12- Blood Groups and Blood Transfusion.pdf

Blood transfusion and blood grouping, the ABO SYSTEM, RHESUS SYSTEM AND OTHER BLOOD GROUPS.

1. BloodGroups and Blood
Transfusion
Dr Oreb
Nankunda

2. Objectives;
Intendedlearningoutcomes(ILOs)
AfterreviewingthePowerPointpresentationandtheassociated
learningresources,thestudentshouldbeableto:
❑Describe theABOandRhesus bloodgroup systems
❑Recognize agglutininsinthe plasma
❑Describe grouping,cross-matching & typingwithanti-sera
❑Listprecautionstaken in preparingbloodfortransfusion and
storage of blood
❑Define autologous transfusion and list itsadvantages
❑Describe transfusion reactions.
❑Define hemolyticdiseaseofnewborn(HDN)

3. LearningResources
Guytonand Hall,Textbook ofMedical
Physiology;13
th
Edition; UnitVI-Chapter
36.

4. Blood Typing
❑RBCsurfaces aremarkedbygeneticallydeterminedantigens
-Agglutinogens or isoantigens
❑Bloodistyped(grouped)basedonsurface antigens
❑Atleast 30commonantigensand100sofrare antigenshavebeen
foundon thesurfacesofhumanbloodcells
❑TheABOandRhesus (Rh) systemsofantigensareof majorclinical
importanceastheyare associated withtransfusion reactions
when mismatched
❑Otherantigensareless likelytocausereactions;however, they
areof forensicimportance (establishparentage).

5. Karl Landsteiner
❑1901:wasthefirstto discover
theABO bloodagglutinins&
classifiedbloodgroups
accordingly.
❑1930:awardedtheNobel
PrizeinPhysiology&Medicine
forhisdiscovery
❑1937:WithAlexanderS.
Wiener,heidentifiedtheRh
factor.

6. Blood Typing
ABO blood group:
A and B antigens are foundin:
-Most cells:RBCs, WBCs and platelets
-In secretions:saliva,sweat,semen
-They areglycoproteins, complex oligosaccharides that
differ intheirterminalsugar
•RBCs with Aantigen =Type A blood
•RBCs with B antigen= Type Bblood
•RBCswith neitherantigens = Type O blood
•RBCs with both antigens =Type AB blood
•DetectionofAand B antigens indriedblood stains is of
forensic importance

7. ABOBloodGroupFrequency
Bloodgroup %Distribution
O 47%
A 41%
B 9%
AB 3%
FrequencyofABOhasethnicvariation

8. GeneticDeterminationof ABOAntigens
Genotypes BloodTypes Agglutinogens
OO O -
OAor AA A A
OBorBB B B
AB AB AandB
❑Twogenes(onematernalandonepaternalinorigin),oneoneachofthetwopairedchromosomes
number 9,determinethe O-A-Bbloodtype.
❑Thesegenescanbeanyoneofthreetypesbutonlyonetypeoneachofthetwochromosomes
number 9:typeO,typeA,ortypeB.
❑ThetypeOgeneiseitherfunctionlessoralmostfunctionless,sothatitcausesnosignificanttypeO
agglutinogenonthecells.Conversely,thetypeAandtypeBgenesdocausestrongagglutinogenson
thecells.
❑ThetypeAandtypeBgenesareco-dominant.ThismeantthatifapersoninheritedonetypeAgene
and onetypeBgene,theirred cellswouldpossessboththeAandBantigens

9. ABOBloodGroupInheritance
Mother/Father OO AA,AO BB,BO AB
OO
o
O,A O,B A,B
AA,AO O,A O,A O,A,B,AB A,B,AB
BB,BO O,B O,A,B,AB O,B A,B,AB
AB A,B A,B,AB A,B,AB A,B,AB

10. PhenotypePossible
Genotype
Agnes:A AAorAO
Moses:B BBorBO
Baby:O OO
The Questionof Paternity
❑Bloodtypescannotbeusedtoprovepaternity.
❑Bloodtypescandisprovepaternity.
❑Agnesblood(typeA)andMosesblood(type B)Haveababy(blood
typeO)CanMosesbethefather?

11. Rh factor (D):
❑There areeightdifferent Rhagglutinogens,threeof
which(C,D, and E)arecommon
❑Rhfactor (antigen)areacomplexsystem ofantigens
with Mendelian inheritanceCc,Dd,Ee
❑Rh factor(antigen)wasfirstdiscoveredin bloodof
Rhesusmonkey.Rh factors only detectable on RBCs
❑C, D & E antigens (Dis themost immunogenic)
•RBCswith Dprotein =Rh
+
•RBCswithoutDprotein= Rh
–
85%ofcaucasians,95%of black Americans,
99%ofchineseandnearly100%ofblack
AfricansareRh+
Blood Typing
Locus ofallelesresponsible
of ABOsystemison
longarmof chromosome 9
whileRhlocusison
chromosome1

12. ❑Plasma containsisoantibodiesor agglutinins
(IgM)to theA or Bantigensnotfoundinthe
blood:
–anti-AantibodyreactswithantigenA.
–anti-BantibodyreactswithantigenB.
❑Anti-AandAnti-Bantibodiesarenot present
at birth.Twoto 8 monthsafter birth,aninfant
beginsto produceagglutinins.Amaximum
titerisusuallyreachedat8to 10 yearsof age,
andthisgraduallydeclinesthroughoutthe
remainingyearsof life.
❑Normalplasmacontainsno anti-Rh(anti-D)
antibodies.
❑Anti-Rhantibodies(IgG)developonlyinRh
-
bloodtypeandonlywithexposuretothe
antigen:
–transfusionofpositiveblood.
–duringapregnancywithapositiveblood
typefetus.
Agglutinins
LANDSTEINER'sLAW:
1.If anagglutinogenispresentonredbloodcell
membrane,thecorrespondingagglutininmustbe
absentintheplasma.
2.If anagglutinogenisabsentonredbloodcell
membrane,thencorrespondingagglutininmustbe
presentinthe plasma.
3.Thislawisonly applicabletoABObloodgrouping
system.

13. Agglutinins
❑Anti-Rhantibodies(IgG)developonlyinRh
-
bloodtypeandonlywithexposure
totheantigen:
–transfusionofpositiveblood.
–duringapregnancywith apositivebloodtype fetus.
❑Anti-RhantibodiesarenotspontaneouslyformedinRh
–
individuals.
❑However,if anRh
–
individual receivesRh
+
blood,anti-Rhantibodiesform.
❑Anti-Rhagglutininsdevelopslowly(2-4months).Onceproducedtheypersist
for yearsandcanproduceserioustransfusionreactionduring2
nd
transfusion.
❑Thisimmuneresponseoccursto amuchgreaterextentinsomepeoplethanin
others.WithmultipleexposurestotheRhfactor,anRh-negativeperson
eventuallybecomesstrongly"sensitized"toRhfactor.

14. Agglutinins
GenotypesBloodTypesAgglutinogensAgglutinins
OO O - Anti-A&
Anti-B
OAorAA A A Anti-B
OBorBB B B Anti-A
AB AB A+B -

15. ABOBlood Typing
•WithABO,personmakes antibodies(agglutinens;IgM)againstfactors
(agglutinogens)he/shedoesNOThave onhis/hercells

16. Blood Typingand Agglutination

17. ABOBlood Typing
BloodType A B AB[1] O[2]
Agglutinogens(antigen
proteins)Present
A B A&B (neither)
MakesAgglutinins
(antibodies)Against
B A (neither) A&B
MayReceiveBloodFrom: A,O B,O A,B,AB,O O
MayGiveBloodTo: A,AB B,AB AB A,B,AB,O
RhFactor
Presentor
Absent
(A+orA-)
Presentor
Absent
(B+orB-)
PresentorAbsent
(AB+orAB-)
Presentor
Absent
(O+orO-)
[1]UniversalRecipient [2]UniversalDonor

19. Blood
Group
AntigensAntibodiesCan give
bloodto
Canreceive
bloodfrom
AB
A
B
O

20. Blood
Group
AntigensAntibodiesCan give
bloodto
Canreceive
bloodfrom
AB A andB None AB AB,A,B, O
A A anti-B A andAB A andO
B B anti-A B and AB B and O
O None anti-A and
anti-B
AB,A,B, O O

21. Rh BloodTypes
BloodType Rh
+
Rh
-
AgglutinogenD(antigenproteins)
PresentorAbsent
Present Absent
MakesAgglutinins(antibodies)Against
Agglutinogen
No Yes[1]
MayReceiveBloodFrom: Rh
+
orRh
-
Rh
-[2]
MayGiveBloodToWithoutReaction
[2]
: Rh
+
Rh
+
orRh
-
Genotype DDorDd dd
[1]Onlymakesantibodies(agglutinens)afterexposuretoRh+bloodcells(viatransfusionorduringbirth
process)
[2]TransfusionofRh
-
individualwithRh+bloodresultsinproductionofanti-Dagglutinens;sensitizespersonto
Rhfactorandmayresultinanaphylaxisifexposedasecondtime.ErythroblastosisfetalisariseswhenRh
-
mother
hasbeenexposedtoRh
+
bloodandiscarryingRh
+
child.

22. UniversalDonor;Suitable forall?
Universaldonor:
❑BloodgroupO,Rhnegative.
❑Maybe given in emergencyto patientswith eitherA,B, AB
andRh negativeor positivebloodgroups.
❑Antibodyconcentrations maybehigh, somaynot besuitable
iflargevolume ofbloodrequired.
Universalrecipient:
❑Peoplewith type ABblood arecalled “universalrecipients”
since haveno antibodies inplasma.

23. Importanceof BloodGroups
❑Inbloodtransfusion.
❑Inpreventinghemolyticdisease(Rhincompatibility).
❑Inpaternitydisputes.
❑Inmedico-legalcases.
❑Inknowingsusceptibilitytodisease
❑GroupO-duodenalcancer
❑GroupA-Carcinomaofstomach,pancreas&salivary
glands

24. Blood Transfusion
Indicationsofbloodtransfusion:
1. Acutehemorrhage.
2. Severeanemia(ifHbdecreasedbelow6g/dL).
3. Erythroblastosisfetalis:in thiscaseexchangetransfusion(all
bloodischanged)is done.
4.Tosupplynecessaryelementse.g.platelets,packedRBCs,
andsomeclottingfactors.

25. RequirementsPrior to Blood Transfusion
•Typing(grouping)oftherecipient:determiningredcellantigensinblood
-ABOtyping
-Rhtyping
•Cross-matching:
Donor’scells+Recipient'sserum
•AntibodyScreening:
–HepatitisBandCvirus
–Antibodyto HIV
–HIVAntigens
–Syphilis
–Cytomegalovirus

26. containantibodiesanti-A,anti-B
donorcells withrecipient’s
causesagglutination(visible
Typingand Cross-MatchingBlood
❑Typing involvestestingblood
with known antiserathat
or anti-Rh.
❑Cross-matchingis mixingof
serum.
❑Mixingofincompatibleblood
clumping):
❑formation of antigen-
antibodycomplexthatsticks
cellstogether(agglutination
reaction).

27. ABOBloodGrouping(Typing)in LaboratoryUsingAnti-sera
Group Anti-A Anti-B
A Agglutination Nil
B Nil Agglutination
ABAgglutinationAgglutination
O Nil Nil

30. TransfusionReactions
❑Incompatiblebloodtransfusions
–Mixingof incompatible bloodcauses theformationof antigen-
antibody complexesbetween recipient’splasma antibodiesand
“foreignproteins; antigens”ondonated RBC's (agglutination)
–Donated RBCsbecomeleakyand burst→diminishedoxygen-
carryingcapacity
–Clumpedcellsimpede bloodflow
–RupturedRBCs release freehemoglobinintothe bloodstream→
circulatinghemoglobinprecipitatesinthekidneys andcauseskidney
damageand renal failure
❑Problemsare causedbyincompatibilitybetween donor’scellsand
recipient’splasma
•Why dodonorantibodiesnot attackrecipientRBCs
•Donorplasmais toodilutedto causeproblems

31. Question
Transfusionreactionoccursbetweenwhichofthefollowing?
-Donor’splasma agglutininsagainstthered cellantigensoftherecipient
-Donor’sred cellantigensagainstplasma agglutininsof therecepient
-Both
Explain

32. HemolyticDiseaseofNewborn
❑Duringbirth,thereis oftena leakage
of thebaby'sredbloodcellsintothe
mother'scirculation.
❑IfthebabyisRh-positive(having
inheritedthe traitfrom itsfather)and
the motherRh-negative,thesered
cellswillcause her todevelop
antibodies(IgG class)againsttheRhD
antigenunlessshe receives ananti-D
injectionsoonafter firstdelivery or
abortion.
❑Anti-Dbindstofetalredbloodcells
andremove themfrom bodybefore
shereacts
❑In2
nd
child,hemolyticdiseaseof the
newborn maydevelop causing
hemolysisof thefetalRBCs→anemia
andjaundice.

34. HemolyticDiseaseofNewborn
❑Hemolyticanemia:
–Ifsevere:
treatedwithexchange
transfusion:Replacebaby
bloodwithRh-veRBC
(severaltimes)
❑Hydropsfetalis(deathin
utero)
❑Kernicterus(yellow,
jaundicebaby)
Prevalence ofDisease
1
st
Pregnancy:0%
2
nd
Pregnancy:3
3
rd
Pregnancy:10%

35. Fetal Incompatibility
❑Mostanti-Aoranti-BantibodiesareoftheIgMclassand
thesedonotcrosstheplacenta.
❑Thus,anRh
−
/typeOmothercarryinganRh
+
/typeA,B,or
ABfoetus isresistanttosensitizationtotheRhantigen.
❑Heranti-A andanti-Bantibodiesdestroyanyfetal cells
thatenterherbloodbeforetheycanstimulateanti-Rh
antibodiesin her.

36. Prevention of Hemolytic Disease of Newborn
Rhimmuneglobulin(RhIg)orRhogamoranti-D:
❑ShortlyaftereachbirthofanRh-positivebaby,the
motherisgivenaninjectionofanti-Rhantibodies.
❑TheseantibodiesdestroyanyRh+fetal cellsthatgot
intothematernalcirculationbeforetheycan
stimulateanactiveimmuneresponseinthemother.
❑TheroutineadministrationofsuchtreatmenttoRh-
vemothersafter thedeliveryofRh+vebabyhas
reducedtheincidenceofdiseaseby>90%.
❑FetalRhtypingfromamniocenthesis,andtreatment
withsmalldoseofRhimmuneserumwillprevent

37. sensitizationduringpregnancy.

38. Objectives;
Intendedlearningoutcomes(ILOs)
AfterreviewingthePowerPointpresentationandtheassociated
learningresources,thestudentshouldbeableto:
❑Describe theABOandRhesus bloodgroup systems
❑Recognize agglutininsinthe plasma
❑Describe grouping,cross-matching & typingwithanti-sera
❑Listprecautionstaken in preparingbloodfortransfusion and
storage of blood
❑Define autologous transfusion and list its advantages
❑Describe transfusion reactions.
❑Define hemolyticdiseaseofnewborn(HDN)

39. ThankYou