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BLOOD GROUPS &

TYPES

By
Dr.M.Anthony David MD,
Professor of Physiology

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HISTORICAL
 19th CENTURY: Boer War
 Massive deaths of people:
 Many infections
 Severe blood loss
 Attempts to transfuse blood
began.
 They had confusing results.
 Some people recovered fully.
 Others died.NOMAD:2006: BP:BldgpsI 2
WHY? WHY? WHY?
 Either all should die
 Or all should live.

 Why this difference?

 This question haunted a

researcher called Karl


Landsteiner.
 He worked hard to find out

why. NOMAD:2006: BP:BldgpsI 3


KARL LANDSTEINER, NOBEL
LAUREATE, 1930.

1 1
8 9
6 4
8 3
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KARL LANDSTEINER
 Wondered about this
phenomenon.
 Studied this extensively.
 Discovered Blood Groups and
types single handedly.
 Framed the Landsteiner’s Law in
1904.
 Continued to research on Blood
groups and types till his death in
1943. NOMAD:2006: BP:BldgpsI 5
LANDSTEINER’S LAW
1.“If an agglutinogen is present in
the red cells of a blood, the
corresponding agglutinin must
be absent from the plasma.”
2. “If an agglutinogen is absent in
the red cells of a blood, the
corresponding agglutinin must
be present in it’s plasma.”

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LANDSTEINER’S LAW:
APPLICABILITY
 The first law is applicable to all
groups and types of blood.
 It is a logical conclusion.
 The second part is a fact, but not
necessarily true always.
 It is a fact for ABO Blood groups.
 The Rh, M,N and other groups or
types do not follow the second
part of the Landsteiner’s Law.
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ABO BLOOD GROUPS

The most common type of


blood grouping in use.

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AGGLUTINOGENS
 Also called antigens.
 These agglutinogens are present
on the outer surface of the
Erythrocyte membranes.
 They are antigenic and have
epitopes or antigenic
determinants, which are
glycoproteins.
 In ABO groups, three types of
agglutinogens can be present.
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AGGLUTINOGENS (Contd)
 Some individuals will have
Erythrocytes with an agglutinogen
called as “A”.
 Others have one called “B”
 The third type of agglutinogen is
non antigenic and it is called “H”
 H doesn’t cause production of
antibodies.
 So those having H antigen are
called O group individuals.
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A AND B, INDIVIDUALS
 Those having the A agglutinogen
on their erythrocytes are called
A blood group people.
 Those having the B agglutinogen
are called the B blood group
people.

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AB & O INDIVIDUALS
 Some have both the A and B
agglutinogens on their
erythrocytes and they are called
AB type.
 Others have neither A nor B
agglutinogens. They have the
non antigenic H on their RBCs
and are called O group people.

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AGGLUTININS
 The antibodies to the
agglutinogens are called
Agglutinins.
 These are present naturally in ABO
groups.
 They are always present in the
plasma of the individual.
 There are two types of agglutinins
in the ABO blood system:
 Anti A or α: Alpha
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 Anti B or β: Beta
AGGLUTININS (Contd)
 The A group people have the Beta or
anti B agglutinin in their plasma.
 Similarly the B group people have
the Alpha or Anti-A agglutinin in
their plasma.
 The AB group of people have no
agglutinins in their plasma.
 The O group people have both Alpha
and Beta types of agglutinins in
their plasma.
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ABO BLOOD GROUPS
GROUP AGGLUTINOGEN/S AGGLUTININ/S
ON RBC IN PLASMA
A A β

B B α

AB Both A & B None

O Neither A nor B Both α and β

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ABO BLOOD GROUP TEST
 Why test?
 To determine the blood

groups.
 How is the test done?

 The erythrocytes of the

patient are exposed to the


two different types of anti
sera. NOMAD:2006: BP:BldgpsI 17
ABO BLOOD GROUP TEST
 Antisera are solutions containing the
respective agglutinins.
 Anti A agglutinin is present in
Antisera A
 Anti sera B contains Beta agglutinin
or anti B agglutinin.
 In this test the patients erythrocytes
are exposed separately to both these
antisera.
 Agglutination is seen in one or more
of the solutions.
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AGGLUTINATION
 Agglutination or clumping is seen
whenever the respective
agglutinogens and agglutinins are
mixed.
 Agglutinogen A + Agglutinin Alpha =
Agglutination.
 Agglutinogen B + Agglutinin Beta =
Agglutination.
 Both agglutinogens + Both antisera
= Agglutination.
 No agglutinogens
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ABO BLOOD GROUP TEST
 If there is agglutination with
antisera A, the blood group of the
individual will be A.
 If there is agglutination with
antisera B, the blood group of the
individual is B.
 If there is agglutination with both
the antisera, then the blood group is
AB.
 If there is no agglutination with
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either of the two antisera, then the
ABO BLOOD GROUP TEST
 By doing this test we can
determine the blood group of
individuals.
 Knowing one’s blood group helps
us in times of need. If a patient
is of Group A, he can receive
blood as transfusion from group
A or group O individuals. He
cannot receive it from Group B or
Group AB people.
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ABO BLOOD GROUP TEST
 Why?
 Because the agglutinogens in

the donor’s blood can


agglutinate with the
agglutinin in the recipient’s
blood and cause hemolysis.
 This is called transfusion

mismatch and can be fatal.


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UNIVERSAL DONOR &
RECEPIENTS
 The blood group O can be given
to any other of the ABO group
persons and so is called the
“Universal Donor”
 The blood group AB persons lack
agglutinins and so can receive
blood from any of the ABO group
persons. So this AB group is
called as the “Universal
Recipient” NOMAD:2006: BP:BldgpsI 23
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DONATIONS…
 A Blood group person can donate
blood to A and AB groups.
 B Blood group person can donate
blood to B and AB groups.
 AB Blood group person can
donate blood only to AB group.
 O blood group person can donate
blood to O, A, B and AB groups.
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ABO BLOOD GROUP TEST:
SUMMARY
RED ANTISERA ANTISERA
CELLS ALPHA BETA
A AGGLUTINATIO NO
N AGGLUTINATIO
B NO AGG. N
AGGLUTINATIO
N
AB AGGLUTINATIO AGGLUTINATIO
N N
O NO NO
AGGLUTINATIO AGGLUTINATIO
N
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CROSS MATCHING
 This is a test done just
before the blood is
transfused.
 It helps rule out other

group mismatches.
 It has two parts: Major &

Minor cross matching.


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MAJOR CROSS MATCHING
 The effects of the recipient’s
serum agglutinins on the
donors erythrocytes.
 This is called major because
about 300 ml of the Blood cells
of the donor are sent into the
circulation of the recipient.
 Donor’s Erythrocytes+
Recipient’s plasma= ?
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MINOR CROSS MATCHING
 The Effect of the donor’s serum
agglutinins on the recipient’s
erythrocytes.
 This is called minor because
these agglutinins get diluted by
the larger volume of the
recipient’s plasma.
 Donor’s Serum + Recipient’s
Erythrocytes
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PERCENTAGE OF BLOOD
GROUPS
WESTERN POPULATION A
B
3 O
AB
42

46

9
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PERCENTAGE OF BLOOD
GROUPS
ASIAN POPULATION A
B
5 O
25 AB

45
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Rh TYPING:
INTRODUCTION
 It is the second most important
typing of blood.
 These blood groups were
originally discovered in Rhesus
monkeys
 Rh is another type of
agglutinogen.
 It is also present on the outer
surface of the erythrocytes.
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Rh Positive and Negative
people
 People who have the Rh
agglutinogen on their RBC
membranes are called Rh Positive.
 Those who do not have the Rh
agglutinogen are called Rh
Negative people.
 Rh-ve people do not NATURALLY
carry the corresponding Anti-Rh
antibody. NOMAD:2006: BP:BldgpsI 34
DISTRIBUTION OF Rh
TYPES
C AUC ASIAN POPULATION
15

Rh+ve
Rh-ve

85

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DISTRIBUTION OF Rh
TYPES
ORIE NTAL POPULATION Rh+ve
Rh-ve
5

95

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Rh or D Agglutinins
 Anti-D agglutinins or antibodies do
not occur naturally.
 They are produced by the Immune
systems as and when it is exposed to
the D antigens.
 So these Anti D agglutinins are found
only in some of the Rh Negative
people.
 Those who have been exposed to the
Rh or D antigen
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Exposure to Antigens:
How?
 The Rh+ve people will never
manufacture Anti D antibodies.
 Only Rh – ve individuals can
develop these Agglutinins.
 When these Rh-ve people receive
Rh+ve blood by mistake, they
get exposed to the antigen.
 Then they will develop the
antibody. NOMAD:2006: BP:BldgpsI 38
Exposure to Antigens:
How?
 In case of an Rh-ve woman, if
she is married to an Rh+ve
man, she can conceive an
Rh+ve child.
 In this case, the D antigen

present on the erythrocytes


of the fetus does not go into
the maternal circulation
throughout the pregnancy
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Exposure to Antigens:
How?
 During the delivery of the baby,
some blood of the fetus spills
over into the maternal
circulation.
 The maternal circulation is
exposed to the D antigens from
the fetal erythrocytes.
 The maternal circulation slowly
develops Anti D antibodies.
 The first child is however spared.
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ERYTHROBLASTOSIS FETALIS

 The second child in such a


woman, if also Rh+ve, can
develop a disease called as
Erythroblastosis fetalis.
 This is due to the Anti D
antibodies developed in the
mother.
 These antibodies traverse
through the placenta, enter the
fetal circulation and
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agglutination of the
PATHOPHYSIOLOGY OF
ERYTHROBLASTOSIS FETALIS
MATERNAL
CIRCULATION
P FETAL
CIRCULATION
Anti-D L Agglutination of RBCs
Antibodies A
Hemolysis
C
E Hemoglobin in Plasma
Blocks Renal
N Tubules Bilirubin
T Jaundice
A Renal Failure
Kernicterus
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NORMAL JAUNDICED

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ERYTHROBLASTOSIS FETALIS or
ICTERUS GRAVIS NEONATORUM
 Rh+ve children of an Rh-ve
mother
 If it is of severe nature, bilirubin
may enter te brain to cause
“kernicterus”
 The fetus may become groosly
edematous (swollen).
 This is called “Hydrops fetalis”
 Such fetuses may die in utero or 44
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hours after preterm or term birth


ERYTHROBLASTOSIS:
PREVENTION
 All pregnant women to be tested
for Rh.
 If any are Rh-ve, their husbands
also to be tested for Rh.
 The first baby’s blood to be
tested for Rh.
 If Rh+ve, then the mother to be
given Rhogam injection within 24
hrs after delivery.
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TREATMENT OF
ERYTHROBLASTOSIS
 EXCHANGE TRANSFUSION.
 The entire blood of the fetus is
replaced by O Rh-ve blood.
 This is done in small
installments.
 Once it is done, slowly the baby
will recover, as erythropoiesis
occurs while these O –ve cells
die. NOMAD:2006: BP:BldgpsI 46
EXCHANGE TRANSFUSION

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AFTER SUCCESSFUL THERAPY

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USES OF BLOOD GROUPS
 CLINICAL:
 For transfusion of blood
 To prevent Erythroblastosis fetalis
 MEDICOLEGAL:
 Determination of suspected
parentage
 Can say whether one could or could
not have been the father of a child.
 DNA fingerprinting is more specific.
 GENETIC STUDIES:
EPIDEMIOLOGY.
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INCOMPATIBLE
TRANSFUSIONS CAUSE…
MILD REACTIONS SUCH AS:
 Chills and rigors

 Fever

 Inapparent Hemolysis.

 Post transfusion Jaundice.

 Severe transfusion

reactions.
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SEVERE TRANSFUSION
REACTIONS
 Violent Backaches.
 Tightness in the chest.
 Jaundice.
 Oliguria.
 Renal Shutdown/Failure.
 Anuria
 Death

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