BMS 201(lab): Blood

Grouping and
Transfusion

Noha Nooh Lasheen

Associate Professor of Physiology
F A C U L T Y O F
M E D I C I N E

F A L L 2 0 2 1
By the end of this lab, you should be able to:
• Remember the ABO blood group system and its significance
• Understand haemolytic disease of the new-born
• Brief understanding of transfusion reactions
• Perform blood typing test
ABO System
 Blood Groups
Complete the following statements:

• The membranes of human RBCs contain a variety of antigens called ………………….

Agglutinogens (glycoprotein in nature).

• Blood groups are classified according to the ………………….of the agglutinogens on the
RBCs.
presence or absence
• There are hundreds of different agglutinogens on the RBCs, but there are two main
systems of blood grouping,
the ABO system and the Rh system.
 Blood Groups
Complete the following statements:

• In the plasma there are antibodies called ………………

Agglutinins.

• if the RBCs of a person have agglutinogen A on their surface, his plasma

would not contain the specific agglutinin for this agglutinogen.

• When these antigens come in contact with their specific antibodies, an antigen-
antibody reaction occurs, the cells become sticky and clump together like
bunches of grapes
Agglutination.
• A single antibody can attach to different red cells at the same time ➔ destruction
of the red blood cells will occur (hemolysis)
Blood Transfusion

Blood Can give Can receive

Antigens Antibodies
Group blood to blood from

A A Anti B A and AB A and O

B B Anti A B and AB B and O

A,B,O and
AB A and B NO AB
AB
Anti A and A,B,O, and
O NO O
Anti B AB
 Rh system
• Rh refers to the presence or absence of the D antigen on the red blood cell
• A person has D antigen is Rh +ve while that does not have D antigen is Rh –ve.
85% are Rh +ve.
15% are Rh -ve.
• Unlike the ABO blood group system, individuals who lack the D antigen do not
naturally make antibodies against it.
• all individuals should be typed for D , if negative must receive Rh (D) negative blood
Case :
A 30 years old woman, previously had an abortion, starts normal labour. Her infant has
jaundice. The physician finds that she has Rh incompatibility
List Clinical Features of the baby?
• Edema Jaundice
• Anemia
• Enlarged Liver & Spleen
• With sever cases intrauterine fatal death occur.

Suggest a treatment of the diseased infant?

• Exchange blood transfusion with O- blood.

How to prevent this condition?

• Rh immune globulin injections to the Rh
negative mother after delivery.
Erythroblastosis Fetalis
(Hemolytic disease of the newborn)
• If the mother is Rh- married Rh+ man, and the baby is Rh+. A small quantity of fetal
blood leaks across the placenta into the maternal blood stream during delivery.

• The mother’s immune system begins to produce anti-Rh antibodies which cross the
placenta during the subsequent pregnancy into the fetal blood.

• The 1st baby has no harm. If the 2nd fetus is Rh+, the antigen-antibody reaction
causes hemolysis of fetal RBCs ➔ erythroblastosis fetalis develops.
Explain hemolysis occurred in thus case?
Anti D binds and destroys fetal Rh D positive erythrocytes that have passed through the
placenta from the fetus to the maternal circulation.
• This prevents maternal B-cell activation and memory cell formation.
Mention three Indications of blood
transfusion?
1. Restore blood volume as in sever hemorrhage.
2. Sever anemia.
3. Bleeding disorders e.g. purpura and hemophilia.
List Complications of blood transfusion?

Immediate Delayed
Incompatibility Transmission of
diseases
Mechanical
overload
Bacterial
contamination
Mention effects of Incompatible blood
transfusion?
1. Blockage of blood capillaries caused by
agglutination RBCs leading to joint pain
and tightness of the chest. Followed by

2. Haemolysis which lead to

A. Shock due to release of histamine.
B. Hyperkalemia.
C. Jaundice.
D. Renal impairment
Mention precautions before
blood transfusion?
1. Blood typing: the donor's blood should be compatible with that of the
recipient regarding ABO system and Rh factor.
2. Cross matching test: should be done
"The donor's cells are added to the recipient plasma and the donor's plasma
tested with the recipient cells".
➔to avoid incompatibility due to any subgroup, or due to increased
concentration of agglutinins in the donor's plasma.
Precautions before blood
transfusion:
3. A healthy donor must be carefully chosen with no history of serious
diseases such as: Hepatitis, HIV or AIDS, Malaria and Syphilis.
4. Good storage of the blood with the addition of acid citrate (to prevent its
clotting) and glucose (as a nutrient to the RBCs).
The blood should be kept at a temperature of 4º C in the blood banks and not
frozen, otherwise the RBCs will be destroyed.
The blood should not be used after 5 weeks.
 2) Platelets
1)Red Blood Cells
Stored at 4oC • Store at 22oC (Room temp) –
Can be stored for up to 35 constantly agitated
days • Shelf life 7 days only - (risk
of bacterial infection)
• Need to know blood group,
no crossmatch needed
3) Fresh Frozen Plasma (FFP)
• Stored at -30oC
• Shelf life 1 year
• Give ASAP - within 1h or else
coagulation factors
degenerate
• Need to know blood group –
no X-match, just choose same group
4) Cryoprecipitate
• From frozen plasma thawed at 4-8oC
overnight residue remains
• Contains fibrinogen and factor VIII
• Same as FFP - store at -30°C for 1 year
Indications:
• If massive bleeding and fibrinogen very
low
• Rarely hypofibrigoneaenemia
Procedure
• Place one drop of anti-A, anti-B and anti-D sera on a
slide.
• Puncture your thumb with a sterile lancet and allow
one drop of blood to contact each of the three anti-
sera.
• Avoid touching the anti-sera by your finger.
• Mix the blood with anti-sera using different small
wooden sticks.
• Observe the results within 2-3 minutes
Observation:
• Agglutination of the RBCs is indicated by grainy (granular)
appearance of the blood sample
Observation:
Anti A Anti B Anti D
References:
Guyton & Hall: Textbook Of Medical Physiology.
Lippincotte Illustrated Reviews Physiology
THANK YOU