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To understand blood typing, it is necessary to define antigen and antibody. An antigen is a substance, usually a protein or a glycoprotein, which, when injected into a human (or other organism) that does not have the antigen, RELATIONSHIPS BETWEEN BLOOD TYPES AND ANTIBODIES Blood Antigens on Red Can Donate Antibodies in Can Receive Type Blood Cell Blood To Serum Blood From A A A, AB Anti-B A, O B B B, AB Anti-A B, O AB A and B AB None AB, O O None A, B, AB, O Anti-A and antiO B will cause an antibody to be produced. Antibodies are a specific type of immunesystem proteins known as immunoglobulin·s, whose role is to fight infections by binding themselves to antigens. In the case of the ABO blood groups, the antigens are present on the surface of the red blood cell, while the antibodies are in the serum. These antibodies are unique to the ABO system and are termed "naturally occurring antibodies." The table shows the relationships between blood types and antibodies. This aspect of the ABO blood group system is very important in transfusion. Blood group O individuals are said to be universal donors, because their blood can be used for transfusion in individuals who have any one of the four blood types. On the other hand, individuals with blood type A can only donate to either type A or type AB, and individuals with blood type B can only donate to B or AB types. AB individuals can only donate to type AB. However, before any transfusions, donor blood is mixed with serum from the recipient (a process called cross matching) to ensure that no agglutination will occur after transfusion. Blood Typing and Crossmatching Definition Blood typing is a laboratory test done to determine a person's blood type. If the person needs a blood transfusion, another test called crossmatching is done after the blood is typed to find blood from a donor that the person's body will accept. Purpose Blood typing and crossmatching are most commonly done to make certain that a person who needs a transfusion will receive blood that matches (is compatible with) his own. People must receive blood of the same blood type, otherwise, a serious, even fatal, transfusion reaction can occur. Parents who are expecting a baby have their blood typed to diagnose and prevent hemolytic disease of the newborn (HDN), a type of anemia also known aserythroblastosis fetalis. Babies who have a blood type different from their

such as semen or saliva. as well as in facilities. and alleged father are compared. such as those operated by the American Red Cross. When red blood cells having a certain blood type antigen are mixed with serum containing antibodies against that antigen. against it. the blood types of the child. that collect. such as most hospitals. Blood bank laboratories are usually located in facilities.S. a person's cells and serum are mixed in a test tube with commercially-prepared serum and cells. process. The antigens found on the surface of red blood cells are important because they determine a person's blood type. mother. this reaction is observed as the formation of clumps of cells (clumping). When blood is crossmatched. Blood typing and crossmatching tests are based on the reaction between antigens and antibodies. and supply blood that is donated. Legal investigations may require typing of blood or other body fluids. after it has separated into cells and serum (serum is the yellow liquid left after the blood clots. A child inherits factors or genes from each parent that determine his blood type. Frequency (%) Of ABO And Rh Blood Types In U. A person's body contains many antigens. called an antibody. Description Blood typing and crossmatching tests are performed in a blood bank laboratory by technologists trained in blood bank and transfusion services. Population Racial Group ABO Blood Type O Whites 45% A B Rh Blood Type AB Positive Negative 15% 40% 11% 4% 85% Blacks 49% 27% 20% 4% 90% 10% When blood is typed. The disease is serious with certain blood type differences. The tests are done on blood. that is uniquely designed to attack and make ineffective (neutralize) the specific antigen that caused the attack. patient serum is mixed with cells from donated blood that might be . to identify persons involved in crimes or other legal matters. These laboratories are regulated by the United States Food and Drug Administration (FDA) and are often inspected and accredited by a professional association such as the American Association of Blood Banks (AABB).) Costs for both tests are covered by insurance when the tests are determined to be medically necessary. This fact makes blood typing useful in paternity testing. that prepare blood for transfusion. In a test tube. but is milder with others. known as an immune response. the antibodies attack and stick to the antigen. The attack begins when the body builds a special protein. Clumping tells which antigens or antibodies are present and reveals the person's blood type.mothers are at risk for developing this disease. A person's body normally doesn't make antibodies against its own antigens. To determine whether or not the alleged father could be the true father. An antigen can be anything that causes the body to launch an attack. only against antigens that are foreign to it.

or Rhesus. randomly combined the serum and red blood cells of his colleagues. This discovery earned him the 1930 Nobel Prize in Medicine. he naturally will have developed antibodies against the antigens his red blood cells lack. system was first detected in 1940 by Landsteiner and Wiener when they injected blood from rhesus monkeys into guinea pigs and rabbits. The Rh. A person's ABO blood type³A. is tested for. That is. and alleged father. AB. In routine blood typing and crossmatching tests. A person must receive ABO-matched blood. The A blood type has only the A antigen and the B blood type has only the B antigen. an Austrian pathologist. Although there are over 600 known red blood cell antigens. mother. An ABO incompatibility between a pregnant woman and her baby is a minor cause of HDN and usually causes no problem for the baby. such as saliva and semen. In 1901. A person with AB blood type will have neither antibody. making it the most complex red blood cell antigen system. ABO typing of these fluids provides clues in legal investigations. a child with blood type B whose mother has blood type O. requires a father with either AB or B blood type. Clumping or lack of clumping in the test tube tells whether or not the blood is compatible. ABO antigens are also found on most body organs. More than 50 antigens have since been discovered belonging to this system. but a person with O blood type will have both anti-A and anti-B antibodies. O is the most common and AB is the least common. ABO typing is the first test done on blood when it is tested for transfusion. or O³is based on the presence or absence of the A and B antigens on his red blood cells. Karl Landsteiner. The AB blood type has both A and B antigens. The structure of ABO antibodies makes it unlikely they will cross the placenta to attack the baby's red blood cells. and a person with B blood type will have anti-A antibodies. The alleged father can't be the true father if the child's blood type requires a gene that neither he nor the mother have. a man with blood type O cannot be the true father. If the D antigen is . a person with A blood type will have anti-B antibodies. Although the distribution of each of the four ABO blood types varies between racial groups. By the time a person is six months old. and the O blood type has neither A nor B antigen. the D antigen. ABO incompatibilities are the major cause of fatal transfusion reactions. organized into 22 blood group systems. also known as the Rh factor or Rho[D]. Paternity testing compares the ABO blood types of the child. Blood typing ABO BLOOD GROUP SYSTEM. ABO antigens can be found in body fluids other than blood. In some people. For example. so ABO compatibility is also important for organ transplants. only one of these 50 antigens. B. RH BLOOD GROUP SYSTEM. he discovered the ABO blood group system.used for transfusion. From the reactions he observed in test tubes. routine blood typing and crossmatching is usually concerned with only two systems: the ABO and Rh blood group systems.

If the mother is Rh-negative and the father is Rh-positive. The next step is to test the mother's serum to make sure she doesn't already have anti-D antibodies from a previous pregnancy or transfusion. antibodies to Rh antigens don't develop naturally. Cells from the baby can cross the placenta and enter the mother's bloodstream. However. Tests for antigens from these systems are not included in routine blood typing. This incompatibility can happen when an Rh-negative woman and an Rhpositive man produce an Rh-positive baby. An Rh-negative woman should also receive RhIg following a miscarriage. Like Rh antibodies. Several other blood group systems may be involved in HDN and transfusion reactions. antibodies in these systems do not develop naturally. testing for the presence of these antigens is useful in paternity testing. These antigens are not usually tested for in routine blood typing tests. Kell. There. 15% of whites and 10% of blacks are Rh-negative. E. In transfusions. They develop only as an immune response after a transfusion or during pregnancy. and P systems. crossmatching is done following blood typing to locate donor blood that the person's body will accept. causing severe or fatal anemia. Rh incompatibility is the most common and severe cause of HDN. that person is Rhnegative. Unlike ABO antibodies. Rh antibodies or find matching blood for a person with antibodies to one or more of these antigens. The first step in preventing HDN is to find out the Rh types of the expectant parents. although they are much less frequent than ABO and Rh. or ectopic pregnancy. Unlike the ABO system. Kidd. A later transfusion of Rh-positive blood could result in a severe or fatal transfusion reaction. abortion.present. the Rh system is next in importance after the ABO system. and e. This procedure is similar to blood typing. Finally. OTHER BLOOD GROUP SYSTEMS. The incidence of the Rh blood types varies between racial groups. and when a technologist tries to identify unexpected Blood typing is a laboratory test done to discover a person's blood type. the structure of anti-D antibodies makes it likely that they will cross the placenta and enter the baby's bloodstream. The RhIg attaches to any Rhpositive cells from the baby in the mother's bloodstream. the Rh-negative mother is given an injection of Rh Immunoglobulin (RhIg) at 28 weeks of gestation and again after delivery. Most Rh-negative people who receive Rh-positive blood will develop anti-D antibodies. preventing them from triggering anti-D antibody production in the mother. c. if the baby is Rh positive. but not as widely as the ABO blood types: 85% of whites and 90% of blacks are Rh-positive. the baby is at risk for developing HDN. causing the mother to make anti-D antibodies. but they are commonly used in paternity testing. that person is Rh-positive. but as an immune response after transfusion or during pregnancy. An antibody screening test . If the person needs a blood transfusion. They are the Duffy. MNS. Other important antigens in the Rh system are C. they can destroy the baby's red blood cells. if the D antigen is absent.

Blood bank ³ A laboratory that specializes in blood typing. the antibody is identified. antibody identification. Antigen ³ Anything that causes the body to launch an immune response against that antigen through the production of antibodies. Blood type ³ Blood categories based on the presence or absence of certain antigens on the red blood cells. If an unexpected antibody is found in either the patient or the donor. even though the transfusion has begun. In either case. Key terms ABO blood type ³ Blood type based on the presence or absence of the A and B antigens on the red blood cells. AB blood type is called the universal recipient because it has no ABO antibodies to attack the antigens on transfused red blood cells. red blood cells of the recipient type (type specific cells) are given. the blood bank does further testing to make sure the blood is compatible." Before blood from a donor and the recipient are crossmatched. the blood is compatible. It is uniquely designed to attack and neutralize the specific antigen that triggered the immune response. Duffy. if clumping does not occur. In addition. In an emergency. MNS. blood from a donor with the same ABO and Rh type as the rcipient is selected. In contrast. Crossmatch ³ A laboratory test done to confirm that blood from a donor and blood from the recipient are compatible. the cross-match is continued. To begin the crossmatch.is done before a crossmatch to check for unexpected antibodies to antigens in these systems. preferably Rh-negative. If an antibody to one of these antigens is found. when there is not enough time for blood typing and crossmatching. both are ABO and Rh typed. serum from the patient is mixed with red blood cells from the donor. and P system antigens. . Kell. the blood is not compatible. only blood without that antigen will be compatible in a crossmatch. O blood type is called the universal donor because it has no ABO antigens for a patient's antibodies to attack. If clumping occurs. It is commonly referred to as compatibility testing. This sequence must be repeated before each transfusion a person receives. In a test tube. O red blood cells may be given. If clumping occurs. and transfusion services. antibody screening is done to look for antibodies to certain Rh. If there is time for blood typing. Antibody ³ A special protein made by the body as a defense against foreign material that enters the body. Crossmatching Crossmatching is the final step in pretransfusion testing. or "Type and Cross. Kidd. A person's serum is mixed in a test tube with commercially-prepared cells containing antigens from these systems.

Blood transfusions always have the risk of an unexpected transfusion reaction. Normal results There is no normal blood type. Aftercare The possible side effects of any blood collection are discomfort or bruising at the site where the needle punctured the skin. Collection of the sample takes only a few minutes. Blood typing and crossmatching must be done three days or less before a transfusion.Gene ³ A piece of DNA. Discomfort is treated with warm packs to the puncture site. or activities before these tests. Transfusion ³ The therapeutic introduction of blood or a blood component into a patient's bloodstream. medications. A person doesn't need to change diet. he has received a blood transfusion or a plasma substitute. a person cannot receive a transfusion without a compatible crossmatch result. that determines how traits such as blood type are inherited and expressed. The attack begins with the production of antibodies against the antigen. or has had a radiology procedure using intravenous contrast media. Vacuum action draws the blood through the needle into an attached tube. A nurse watches a patient for signs of a reaction during the entire transfusion. but a compatible crossmatch is no guarantee that an unexpected adverse reaction will not appear during the transfusion. Risks There are no risks from the blood collection or test procedures. These can give false clumping reactions in both typing and crossmatching tests. Rh blood type ³ Blood type based on the presence or absence of the D antigen on the red blood cells. Compatibility testing procedures are designed to provide the safest blood product possible for the recipient. Bruising is reduced if pressure is applied with a finger to the puncture site until the bleeding stops. . and inserts a needle into that vein. during the last three months. located on a chromosome. locates a vein in the inner elbow region. Immune response ³ The body's attack against an antigen that it considers foreign to itself. The desired result of a crossmatch is that compatible donor blood is found. Abnormal results Except in an emergency. as well as dizziness or fainting. He should tell his healthcare provider if. a healthcare worker ties a tourniquet above the patient's elbow. Preparation To collect the 10 mL blood needed for these tests.

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