Blood Groups

Dr. Kenan GUMUSTEKIN

 Learning Outcomes
After lecture and studying this section, student should be able to:

• Explain blood typing and how it is used to avoid adverse

reactions following blood transfusions.
• Name the two main "naturally occurring" antibodies to red
cell antigens.
• Describe how blood reactions may occur between fetal and
maternal tissues.
• Explain why the OAB system is the most important red cell
blood group system for transfusion therapy.

Blood Groups
• When blood transfusions from one person to another were
first attempted, immediate or delayed agglutination and
hemolysis of the red blood cells often occurred, resulting
in typical transfusion reactions that frequently led to
death.
• At least 30 commonly occurring antigens and hundreds of
other rare antigens have been found on the surfaces of
the cell membranes of human blood cells.

Blood Groups
• Two particular types of antigens are much more likely
than the others to cause blood transfusion reactions.
• They are:

the O-A-B system of antigens and

the Rh system.

Blood Groups
The OAB System
• Discovered in 1901 by Dr. Karl Landsteiner
• 4 Main Phenotypes (O, A, B and AB)
• ABO gene located on long arm of chromosome 9

• In 1930 Landsteiner was awarded the 

Nobel Prize in Physiology or Medicine

Blood Groups
• Two antigens —A and B— occur on the surfaces of the
red blood cells
• It is these antigens (also called agglutinogens because
they often cause blood cell agglutination) that cause most
blood transfusion reactions.
• Because of the way these agglutinogens are inherited,
people may have neither of them on their cells, they may
have one, or they may have both simultaneously.

Blood Groups
The OAB Antigens & Antibodies

Blood Groups
 OAB Antibodies
• A and B substances very common
• Antibodies produced to “non-self”
small amounts of type A and B antigens enter the body in food, in
bacteria, and in other ways, and these substances initiate the
development of the anti-A and anti-B agglutinins.
• Produced after first few months of life
• A & B people have mainly IgM
• O people have IgG
• May fade in old age

Blood Groups
 Titer of the Agglutinins at Different Ages
• Immediately after birth, the quantity of agglutinins in the
plasma is almost zero.
• 2 to 8 months after birth, an infant begins to produce
agglutinins.
• A maximum titer is usually
reached at 8 to 10 years of
age, and
• this gradually declines
throughout the remaining
years of life
 Agglutination Process in Transfusion Reactions
• When bloods are mismatched
• so that anti-A or anti-B plasma agglutinins are mixed with red blood cells that
contain A or B agglutinogens,
• respectively, the red cells agglutinate as a result of the agglutinins’
attaching themselves to the red blood cells.
• Because the agglutinins have 2 binding sites (IgG type) or 10 binding sites
(IgM type),
• a single agglutinin can attach to two or more red blood cells at the
same time, thereby causing the cells to be bound together by the
agglutinin.
• This causes the cells to clump, which is the process of “agglutination”.
• Then these clumps plug small blood vessels.
Agglutination Process in Transfusion Reactions
Both donor and
recipient blood groups
should be identified
prior to blood
transfusion.
Cross - matching
(comparison of
recipient blood and
donor blood) should
be done.
 Agglutination Process in Transfusion Reactions
• Acute hemolysis occurs in some transfusion reactions.
• In this case, the antibodies cause lysis of the red blood cells by
activating the complement system, which releases proteolytic
enzymes (the lytic complex) that rupture the cell membranes
• Immediate intravascular hemolysis is far less common than
agglutination followed by delayed hemolysis,
• because not only does there have to be a high titer of antibodies
for lysis to occur, but also a different type of antibody seems to be
required, mainly the IgM antibodies; these antibodies are called
hemolysins.
Antigens & Antibodies
Blood Antigens
Antibodies in Serum Genotypes
Group on RBCs

A A Anti-B AA or AO

B B Anti-A BB or BO

AB A and B Neither AB

O Neither Anti-A and anti-B OO

Blood Groups
Distribution of OAB Groups

• O (%47)
• A (%41)
• B (%9)
• AB (%3)

Blood Groups
Distribution of the O Allele

Blood Groups
Distribution of the A Allele

Blood Groups
Distribution of the B Allele

Blood Groups
Significance of OAB Group
• ABO mismatched transfusions:
• Rare
• May be life threatening
• Can be caused by technical or clerical error
• Intravascular haemolysis
• More severe in group O patients

Blood Groups
Universal Donor and Recipient
• Universal Donor • Universal Recipient
• Group O • Group AB
• Carries no A or B antigens • Patient has no anti-A or anti-B
present

Blood Groups
The Rh (D) Antigen
• RH is the most complex system, with over
45 antigens
• Discovered in 1940 after work on Rhesus
monkeys
• Subsequently discovered to be unrelated
to monkeys
• RH gene located on short arm of
chromosome 1
Blood Groups
• The major difference between the O-A-B system and the
Rh system is the following:
• In the O-A-B system, the plasma agglutinins responsible for
causing transfusion reactions develop spontaneously,
• whereas in the Rh system, spontaneous agglutinins almost
never occur.
Instead, the person must first be massively exposed to an Rh
antigen.

Blood Groups
• 86% of caucasians are Rh (D) positive
• There are 6 antigens in the Rh system: C, D, E and c, d, e.
• If there is an antigen shown in capital letters in a person,
there is no indication in lower case.
• Each person has 3 Rh antigens (like Dce).
• If a person has antigen D, the person is considered as Rh
(+), otherwise Rh (-) is accepted.
• Rh D most reactive
• Anti-D agglutinins not normally present
Significance of Rh(D)
• 80% of Rh(D) negative persons exposed to Rh(D) positive
blood will develop anti-D
• Anti-D can also be stimulated by pregnancy with an Rh(D)
positive baby
• Sensitisation can be prevented by the use of anti-D
immunoglobulin, antenatally and post natally
• Rh(D) negative females of childbearing potential should
never be given Rh(D) positive blood products

Blood Groups
Inheritance
• ABO & RH genes are not linked
• ABO & Rh(D) type are inherited independently
For example:
An A Rh(D) positive mother
and a B Rh(D) positive father
could have an O Rh(D) negative child

Blood Groups
 Inheritance of ABO and Rh(D)
ABO and Rh genes are not linked
ABO and Rh types are inherited independently

Mother Father
Group A AO Group B BO
Rh(D) pos Dd Rh(D) pos Dd

Group AB AB Group A AO Group B BO Group O OO

Rh(D) pos Dd or dd Rh(D) pos Dd or dd Rh(D) pos Dd or dd Rh(D) neg dd or dd

Blood Groups
 Transfusion
• Transfer of blood or blood components from one person
(donor) into another person (recipient)
• Antigens are important in blood transfusion.
• Thirty kinds of antigens have been detected in human
erythrocyte membrane which can lead to antigen - antibody
reactions.
• ABO and Rh are more important than others.
• In the ABO system the reaction is milder and develops earlier
• In the Rh system the reaction develops violently and late

Blood Groups
 TYPES OF BLOOD TRANSFUSION
• FRESH BLOOD TRANSFUSION
Blood less than 24 hours old from the time of collection

• AUTOLOGOUS TRANSFUSION
Blood collected from a patient for re-transfusion at a later time into the
same individual

• MASSIVE TRANSFUSION
Number of units transfused in a 24 hours period exceeds the recipient’s
blood volume

• MULTIPLE TRANSFUSION
Repeated transfusion of blood over a long period of time (months or year)
INDICATIONS OF BLOOD TRANSFUSION
• Whole Blood:
• Acute blood loss
• Shock
• Exchange transfusion in neonate
• Packed red blood cells:
• Chronic severe Anemia
• Leukemia
• Thalassemia
• Platelets concentrate:
• Thrombocytopenia
• Bleeding due to platelet dysfunction
• Malignancy
• Major surgery
INDICATIONS

• Fresh frozen plasma:

• Liver disorders
• DIC
• Coagulation factor deficiency (V, VII)
• Cryoprecipitate:
• Hemophilia A
• von Willebrand’s disease
• Fibrinogen deficiency
Incorrect Transfusion Reactions

1 plasma

erythrocytes
Donor blood
(500 ml)

The reaction between the recipient's plasma

and the donor's erythrocytes (1) is more
important! Recipient (5000 ml)
The antibodies in donor's plasma are
ineffective because they are diluted
Blood group identification

Blood Groups
Erythroblastosis Fetalis
“Hemolytic Disease of the Newborn”
Father Rh (+)
Mother Rh (-)
Baby Rh (+)

Blood Groups
Erythroblastosis Fetalis
“Hemolytic Disease of the Newborn”

Blood Groups
Erythroblastosis Fetalis
“Hemolytic Disease of the Newborn”

Blood Groups
Erythroblastosis Fetalis
“Hemolytic Disease of the Newborn”

• A Rh-negative mother having her first Rh-positive child usually

does not develop sufficient anti-Rh agglutinins to cause any
harm.
• However, about 3 percent of second Rh-positive babies exhibit
some signs of erythroblastosis fetalis; about 10 percent of
third babies exhibit the disease; and the incidence rises
progressively with subsequent pregnancies.
 Clinical Picture of Erythroblastosis
• Anti-Rh antibodies cause agglutination of the fetus’s blood.
• The agglutinated RBCs subsequently hemolyze, releasing
hemoglobin into the blood.
• The fetus’s macrophages then convert the hemoglobin into
bilirubin, which causes the baby’s skin to become yellow
(jaundiced).
• The jaundiced, erythroblastotic newborn baby is usually anemic
at birth, and the anti-Rh agglutinins from the mother usually circulate in
the infant’s blood for another 1 to 2 months after birth, destroying more
and more RBCs.
 Clinical Picture of Erythroblastosis
• The liver and spleen become greatly enlarged and produce
RBCs in the same manner that they normally do during the middle of
gestation.
• Because of the rapid production of RBCs, many early forms of
RBCs, including many nucleated blastic forms, are passed from the
baby’s bone marrow into the circulatory system, and it is
because of the presence of these nucleated blastic RBCs that
the disease is called erythroblastosis fetalis.
• Although the severe anemia of erythroblastosis fetalis is
usually the cause of death.
Treatment of Neonates with Erythroblastosis
Fetalis
• To replace the neonate’s blood with Rh-negative blood.
 Prevention of Erythroblastosis Fetalis
• If the anti-D Gamma globulin (Rhogam) is administered to
• the pregnant mother within 28-30th weeks
• and after birth 72 hours, it binds the antibodies and
removes from blood of the mother

Blood Groups
TRANSPLANTATION OF TISSUES AND ORGANS
• A transplant of a tissue or whole organ from one part of the
same animal to another part is called an autograft;
• from one identical twin to another, an isograft;
• from one human being to another, an allograft;
• and from a non-human animal to a human being or from an
animal of one species to one of another species, a xenograft.
• The best transport is autografts and isografts.
TRANSPLANTATION OF TISSUES AND
ORGANS
• The most important antigens for causing graft rejection are a
complex called the human leukocyte antigen (HLA) antigens.
• Six of these antigens are present on the tissue cell
membranes of each person, but there are about 150
different HLA antigens to choose from, representing more
than a trillion possible combinations.
• Consequently, it is virtually impossible for two persons,
except in the case of identical twins, to have the same six
HLA antigens.
 Questions
• Thanks
 You should study these pages;

Guyton And Hall Textbook of Medical Physiology, 12th Edition 2012

Chapter 35
Pages:444-450