has a specific inhibitory effect on the

formation of helper T cells.