Blood group

physiology

1. BLOOD GROUPS & BLOOD TRANSFUSION Presented by: Dr. Mujtaba Ashraf MDS JR-1 Dept. of Prosthodontics 16/09/2015 1 Mujtaba Ashraf

2. Introduction Blood group systems   ABO blood group system Rh blood group system Contents 16/09/2015 2 Mujtaba Ashraf

3. Blood transfusion Introduction Precautions „ Adverse effect Of Blood Transfusion Exchange Transfusion 16/09/2015 3 Mujtaba Ashraf

4. Introduction A blood group 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) These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system. 16/09/2015 4 Mujtaba Ashraf

5. ABO Blood Group System 16/09/2015 5 Mujtaba Ashraf

6. 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. 16/09/2015 6 Mujtaba Ashraf

7. 16/09/2015 Mujtaba Ashraf 7 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 .

8. 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. History Karl Landsteiner 16/09/2015 8 Mujtaba Ashraf

9. 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   16/09/2015 9 Mujtaba Ashraf

10. Landsteiner Rule If an antigen is present on a patients red blood cells (RBCs) the corresponding antibody will NOT be present in the patients plasma, under ‘normal conditions’. 16/09/2015 10 Mujtaba Ashraf

11. ABO BASICS Based on the presence or absence of antigen A and antigen B, blood is divided into four groups: ‘A, B, AB and ‘O’ group. Blood having antigen A belongs to ‘A’ group. This blood has β-antibody in the serum. 16/09/2015 11 Mujtaba Ashraf

12. 16/09/2015 Mujtaba Ashraf 12 Blood with antigen B and α-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 α and β antibodies are present in the serum.

13. 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 Antigen and Antibody Present in ABO Blood Group 16/09/2015 13 Mujtaba Ashraf

14. 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. 16/09/2015 14 Mujtaba Ashraf

15. 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. 16/09/2015 15 Mujtaba Ashraf

16. 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’. 16/09/2015 16 Mujtaba Ashraf

17. 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’. 16/09/2015 17 Mujtaba Ashraf

18. 16/09/2015 Mujtaba Ashraf 18 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.

19. Blood Compatibility 16/09/2015 19 Mujtaba Ashraf

20. 16/09/2015 Mujtaba Ashraf 20 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.

21. Rh Blood Group System 16/09/2015 21 Mujtaba Ashraf

22. 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. 16/09/2015 22 Mujtaba Ashraf

23. 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. 16/09/2015 23 Mujtaba Ashraf

24. 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’. 16/09/2015 24 Mujtaba Ashraf

25. 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. 16/09/2015 25 Mujtaba Ashraf

26. Symptoms and signs in the fetus : Enlarged liver spleen, or heart fluid buildup in the fetus' abdomen seen via ultrasound. 16/09/2015 26 Mujtaba Ashraf

27. 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. 16/09/2015 27 Mujtaba Ashraf

28. Other Blood Group System 16/09/2015 28 Mujtaba Ashraf

29. 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. 16/09/2015 29 Mujtaba Ashraf

30. An individual can be AB Rh D positive, and at the same time M and N positive (MNS system), K positive (Kell system), and Le a  or Le b  positive (Lewis system). Many of the blood group systems were named after the patients in whom the corresponding antibodies were initially encountered. 16/09/2015 30 Mujtaba Ashraf

31. 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 16/09/2015 31 Mujtaba Ashraf

32. Blood Transfusion 16/09/2015 32 Mujtaba Ashraf

33. 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. 16/09/2015 33 Mujtaba Ashraf

34. 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. 16/09/2015 34 Mujtaba Ashraf

35. 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. 16/09/2015 35 Mujtaba Ashraf

36. 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 ) 16/09/2015 36 Mujtaba Ashraf

37. 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. 16/09/2015 37 Mujtaba Ashraf

38. CONDITIONS WHEN BLOOD TRANSFUSION IS NECESSARY Anemia Hemorrhage Trauma Burns Surgery 16/09/2015 38 Mujtaba Ashraf

39. PRECAUTIONS TO BE TAKEN BEFORE THE TRANSFUSION OF BLOOD Donor must be healthy, without any diseases like: a. Sexually transmitted diseases such as syphilis b. 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. 16/09/2015 39 Mujtaba Ashraf

40. 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. 16/09/2015 40 Mujtaba Ashraf

41. 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 16/09/2015 41 Mujtaba Ashraf

42. 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. 16/09/2015 42 Mujtaba Ashraf

43. References Guyton-Physiology-11th edition Essentials of Medical Physiology, 6th Edition By K Sembulingam 16/09/2015 43 Mujtaba Ashraf

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