Blood Type - Wikipedia 08-26-2021

8/26/2021 Blood type - Wikipedia
Blood type
A blood type (also known as a
blood group) is a classification of
blood, based on the presence and
absence of antibodies and
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. Some of these antigens are
also present on the surface of other
types of cells of various tissues.
Several of these red blood cell
surface antigens can stem from one
allele (or an alternative version of a
Blood type (or blood group) is determined, in part, by the ABO blood
gene) and collectively form a blood group antigens present on red blood cells.
group system.[1]
Blood types are inherited and

represent contributions from both parents. As of 2019, a total of 41 human blood group systems are
recognized by the International Society of Blood Transfusion (ISBT).[2] The two most important blood
group systems are ABO and Rh; they determine someone's blood type (A, B, AB, and O, with +, − or
null denoting RhD status) for suitability in blood transfusion.
Contents
Blood group systems
ABO blood group system
Rh blood group system
ABO and Rh distribution by country
Other blood group systems
Clinical significance
Blood transfusion
Hemolytic disease of the newborn (HDN)
Blood products
Red blood cell compatibility
Plasma compatibility
Universal donors and universal recipients
Blood typing
Blood group genotyping
https://en.wikipedia.org/wiki/Blood_type 1/14
History
Society and culture
See also
References
Further reading
External links
Blood group systems

A complete blood type would describe each of the 38 blood groups, and an individual's blood type is
one of many possible combinations of blood-group antigens.[2] Almost always, an individual has the
same blood group for life, but very rarely an individual's blood type changes through addition or
suppression of an antigen in infection, malignancy, or autoimmune disease.[3][4][5][6] Another more
common cause of blood type change is a bone marrow transplant. Bone-marrow transplants are
performed for many leukemias and lymphomas, among other diseases. If a person receives bone
marrow from someone who is a different ABO type (e.g., a type A patient receives a type O bone
marrow), the patient's blood type will eventually convert to the donor's type.
Some blood types are associated with inheritance of other diseases; for example, the Kell antigen is
sometimes associated with McLeod syndrome.[7] Certain blood types may affect susceptibility to
infections, an example being the resistance to specific malaria species seen in individuals lacking the
Duffy antigen.[8] The Duffy antigen, presumably as a result of natural selection, is less common in
population groups from areas having a high incidence of malaria.[9]
ABO blood group system
The ABO blood group system involves two

antigens and two antibodies found in human
blood. The two antigens are antigen A and
antigen B. The two antibodies are antibody A
and antibody B. The antigens are present on
the red blood cells and the antibodies in the
serum. Regarding the antigen property of the
blood all human beings can be classified into 4
groups, those with antigen A (group A), those
with antigen B (group B), those with both
antigen A and B (group AB) and those with
neither antigen (group O). The antibodies
present together with the antigens are found as
follows:
ABO blood group system: diagram showing the
1. Antigen A with antibody B carbohydrate chains that determine the ABO blood group
2. Antigen B with antibody A
3. Antigen AB has no antibodies
4. Antigen nil (group O) with antibody A and B.
There is an agglutination reaction between similar antigen and antibody (for example, antigen A
agglutinates the antibody A and antigen B agglutinates the antibody B). Thus, transfusion can be
considered safe as long as the serum of the recipient does not contain antibodies for the blood cell
antigens of the donor.
The ABO system is the most important blood-group system in human-blood transfusion. The
associated anti-A and anti-B antibodies are usually immunoglobulin M, abbreviated IgM, antibodies.
It has been hypothesized that ABO IgM antibodies are produced in the first years of life by
sensitization to environmental substances such as food, bacteria, and viruses, although blood group
compatibility rules are applied to newborn and infants as a matter of practice.[10] The original
terminology used by Karl Landsteiner in 1901 for the classification was A/B/C; in later publications
"C" became "O".[11] Type O is often called 0 (zero, or null) in other languages.[11][12]
Phenotype and genotype

of blood types
Phenotype Genotype
A AA or AI
B BB or BI
AB AB
O II
Rh blood group system
The Rh system (Rh meaning Rhesus) is the second most significant blood-group system in human-
blood transfusion with currently 50 antigens. The most significant Rh antigen is the D antigen,
because it is the most likely to provoke an immune system response of the five main Rh antigens. It is
common for D-negative individuals not to have any anti-D IgG or IgM antibodies, because anti-D
antibodies are not usually produced by sensitization against environmental substances. However, D-
negative individuals can produce IgG anti-D antibodies following a sensitizing event: possibly a
fetomaternal transfusion of blood from a fetus in pregnancy or occasionally a blood transfusion with
D positive RBCs.[13] Rh disease can develop in these cases.[14] Rh negative blood types are much less
common in Asian populations (0.3%) than they are in European populations (15%).[15]
The presence
or absence of the Rh(D) antigen is signified by the + or − sign, so that, for example, the A− group is
ABO type A and does not have the Rh (D) antigen.
ABO and Rh distribution by country
As with many other genetic traits, the distribution of ABO and Rh blood groups varies significantly
between populations.
Other blood group systems
As of 2019, 36 blood-group systems have been identified by the International Society for Blood
Transfusion in addition to the ABO and Rh systems.[2] Thus, in addition to the ABO antigens and Rh
antigens, many other antigens are expressed on the RBC surface membrane. For example, an
individual can be AB, D positive, and at the same time M and N positive (MNS system), K positive
(Kell system), Lea or Leb negative (Lewis system), and so on, being positive or negative for each blood
group system antigen. Many of the blood group systems were named after the patients in whom the
corresponding antibodies were initially encountered. Blood group systems other than ABO and Rh
pose a potential, yet relatively low, risk of complications upon mixing of blood from different
people.[16]
Following is a comparison of clinically relevant characteristics of antibodies against the main human
blood group systems:[17]
ABO Rh Kell Duffy Kidd

Naturally occurring Yes No No No No
Most common in immediate hemolytic transfusion reactions A Yes Fya Jka
Most common in delayed hemolytic transfusion reactions E,D,C Jka

Most common in hemolytic disease of the newborn Yes D,C Yes
Commonly produce intravascular hemolysis Yes Yes
Clinical significance
Blood transfusion
Transfusion medicine is a specialized branch of hematology that is concerned with the study of blood
groups, along with the work of a blood bank to provide a transfusion service for blood and other blood
products. Across the world, blood products must be prescribed by a medical doctor (licensed
physician or surgeon) in a similar way as medicines.
Much of the routine work of a blood bank involves testing blood

from both donors and recipients to ensure that every individual
recipient is given blood that is compatible and is as safe as
possible. If a unit of incompatible blood is transfused between a
donor and recipient, a severe acute hemolytic reaction with
hemolysis (RBC destruction), kidney failure and shock is likely to
occur, and death is a possibility. Antibodies can be highly active
and can attack RBCs and bind components of the complement
system to cause massive hemolysis of the transfused blood.
Patients should ideally receive their own blood or type-specific

blood products to minimize the chance of a transfusion reaction.
It is also possible to use the patient's own blood for transfusion.
This is called autologous blood transfusion, which is always Main symptoms of acute hemolytic
compatible with the patient. The procedure of washing a patient's reaction due to blood type
own red blood cells goes as follows: The patient's lost blood is mismatch.[18][19]
collected and washed with a saline solution. The washing
procedure yields concentrated washed red blood cells. The last
step is reinfusing the packed red blood cells into the patient. There are multiple ways to wash red
blood cells. The two main ways are centrifugation and filtration methods. This procedure can be
performed with microfiltration devices like the Hemoclear filter. Risks can be further reduced by
cross-matching blood, but this may be skipped when blood is required for an emergency. Cross-
matching involves mixing a sample of the recipient's serum with a sample of the donor's red blood
cells and checking if the mixture agglutinates, or forms clumps. If agglutination is not obvious by
direct vision, blood bank technicians usually check for agglutination with a microscope. If
agglutination occurs, that particular donor's blood cannot be transfused to that particular recipient.
In a blood bank it is vital that all blood specimens are correctly identified, so labelling has been
standardized using a barcode system known as ISBT 128.
The blood group may be included on identification tags or on tattoos worn by military personnel, in
case they should need an emergency blood transfusion. Frontline German Waffen-SS had blood group
tattoos during World War II.
Rare blood types can cause supply problems for blood banks and hospitals. For example, Duffy-
negative blood occurs much more frequently in people of African origin,[20] and the rarity of this
blood type in the rest of the population can result in a shortage of Duffy-negative blood for these
patients. Similarly, for RhD negative people there is a risk associated with travelling to parts of the
world where supplies of RhD negative blood are rare, particularly East Asia, where blood services may
endeavor to encourage Westerners to donate blood.[21]
Hemolytic disease of the newborn (HDN)
A pregnant woman may carry a fetus with a blood type which is different from her own. Typically, this
is an issue if a Rh- mother has a child with a Rh+ father, and the fetus ends up being Rh+ like the
father.[22] In those cases, the mother can make IgG blood group antibodies. This can happen if some
of the fetus' blood cells pass into the mother's blood circulation (e.g. a small fetomaternal hemorrhage
at the time of childbirth or obstetric intervention), or sometimes after a therapeutic blood transfusion.
This can cause Rh disease or other forms of hemolytic disease of the newborn (HDN) in the current
pregnancy and/or subsequent pregnancies. Sometimes this is lethal for the fetus; in these cases it is
called hydrops fetalis.[23] If a pregnant woman is known to have anti-D antibodies, the Rh blood type
of a fetus can be tested by analysis of fetal DNA in maternal plasma to assess the risk to the fetus of
Rh disease.[24] One of the major advances of twentieth century medicine was to prevent this disease
by stopping the formation of Anti-D antibodies by D negative mothers with an injectable medication
called Rho(D) immune globulin.[25][26] Antibodies associated with some blood groups can cause
severe HDN, others can only cause mild HDN and others are not known to cause HDN.[23]
Blood products
To provide maximum benefit from each blood donation and to extend shelf-life, blood banks
fractionate some whole blood into several products. The most common of these products are packed
RBCs, plasma, platelets, cryoprecipitate, and fresh frozen plasma (FFP). FFP is quick-frozen to retain
the labile clotting factors V and VIII, which are usually administered to patients who have a
potentially fatal clotting problem caused by a condition such as advanced liver disease, overdose of
anticoagulant, or disseminated intravascular coagulation (DIC).
Units of packed red cells are made by removing as much of the plasma as possible from whole blood
units.
Clotting factors synthesized by modern recombinant methods are now in routine clinical use for
hemophilia, as the risks of infection transmission that occur with pooled blood products are avoided.
Red blood cell compatibility
Blood group AB individuals have both A and B antigens on the surface of their RBCs, and their
blood plasma does not contain any antibodies against either A or B antigen. Therefore, an
individual with type AB blood can receive blood from any group (with AB being preferable), but
cannot donate blood to any group other than AB. They are known as universal recipients.
Blood group A individuals have the A antigen on the surface of their RBCs, and blood serum
containing IgM antibodies against the B antigen. Therefore, a group A individual can receive blood
only from individuals of groups A or O (with A being preferable), and can donate blood to
individuals with type A or AB.
Blood group B individuals have the B antigen on the surface of their RBCs, and blood serum
containing IgM antibodies against the A antigen. Therefore, a group B individual can receive blood
only from individuals of groups B or O (with B being preferable), and can donate blood to
individuals with type B or AB.
Blood group O (or blood group zero in some countries) individuals do not have either A or B
antigens on the surface of their RBCs, and their blood serum contains IgM anti-A and anti-B
antibodies. Therefore, a group O individual can receive blood only from a group O individual, but
can donate blood to individuals of any ABO blood group (i.e., A, B, O or AB). If a patient needs an
urgent blood transfusion, and if the time taken to process the recipient's blood would cause a
detrimental delay, O negative blood can be issued. Because it is compatible with anyone, O
negative blood is often overused and consequently is always in short supply.[27] According to the
American Association of Blood Banks and the British Chief Medical Officer's National Blood
Transfusion Committee, the use of group O RhD negative red cells should be restricted to
persons with O negative blood, women who might be pregnant, and emergency cases in which
blood-group testing is genuinely impracticable.[27]
Red blood cell compatibility table[28][29]
Donor[1]
Recipient[1]
O− O+ A− A+ B− B+ AB− AB+
O−
O+
A−
A+
B−
B+
Red blood cell compatibility chart
AB− In addition to donating to the same

blood group; type O blood donors can
AB+
give to A, B and AB; blood donors of
types A and B can give to AB.
Table note
1. Assumes absence of atypical antibodies that would cause an

incompatibility between donor and recipient blood, as is usual for blood selected by cross matching.
An Rh D-negative patient who does not have any anti-D antibodies (never being previously sensitized
to D-positive RBCs) can receive a transfusion of D-positive blood once, but this would cause
sensitization to the D antigen, and a female patient would become at risk for hemolytic disease of the
newborn. If a D-negative patient has developed anti-D antibodies, a subsequent exposure to D-
positive blood would lead to a potentially dangerous transfusion reaction. Rh D-positive blood should
never be given to D-negative women of child-bearing age or to patients with D antibodies, so blood
banks must conserve Rh-negative blood for these patients. In extreme circumstances, such as for a
major bleed when stocks of D-negative blood units are very low at the blood bank, D-positive blood
might be given to D-negative females above child-bearing age or to Rh-negative males, providing that
they did not have anti-D antibodies, to conserve D-negative blood stock in the blood bank. The
converse is not true; Rh D-positive patients do not react to D negative blood.
This same matching is done for other antigens of the Rh system as C, c, E and e and for other blood
group systems with a known risk for immunization such as the Kell system in particular for females of
child-bearing age or patients with known need for many transfusions.
Plasma compatibility
Blood plasma compatibility is the inverse of red blood cell

compatibility.[30] Type AB plasma carries neither anti-A nor anti-B
antibodies and can be transfused to individuals of any blood group;
but type AB patients can only receive type AB plasma. Type O carries
both antibodies, so individuals of blood group O can receive plasma
from any blood group, but type O plasma can be used only by type O
recipients.
Plasma compatibility table[31]

Donor
Recipient
O A B AB
O
A
B
AB Plasma compatibility chart
In addition to donating to the

Table note
same blood group; plasma
1. Assumes absence of strong atypical antibodies in donor plasma from type AB can be given to
A, B and O; plasma from types
Rh D antibodies are uncommon, so generally neither D negative nor D A, B and AB can be given to O.
positive blood contain anti-D antibodies. If a potential donor is found
to have anti-D antibodies or any strong atypical blood group antibody
by antibody screening in the blood bank, they would not be accepted as a donor (or in some blood
banks the blood would be drawn but the product would need to be appropriately labeled); therefore,
donor blood plasma issued by a blood bank can be selected to be free of D antibodies and free of other
atypical antibodies, and such donor plasma issued from a blood bank would be suitable for a recipient
who may be D positive or D negative, as long as blood plasma and the recipient are ABO compatible.
Universal donors and universal recipients
In transfusions of packed red blood cells, individuals with type O Rh D negative blood are often called
universal donors. Those with type AB Rh D positive blood are called universal recipients. However,
these terms are only generally true with respect to possible reactions of the recipient's anti-A and anti-
B antibodies to transfused red blood cells, and also possible sensitization to Rh D antigens. One
exception is individuals with hh antigen system (also known as the Bombay phenotype) who can only
receive blood safely from other hh donors, because they form antibodies against the H antigen present
on all red blood cells.[32][33]
Blood donors with exceptionally strong anti-A, anti-B or any

atypical blood group antibody may be excluded from blood
donation. In general, while the plasma fraction of a blood
transfusion may carry donor antibodies not found in the
recipient, a significant reaction is unlikely because of dilution.
Additionally, red blood cell surface antigens other than A, B and

Rh D, might cause adverse reactions and sensitization, if they can
bind to the corresponding antibodies to generate an immune
A hospital worker takes samples of
response. Transfusions are further complicated because platelets
blood from a donor for testing
and white blood cells (WBCs) have their own systems of surface
antigens, and sensitization to platelet or WBC antigens can occur
as a result of transfusion.
For transfusions of plasma, this situation is reversed. Type O plasma, containing both anti-A and anti-
B antibodies, can only be given to O recipients. The antibodies will attack the antigens on any other
blood type. Conversely, AB plasma can be given to patients of any ABO blood group, because it does
not contain any anti-A or anti-B antibodies.
Blood typing
Typically, blood type tests are performed through addition of a blood sample to a solution containing
antibodies corresponding to each antigen. The presence of an antigen on the surface of the blood cells
is indicated by agglutination. In these tests, rather than agglutination, a positive result is indicated by
decolorization as red blood cells which bind to the nanoparticles are pulled toward a magnet and
removed from solution.
Blood group genotyping
In addition to the current practice of serologic testing of blood types, the progress in molecular
diagnostics allows the increasing use of blood group genotyping. In contrast to serologic tests
reporting a direct blood type phenotype, genotyping allows the prediction of a phenotype based on the
knowledge of the molecular basis of the currently known antigens. This allows a more detailed
determination of the blood type and therefore a better match for transfusion, which can be crucial in
particular for patients with needs for many transfusions to prevent allo-immunization.[34][35]
History
Blood types were first discovered by an Austrian physician, Karl Landsteiner, working at the
Pathological-Anatomical Institute of the University of Vienna (now Medical University of Vienna). In
1900, he found that blood sera from different persons would clump together (agglutinate) when
mixed in test tubes, and not only that, some human blood also agglutinated with animal blood.[36] He
wrote a two-sentence footnote:
The serum of healthy human beings not only agglutinates animal red cells, but also often
those of human origin, from other individuals. It remains to be seen whether this
appearance is related to inborn differences between individuals or it is the result of some
damage of bacterial kind.[37]
This was the first evidence that blood variation exists in humans. The next year, in 1901, he made a
definitive observation that blood serum of an individual would agglutinate with only those of certain
individuals. Based on this he classified human bloods into three groups, namely group A, group B,
and group C. He defined that group A blood agglutinates with group B, but never with its own type.
Similarly, group B blood agglutinates with group A. Group C blood is different in that it agglutinates
with both A and B.[38] This was the discovery of blood groups for which Landsteiner was awarded the
Nobel Prize in Physiology or Medicine in 1930. (C was later renamed to O after the German Ohne,
meaning without, or zero, or null.[39]) The group AB was discovered a year later by Landsteiner's
students Adriano Sturli and Alfred von Decastello.[40][41]
In 1927, Landsteiner, with Philip Levine, discovered the MN blood group system,[42] and the P
system.[43] Development of the Coombs test in 1945,[44] the advent of transfusion medicine, and the
understanding of ABO hemolytic disease of the newborn led to discovery of more blood groups. As of
2020, the International Society of Blood Transfusion (ISBT) recognizes 41 blood groups.[2]
Society and culture

A popular pseudoscientific belief in Eastern Asian countries (especially in Japan in Korea; known as
血液型 ketsuekigata / hyeoraekhyeong) is that a person's ABO blood type is predictive of their
personality, character, and compatibility with others.[45] Researchers have established no scientific
basis exists for blood type personality categorization, and studies have found no "significant
relationship between personality and blood type, rendering the theory "obsolete" and concluding that
no basis exists to assume that personality is anything more than randomly associated with blood
type."[46]
See also
Blood type (non-human)
Human leukocyte antigen
hh blood group
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Further reading
Dean, Laura (2005). Blood Groups and Red Cell Antigens, a guide to the differences in our blood
types that complicate blood transfusions and pregnancy (https://www.ncbi.nlm.nih.gov/books/NBK
2261/). Bethesda MD: National Center for Biotechnology Information. ISBN 1-932811-05-2.
NBK2261.
Mollison PL, Engelfriet CP, Contreras M (1997). Blood Transfusion in Clinical Medicine (10th ed.).
Oxford UK: Blackwell Science. ISBN 0-86542-881-6.
External links
BGMUT (https://www.ncbi.nlm.nih.gov/gv/mhc/xslcgi.cgi?cmd=bgmut/home) Blood Group Antigen

Gene Mutation Database at NCBI, NIH has details of genes and proteins, and variations thereof,
that are responsible for blood types
Online Mendelian Inheritance in Man (OMIM): ABO Glycosyltransferase; ABO - 110300 (https://o
mim.org/entry/110300)
Online Mendelian Inheritance in Man (OMIM): Rhesus Blood Group, D Antigen; RHD - 111680 (htt
ps://omim.org/entry/111680)
"Blood group test" (https://web.archive.org/web/20170324083743/http://www.gene-tests.org/blood
-group-test). Gentest.ch GmbH. Archived from the original (http://www.gene-tests.org/blood-group
-test) on 2017-03-24. Retrieved 2017-03-23.
"Blood Facts – Rare Traits" (https://web.archive.org/web/20060926110321/http://www.lifeshare.or
g/facts/raretraits.htm). LifeShare Blood Centers. Archived from the original (http://www.lifeshare.or
g/facts/raretraits.htm) on September 26, 2006. Retrieved September 15, 2006.
"Modern Human Variation: Distribution of Blood Types" (https://web.archive.org/web/20010606114
236/http://anthro.palomar.edu/vary/vary_3.htm). Dr. Dennis O'Neil, Behavioral Sciences
Department, Palomar College, San Marcos, California. 2001-06-06. Archived from the original (htt
p://anthro.palomar.edu/vary/vary_3.htm) on 2001-06-06. Retrieved November 23, 2006.
"Racial and Ethnic Distribution of ABO Blood Types – BloodBook.com, Blood Information for Life"
(https://web.archive.org/web/20100304222457/http://www.bloodbook.com/world-abo.html).
bloodbook.com. Archived from the original (http://www.bloodbook.com/world-abo.html) on 2010-
03-04. Retrieved September 15, 2006.
"Molecular Genetic Basis of ABO" (http://abobloodgroup.googlepages.com/home). Retrieved
July 31, 2008.
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Blood types are inherited and

Blood group systems

ABO blood group system

The ABO blood group system involves two

Phenotype and genotype

Rh blood group system

ABO and Rh distribution by country

Other blood group systems

ABO Rh Kell Duffy Kidd

Most common in immediate hemolytic transfusion reactions A Yes Fya Jka

Most common in delayed hemolytic transfusion reactions E,D,C Jka

Much of the routine work of a blood bank involves testing blood

Patients should ideally receive their own blood or type-specific

Hemolytic disease of the newborn (HDN)

Red blood cell compatibility

Red blood cell compatibility table[28][29]

AB− In addition to donating to the same

1. Assumes absence of atypical antibodies that would cause an

Blood plasma compatibility is the inverse of red blood cell

Plasma compatibility table[31]

In addition to donating to the

Universal donors and universal recipients

Blood donors with exceptionally strong anti-A, anti-B or any

Additionally, red blood cell surface antigens other than A, B and

Blood group genotyping

Society and culture

5. Matsushita S, Imamura T, Mizuta T, Hanada M (November 1983). "Acquired B antigen and

BGMUT (https://www.ncbi.nlm.nih.gov/gv/mhc/xslcgi.cgi?cmd=bgmut/home) Blood Group Antigen

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