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Blood Groups
Blood Groups
Mansyur Arif
Bag. Patologi Klinik FK UNHAS / RSUP
Dr. Wahidin Sudirohusodo
Dec 11, 2016
Definitions
Blood groups are determined by antigens
structures on the surfaces or red cells and
are detected by reactions with specific
antibodies.
A blood group system is defined by a.g that
are regulated either by allelic genes or
closely linked genes.
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A1,A2,B,H,A3,Am,Ax
M,N,S,s,U,Mg,Mia,Hu,HeMta,Vw,M2,N2,S2
P1,pk,P2,(Tja)
D,C,E,c,e,Cw,Ew,ce,Ce,G,CE,cE,Du,Cu,Eu,LW
Lua,Lub
K,k,Kpa,Kpb,Jsa,Jsb
Lea,Leb
Wra,Wrb
Dia,Dib
Yta,Ytb
Xga
Doa,Dob
Coa,Cob
2. Immunized animals
If animals are immunized with human red cells
may form a.bodies to certain of the
xenogeneic blood group a.g important
source of blood group anti sera carefully
absorbed with human red cells to establish
specificity.
Recently developed a.g specific monoclonal
a.bodies do not require such absorption.
Dec 11, 2016
3. Immunized humans
The third major source of the blood group anti
bodies are donors who have been
allogenically immunized either by (1) prior
blood transfusions or (2) previous pregnancies
immune antibodies elicited by prior
exposure to red cell a.g are commonly IgGs
Methods of detection
1. Agglutination by specific antibody
Under physiologic conditions of pH and ionic
strength, normal red cells repel each other
owing to their negative surface charge or
zeta potential
2. Enhancement of agglutination by antibody
a. Reduction of zeta potential
Can be reduced by addition of colloid (alb,
polyvinylpyrrolidone or dextran).
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Genetics
According to Mendelian laws
Heredity is generally autosomal
codominant i.e there is an expression of
both alleles in the heterozygous individual
1.Linked genes
2.Interaction with other genes
3.Loci of blood groups genes on
chromosomes (table 2)
4.Occurrence of blood group antigens
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Chromosome
9
1
1
6
4
X
1
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ABO SYSTEM
a. Historical notes
In subsequent work Landsteiner recognized
that the pattern of reactions could be
explained by two a.g, which designated A
and B. O signified the state of not having A
or B.
Table 3. The Landsteiner scheme
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Antigens on RC
Antibodies in serum
O
A
B
AB
None
A
B
A and B
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b. Subdivisions of A antigen
A antigen and anti-A are complex. Anti-A
serum from a group B donor contains 2 types
of a.b, anti-A and anti-A1 . (table 4)
Group
Antigens
A1
AA1
A2
Reaction with
Anti-A
Anti-A1
+
+
+
-
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Genetics
Determining the blood group : genotype and
phenotype. A child receives one of four genes
from each parent : A1, A2, B, or O. Six phenotypes
are possible because the A a.g associated with
group A2 and also A1.
There are ten possible genotypes. Group A1 may
have 3 genotypes (A1 A1, A1 O, A1A2). Group A2
can have either A2A2 or A2 O genotypes. Group B
can have either BB or BO genotypes
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Genotype :
- specific genes that person carries
- determined by family studies
- AA, AO, BB, BO, AB and OO
- see fig 1.
16
Family 1
Phenotype
Genotype
B
BO
A1
A1O
Phenotype
A1B
Genotype
OO
OO
A1B
Family 2
Phenotype
A1
Genotype
A2B
A 1A2
Phenotype
A2B A1
Genotype
A2B A1A2
A 2B
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Phenotype :
Four phenotypes : A, B, AB and O
Although there are ten possible genotypes,
the absence of a specific anti-O prevents the
serological recognition of more than four
phenotypes. (table 5)
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Genotype
Antigens
on red cell
Antibodies in
plasma
O
A
B
AB
OO
AA or AO
BB or BO
AB
O
A
B
AB
Anti-A, Anti-B
Anti-B
Anti-A
None
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gal
glcnac
gal
H precursor
Hh gen
fuc
R
glc
gal
glcnac
gal
A gene
fuc
R
glc
gal
glcnac gal
A antigen
glcnac
H antigen
B gene
fuc
R
glc
gal
glcnac gal
B antigen
gal
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H antigen
The surfaces oligosaccharides that
constitutes the H a.g is the precursor of the
A and B a.g
Gene A & B responsible for converting H
substance into A & B substance
The O gene is an amorph and doesnt
transform the H substance
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22
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b. P system
These ag were recognized by antisera
developed in rabbits glycosphingolipids
and originate on a ceramide dihexose (GalGal-ceramide)
c. Ii system
Most cold a.bodies have specificity against
the Ii a.g system. These a.g are found in red
cells and nonhematopoietic tissue
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Rhesus System
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B.
C.
D.
E.
2. Weiner system
3. Rosenfield system
Compound antigens
Weakened antigens :
- weakly reactive ag Du
- formal terminology : Rh +, Du variant
- for transfusion : Du is equivalent to Rh +
Deleted antigens : Rh null cells.
Rh antigens structure
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Wiener
R1
r
R2
Ro
R1W
ru
r1
Rz
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3. Kidd system
Immunization to Kidd is caused mainly by
transfusions. Kidd a.b are evanescent warm-active
incomplete a.b that may not be detected in red cell
a.b screens. Consequently they often cause
delayed transfusions rx, which may be severe.
4. Lutheran system
There are 2 common alleles, Lua and Lub and a
silent one. The double-negative phenotype caused
by either dominant inhibitor gene or a recessive
silent allele.
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Frequency of a.body
ABO
Very common
Rh Common
Yes
Kell Occasional Yes
Duffy
Occasional Yes
Kidd
Occasional Yes
Lutheran Rare No
Lewis
Occasional No
P Occasional Yes (rare)
MN Rare Yes (rare)
Ii Rare No
Cause of HDN
Yes
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Thank you
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