The Physiology of Blood

BLOOD GROUPS &
TYPES
By
Dr.M.Anthony David MD,
Professor of Physiology
NOMAD:2006: BP:BldgpsI 1
HISTORICAL
 19th CENTURY: Boer War
 Massive deaths of people:
 Many infections
 Severe blood loss
 Attempts to transfuse blood
began.
 They had confusing results.
 Some people recovered fully.
 Others died.NOMAD:2006: BP:BldgpsI 2
WHY? WHY? WHY?
 Either all should die
 Or all should live.
 Why this difference?
 This question haunted a
researcher called Karl

Landsteiner.
 He worked hard to find out
why. NOMAD:2006: BP:BldgpsI 3

KARL LANDSTEINER, NOBEL
LAUREATE, 1930.
1 1
8 9
6 4
8 3
KARL LANDSTEINER
 Wondered about this
phenomenon.
 Studied this extensively.
 Discovered Blood Groups and
types single handedly.
 Framed the Landsteiner’s Law in
1904.
 Continued to research on Blood
groups and types till his death in
1943. NOMAD:2006: BP:BldgpsI 5
LANDSTEINER’S LAW
1.“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.”
LANDSTEINER’S LAW:
APPLICABILITY
 The first law is applicable to all
groups and types of blood.
 It is a logical conclusion.
 The second part is a fact, but not
necessarily true always.
 It is a fact for ABO Blood groups.
 The Rh, M,N and other groups or
types do not follow the second
part of the Landsteiner’s Law.
ABO BLOOD GROUPS
The most common type of

blood grouping in use.
AGGLUTINOGENS
 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.
AGGLUTINOGENS (Contd)
 Some individuals will have
Erythrocytes with an agglutinogen
called as “A”.
 Others have one called “B”
 The third type of agglutinogen is
non antigenic and it is called “H”
 H doesn’t cause production of
antibodies.
 So those having H antigen are
called O group individuals.
A AND B, INDIVIDUALS
 Those having the A agglutinogen
on their erythrocytes are called
A blood group people.
 Those having the B agglutinogen
are called the B blood group
people.
AB & O INDIVIDUALS
 Some have both the A and B
agglutinogens on their
erythrocytes and they are called
AB type.
 Others have neither A nor B
agglutinogens. They have the
non antigenic H on their RBCs
and are called O group people.
AGGLUTININS
 The antibodies to the
agglutinogens are called
Agglutinins.
 These are present naturally in ABO
groups.
 They are always present in the
plasma of the individual.
 There are two types of agglutinins
in the ABO blood system:
 Anti A or α: Alpha
 Anti B or β: Beta
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.
ABO BLOOD GROUPS
GROUP AGGLUTINOGEN/S AGGLUTININ/S
ON RBC IN PLASMA
A A β
B B α
AB Both A & B None
O Neither A nor B Both α and β
ABO BLOOD GROUP TEST
 Why test?
 To determine the blood
groups.
 How is the test done?
 The erythrocytes of the
patient are exposed to the

two different types of anti
sera. NOMAD:2006: BP:BldgpsI 17
 Antisera are solutions containing the
respective agglutinins.
 Anti A agglutinin is present in
Antisera A
 Anti sera B contains Beta agglutinin
or anti B agglutinin.
 In this test the patients erythrocytes
are exposed separately to both these
antisera.
 Agglutination is seen in one or more
of the solutions.
AGGLUTINATION
 Agglutination or clumping is seen
whenever the respective
agglutinogens and agglutinins are
mixed.
 Agglutinogen A + Agglutinin Alpha =
Agglutination.
 Agglutinogen B + Agglutinin Beta =
Agglutination.
 Both agglutinogens + Both antisera
= Agglutination.
 No agglutinogens
NOMAD:2006:= No
BP:BldgpsI 19
 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
 By doing this test we can
determine the blood group of
individuals.
 Knowing one’s blood group helps
us in times of need. If a patient
is of Group A, he can receive
blood as transfusion from group
A or group O individuals. He
cannot receive it from Group B or
Group AB people.
 Why?
 Because the agglutinogens in
the donor’s blood can

agglutinate with the
agglutinin in the recipient’s
blood and cause hemolysis.
 This is called transfusion
mismatch and can be fatal.

UNIVERSAL DONOR &
RECEPIENTS
 The blood group O can be given
to any other of the ABO group
persons and so is called the
“Universal Donor”
 The blood group AB persons lack
agglutinins and so can receive
blood from any of the ABO group
persons. So this AB group is
called as the “Universal
Recipient” NOMAD:2006: BP:BldgpsI 23
DONATIONS…
 A Blood group person can donate
blood to A and AB groups.
 B Blood group person can donate
blood to B and AB groups.
 AB Blood group person can
donate blood only to AB group.
 O blood group person can donate
blood to O, A, B and AB groups.
ABO BLOOD GROUP TEST:
SUMMARY
RED ANTISERA ANTISERA
CELLS ALPHA BETA
A AGGLUTINATIO NO
N AGGLUTINATIO
B NO AGG. N
AGGLUTINATIO
N
AB AGGLUTINATIO AGGLUTINATIO
N N
O NO NO
AGGLUTINATIO AGGLUTINATIO
N
NOMAD:2006: BP:BldgpsI N 27
CROSS MATCHING
 This is a test done just
before the blood is
transfused.
 It helps rule out other
group mismatches.
 It has two parts: Major &
Minor cross matching.

MAJOR CROSS MATCHING
 The effects of the recipient’s
serum agglutinins on the
donors erythrocytes.
 This is called major because
about 300 ml of the Blood cells
of the donor are sent into the
circulation of the recipient.
 Donor’s Erythrocytes+
Recipient’s plasma= ?
MINOR CROSS MATCHING
 The Effect of the donor’s serum
agglutinins on the recipient’s
erythrocytes.
 This is called minor because
these agglutinins get diluted by
the larger volume of the
recipient’s plasma.
 Donor’s Serum + Recipient’s
Erythrocytes
PERCENTAGE OF BLOOD
GROUPS
WESTERN POPULATION A
B
3 O
AB
42
46
9
PERCENTAGE OF BLOOD
GROUPS
ASIAN POPULATION A
B
5 O
25 AB
45
NOMAD:2006: BP:BldgpsI 25 32
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.
Rh Positive and Negative
people
 People who have the Rh
agglutinogen on their RBC
membranes are called Rh Positive.
 Those who do not have the Rh
agglutinogen are called Rh
Negative people.
 Rh-ve people do not NATURALLY
carry the corresponding Anti-Rh
antibody. NOMAD:2006: BP:BldgpsI 34
DISTRIBUTION OF Rh
TYPES
C AUC ASIAN POPULATION
15
Rh+ve
Rh-ve
85
DISTRIBUTION OF Rh
TYPES
ORIE NTAL POPULATION Rh+ve
Rh-ve
5
95
Rh or D Agglutinins
 Anti-D agglutinins or antibodies do
not occur naturally.
 They are produced by the Immune
systems as and when it is exposed to
the D antigens.
 So these Anti D agglutinins are found
only in some of the Rh Negative
people.
 Those who have been exposed to the
Rh or D antigen
Exposure to Antigens:
How?
 The Rh+ve people will never
manufacture Anti D antibodies.
 Only Rh – ve individuals can
develop these Agglutinins.
 When these Rh-ve people receive
Rh+ve blood by mistake, they
get exposed to the antigen.
 Then they will develop the
antibody. NOMAD:2006: BP:BldgpsI 38
How?
 In case of an Rh-ve woman, if
she is married to an Rh+ve
man, she can conceive an
Rh+ve child.
 In this case, the D antigen
present on the erythrocytes

of the fetus does not go into
the maternal circulation
throughout the pregnancy
How?
 During the delivery of the baby,
some blood of the fetus spills
over into the maternal
circulation.
 The maternal circulation is
exposed to the D antigens from
the fetal erythrocytes.
 The maternal circulation slowly
develops Anti D antibodies.
 The first child is however spared.
NOMAD:2006: BP:BldgpsI
ERYTHROBLASTOSIS FETALIS
 The second child in such a

woman, if also Rh+ve, can
develop a disease called as
Erythroblastosis fetalis.
 This is due to the Anti D
antibodies developed in the
mother.
 These antibodies traverse
through the placenta, enter the
fetal circulation and
cause 41
agglutination of the
PATHOPHYSIOLOGY OF
ERYTHROBLASTOSIS FETALIS
MATERNAL
CIRCULATION
P FETAL
CIRCULATION
Anti-D L Agglutination of RBCs
Antibodies A
Hemolysis
C
E Hemoglobin in Plasma
Blocks Renal
N Tubules Bilirubin
T Jaundice
A Renal Failure
Kernicterus
NORMAL JAUNDICED
ERYTHROBLASTOSIS FETALIS or
ICTERUS GRAVIS NEONATORUM
 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 44
hours after preterm or term birth

ERYTHROBLASTOSIS:
PREVENTION
 All pregnant women to be tested
for Rh.
 If any are Rh-ve, their husbands
also to be tested for Rh.
 The first baby’s blood to be
tested for Rh.
 If Rh+ve, then the mother to be
given Rhogam injection within 24
hrs after delivery.
TREATMENT OF
ERYTHROBLASTOSIS
 EXCHANGE TRANSFUSION.
 The entire blood of the fetus is
replaced by O Rh-ve blood.
 This is done in small
installments.
 Once it is done, slowly the baby
will recover, as erythropoiesis
occurs while these O –ve cells
die. NOMAD:2006: BP:BldgpsI 46
EXCHANGE TRANSFUSION
AFTER SUCCESSFUL THERAPY
USES OF BLOOD GROUPS
 CLINICAL:
 For transfusion of blood
 To prevent Erythroblastosis fetalis
 MEDICOLEGAL:
 Determination of suspected
parentage
 Can say whether one could or could
not have been the father of a child.
 DNA fingerprinting is more specific.
 GENETIC STUDIES:
EPIDEMIOLOGY.
INCOMPATIBLE
TRANSFUSIONS CAUSE…
MILD REACTIONS SUCH AS:
 Chills and rigors
 Fever
 Inapparent Hemolysis.
 Post transfusion Jaundice.
 Severe transfusion
reactions.
SEVERE TRANSFUSION
REACTIONS
 Violent Backaches.
 Tightness in the chest.
 Jaundice.
 Oliguria.
 Renal Shutdown/Failure.
 Anuria
 Death

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BLOOD GROUPS &

 Why this difference?

 This question haunted a

researcher called Karl

why. NOMAD:2006: BP:BldgpsI 3

The most common type of

AB Both A & B None

O Neither A nor B Both α and β

 The erythrocytes of the

patient are exposed to the

the donor’s blood can

mismatch and can be fatal.

Minor cross matching.

present on the erythrocytes

 The second child in such a

hours after preterm or term birth

 Post transfusion Jaundice.

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