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Physiology : HEMATOLOGY

Blood groups.
Medicine, L3.
PSL 222
Lecture 9.
1

Dr. S.Bashir

Lecture objectives

Identify the importance of blood grouping.


Explain the basis of blood grouping.
Describe the ABO and Rhesus blood grouping systems.
State the prevalence of the different groups.
Explain the blood grouping principles considered during
transfusion.
Describe the possible incompatibilities between mother
and fetus and the hemolytic disease of the newborn.
Identify tissue compatibility antigens.

Dr. S.Bashir

Importance of transfusions
Large losses of blood have serious
consequences
loss of 15 to 30 % causes weakness
loss of over 30 % causes shock, which
can be fatal.
Transfusions are the only way to replace
blood quickly.
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Dr. S.Bashir

Blood Groups and transfusions


Blood transfusions were not
possible until Karl
Landsteiner first identified
the major human blood
groups -- namely O, A, B,
and AB - in a series of
experiments in 1901 that
earned him the Nobel Prize.
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Dr. S.Bashir

The ABO blood groups


The ABO blood groups are defined by
specific inherited molecules, or antigens,
that are present on the surface of red blood
cells .
An individual does not contain antibodies to
the antigens on their red blood cells.
i.e. A person with an A antigen would not
have an A antibody but antibody to antigens
that are not present i.e.(anti-B) .
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Dr. S.Bashir

Blood groups:
antigens & antibodies

Dr. S.Bashir

Blood Types
Antigens on RBC
(A, B, AB or none = O)
Antibodies in plasma
(anti A, anti B, anti A&B)
Antibodies in the ABO group
appear usually in babies
within the first six months
following their birth
naturally occurring
antibodies.
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Dr. S.Bashir

Miss-match reactions
If group A red cells
are mistakenly
transfused to a group
O or B recipient , the
anti-A antibody in the
recipient's plasma
destroys the
transfused group A
cells and a serious
transfusion reaction
occurs.
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Dr. S.Bashir

Prevalence of different groups


Most of the world
population is group O.
The 2nd commonest group
is?
Different ethnic groups
have different
distributions. What is
distribution in KSA?
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Dr. S.Bashir

Genetic Inheritance
Parent Alleles

AA
(A)

AB
(AB)

AO
(A)

AB
(AB)

BB
(B)

BO
(B)

AO
(A)

BO
(B)

OO
(O)

A& B are co-dominant genes.


The O gene is recessive.
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Dr. S.Bashir

Genetic Inheritance of the ABO


:System
Both A and B alleles are dominant over O.
As a result, individuals who have an AO
genotype will have an A phenotype.
People who are type O have OO
genotypes.
i). O is recessive to A & B
ii). A and B are codominant
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Dr. S.Bashir

Rh- blood groups


Based on presence (Rh+) or absence (Rh-)
of one of Rh Antigens ( D antigen).
Named for Rhesus monkey
Most people are Rh+.
Rh- person will develop an immune
response to Rh+ blood production of antiD antibodies
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Dr. S.Bashir

Rh- Blood groups


A person with Rh - blood
does not have Rh
antibodies naturally in the
plasma
A person with Rh- blood
can develop Rh antibodies
in the plasma if he or she
receives blood from a
person with Rh+ blood.
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Dr. S.Bashir

Genetic Inheritance of Rh- factors

Rh+ is dominant over Rh-

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Dr. S.Bashir

Considerations during Transfusion :


Consider recipient
plasma Vs. donor cells.

Universal donor? Can


give blood to any body?

Universal recipient?
Can receive blood from
all others? has no
antibodies against A or
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Dr. S.Bashir
B?

Is there Really a Universal


donor?
Persons who are group A/ B/
AB can be transfused with
group O blood.
Why dont the antibodies in the
transfused blood destroy
recipient s RBC?
A potent anti-A or anti-B in
donor blood of group O may
destroy the A or B red cells of a
non-O recipient. So ?
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Dr. S.Bashir

Mother-fetus incompatibility
(Hemolytic Disease of the Newborn)

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Dr. S.Bashir

Mechanism of HDN

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Dr. S.Bashir

Why doesnt fetus/ mother incompatibility


occur with ABO system
A mother group O and fetus group A. is
there a problem?
No because anti A & anti-B are (IgM)
large molecules that do not cross the
placenta into the fetus.

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Dr. S.Bashir

Prevention of HDN
The 1st baby is usually not affected. Why?
Prevention: Administer anti-D immunoglobulin
( Rhogam) to the mother within 72 hours after
delivery.
This will destroy any fetus cells in mother
circulation and stop any immunological reaction.
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Dr. S.Bashir

Erythroblastosis Fetalis
Severity of HDN
increases with
successive pregnancies.
-Anemia
-anemia+ jaundice
-Sever cases death
in utero.
(Erythroblastosis fetalis).
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Dr. S.Bashir

Other blood groups


Several other blood group antigens have
been identified in humans. Some
examples: MN , Duffy, Lewis, Kell.
They, too, may sometimes cause
- transfusion reactions and even
hemolytic disease of the newborn
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Dr. S.Bashir

Other uses for blood groups


ABO Blood type antigens are not only
found on the surface of cells. They are
also normally secreted by some people in
their body fluids, including saliva, tears,
and urine Secretors. This is used in
forensic medicine for identification.
Blood groups are no longer used for
paternity disputes . DNA typing is used
instead .
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Dr. S.Bashir

Human leukocyte antigen


(HLA) system
WBC & other body
cells have additional
inherited surface
antigens
The HLA is the most
polymorphic of all
known human genetic
systems.
There are > 100
antigens on tissue cells
in humans resulting in
30million possible HLA
genotypes.
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Dr. S.Bashir

Organ transplantation
The chances of two unrelated people
having the same HLA genotypes is very
slim.
HLA incompatibility between organ
donors and recipients are common.
Immunosuppressive drugs must be used
for life ,after organ transplants.
What are the risks?
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Dr. S.Bashir

:Short notes Q
A woman who is group O negative marries a
man who is group A positive. She becomes
pregnant with a group A positive fetus.
1. Is there a risk of hemolytic incompatibility?
2. Does she need any special management
after delivery?
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Dr. S.Bashir

Physiology: Hematology
Medicine L3.
PSL222
Blood transfusion
Lecture 10.
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Dr. S.Bashir

Lecture Objectives
Identify different types of blood products
transfused.
Describe methods of storing blood.
Describe methods of matching blood to
recipient.
Name the blood transfusion risks &
reactions and describe the most
important ones.
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Dr. S.Bashir

Selecting donors.
What are the criteria for accepting donation of
blood from a volunteer?
Age?
Medical history?
Physical examination?
HB level?
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Dr. S.Bashir

.Selecting donors
Must be at least 17 years of
age
Must be in good health
Must weigh at least 110
pounds
Must pass the physical and
health history examination
given prior to donation
Must have normal HB level.
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Dr. S.Bashir

Blood Collection
A unit (450 mL) of

blood is then
collected into a
plastic bag
containing citratephosphate-dextroseadenine solution
(CPDA-1).
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Dr. S.Bashir

Tests Performed
Determination of the blood type .
Screening for antibodies that may produce
adverse effects if transfused.
Screening for possible infectious agents that
could be transmitted with transfusion.
Crossmatch: The recipients serum is tested
against the donors red cells, to determine
whether the recipient has antibodies that will
attack the donors red cells.
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Dr. S.Bashir

Tests Performed
Typing: ABO group (blood type) ,Rh typing
Screening for any unexpected red blood cell
antibodies that may cause problems in the
recipient
Screening for current or past infections including:
hepatitis viruses B and C
human immunodeficiency virus (HIV)
syphilis
Irradiation to blood cells is performed to disable
any T-lymphocytes present
in the donated blood.
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Dr. S.Bashir
(T-lymphocytes can cause a reaction )

Blood Preservation and Storage


Preservative solution contains adenine,
dextrose, and phosphate to help maintain
adequate pH and ATP level.

Storage temperature: Refrigerator (1- 6oC) .


Shelf life: 35 to 42 days .
Unit contents: ~250mL red cells, citrate;
preservative solution.
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Dr. S.Bashir

Preventing stored blood from


:clotting
Citrate is used as anticoagulant: used in all
blood components. Chelates (binds) ionized
calcium and magnesium ?
Does it cause problems when transfused?
No. Metabolized quickly by the liver through
Krebs cycle when blood is administered to a
recipient.
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Dr. S.Bashir

Component Preparation from


Whole Blood
First step: centrifuge whole blood
Red blood cells = packed cells
Platelet rich plasma .
Second step: centrifuge platelet rich plasma
Plasma
Platelets concentrate .

Thaw and centrifuge frozen plasma take precipitate.


Cryoprecipitate (Factor VIII, von Willebrands Factor, Factor
XIII, and fibrinogen)
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Dr. S.Bashir

Transfusion Indications
Acute blood loss whole blood.
Anemia or chronic blood loss packed
cells. Why?
Deficiency of clotting factors fresh frozen
plasma or cryoprecipitate.
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Dr. S.Bashir

Transfusion of RBC
To increase oxygen carrying capacity
Expected effect of one unit transfused to a
70 kg patient
Hemoglobin: increase by 1 g/dL
Hematocrit: increase by 3 %

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Dr. S.Bashir

Acute Adverse Reactions to


transfusion
A- Common non lethal reactions:

Febrile, non-hemolytic reaction.


are caused by patient antibodies directed
against antigens present on transfused
lymphocytes or granulocytes.
Symptoms usually consist of chills and a
temperature rise.
Allergic reaction :
-Allergic reactions to plasma proteins can cause
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Dr. S.Bashir

Adverse Reactions to transfusion


B-Life-threatening reactions:
Hemolytic transfusion reaction
Anaphylactic reaction
Sepsis due to bacterially
contaminated unit
Circulatory overload
Transfusion Related Acute Lung
Injury (TRALI).
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Dr. S.Bashir

Hemolytic transfusion reaction


Infusion of ABO
incompatible red cells
Antigen-antibody reaction
with activation of
complement & lyses of red
blood cells
Hypotension; renal failure;
DIC; back pain; fever;
chills
Often fatal
Usual cause is wrong
identification of patient
.
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Dr. S.Bashir

Anaphylactic Reaction
Can occur with any type component
IgE mediated antigen-antibody reaction to
proteins in plasma
Features: Sudden respiratory distress,
wheezing; hypotension; localized edema;
urticaria.
Treatment: Epinephrine,corticosteroids.beta2 agonists, anti-histamines.
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Dr. S.Bashir

Bacterial Sepsis
Bacteria from donors skin or
asymptomatic bacteremia in the donor.
Hypotension; fever; renal failure
High mortality rate
Treatment: IV antibiotics; treat shock &
renal failure

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Dr. S.Bashir

Transfusion Transmitted Viruses &


parasites
Human immunodeficiency virus
Hepatitis viruses
Hepatitis B
Hepatitis C
Malaria parasite

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Dr. S.Bashir

Circulatory Overload
Iatrogenic
Infusion of large volume of blood too
rapidly into a non-bleeding patient e.g.
patient with chronic anemia transfused
large volume of whale blood.
Patient has a cardiac or pulmonary
disease.

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Dr. S.Bashir

Transfusion Related Acute Lung Injury

Donor antibodies against antigens on the


patients white blood cells
White cells agglutinate in the lung
capillaries, complement is activated
Capillaries become leaky, fluid collects
in alveolar spaces
Hypoxemia, respiratory failure,
hypotension, fever.
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Dr. S.Bashir

Rare complications

Hyperkalemia: stored blood Lyses of


RBC release of K+ into ECF.
Hypothermia ? Transfusion of cold
plasma or blood.
How is it prevented?
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Dr. S.Bashir

Synthetic blood
Perflurocarbons (PFCs) instead of
human hemoglobin.
PFCs are 40 times smaller than RBC, but
can carry twice as much oxygen twice as
quickly due to adsorption of the O 2
For patients at risk of acute hypoxia
resulting from transient anemia, blood
loss or ischemia.
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Dr. S.Bashir

Synthetic blood
Could be given to
anyone without
triggering rejection
New research :
hemoglobin
molecules coated with
polyethylene glycol to
make them bulkier
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Dr. S.Bashir

An patient requires emergency transfusion


because of sever anemia. Her blood group is B
positive. The blood bank does not have her
group in storage. Which of the following blood
units carries the least risk of inducing an
immediate transfusion reaction?

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a-Type AB -ve whole blood.


b-Type O +ve whole blood.
c-Type O ve whole blood.
d- Type O +ve packed red cells.
Dr. S.Bashir

:Prevention of clotting in the lab


Heparinized containers.
Add Ca ++ chelating agents : EDTA,
citrates .

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Dr. S.Bashir