ABO Blood Group System

Shawkat Ali
MT
Abasyn University peshawar
 History: Karl Landsteiner
• Discovered the ABO Blood Group System in
1901
• He and his five co-workers began mixing each
others red cells and serum together and
inadvertently performed the first forward and
reverse ABO groupings
 Why is it important?
• ABO compatibility between donor cell and
patient serum is the essential foundation of
pretransfusion testing
• It is the only system with expected antibodies
• Whether they are IgG or IgM, ABO antibodies
can activate complement readily
– This means that incompatibilities can cause life
threatening situations (transfusion reactions)
 Landsteiner’s Rule:
• Normal, Healthy
individuals possess ABO
antibodies to the ABO
antigen absent from
their RBCs
 ABO Blood Group System
• The ABO Blood Group System was the first to
be identified and is the most significant for
transfusion practice
• It is the ONLY system that the reciprocal
antibodies are consistently and predictably
present in the sera of people who have had no
exposure to human red cells
 Blood Group Systems
• Most blood group systems (ABO and others)
are made up of:
– An antigen on a red cell and the absence of it’s
corresponding antibody in the serum (if you’re A,
you don’t have anti-A)
• If you do NOT have a particular antigen on
your red cells then it is possible (when
exposed to foreign RBCs) to illicit an immune
response that results in the production of the
antibody specific for the missing antigen.
 H Antigen
• The H gene codes for an enzyme that adds the
sugar fucose to the terminal sugar of a
precursor substance (PS)
• The precursor substance (proteins and lipids)
is formed on an oligosaccharide chain (the
basic structure)
RBC Precursor Structure
RBC

Glucose

Galactose
Precursor
Substance
(stays the N-acetylglucosamine
same)
Galactose
Formation of the H antigen
RBC

Glucose

H antigen Galactose

N-acetylglucosamine

Galactose

Fucose
 H antigen
• The H antigen is the foundation upon which A
and B antigens are built
• A and B genes code for enzymes that add a
sugar to the H antigen
– Immunodominant sugars are present at the
terminal ends of the chains and confer the ABO
antigen specificity
 A and B Antigen
• The “A” gene codes for an enzyme (transferase) that
adds N-acetylgalactosamine to the terminal sugar of
the H antigen
– N-acetylgalactosaminyltransferase

• The “B” gene codes for an enzyme that adds D-

galactose to the terminal sugar of the H antigen
– D-galactosyltransferase
Formation of the A antigen
RBC

Glucose

Galactose

N-acetylglucosamine

Galactose

N-acetylgalactosamine
Fucose
Formation of the B antigen
RBC

Glucose

Galactose

N-acetylglucosamine

Galactose

Galactose
Fucose
 ABO
• Remember:
– The ABO Blood Group System does NOT require the
presence of a foreign red blood cell for the production
of ABO antibodies
– ABO antibodies are “non-red blood cell stimulated”
probably from environmental exposure and are
referred to as “expected antibodies”
– Titer of ABO Abs is often reduced in elderly and in
patients with hypogammaglobulinemia
– Infants do not produce Abs until 3-6 months of age
 ABO antibodies
RBC Serum Ab
Phenotype
A Anti-B

B Anti-A

AB --------

O Anti-A,B
 Anti-A1
• Group O and B individuals Anti-A1

contain anti-A in their serum

Clinically Abs class
• However, the anti-A can be Significant IgM
separated into different Sometimes
components: anti-A and Thermal HDNB
anti-A1 range No
• Anti-A1 only agglutinates the 4 - 22
A1 antigen, not the A2 Transfusion Reactions

antigen Extravascular Intravascular

• There is no anti-A2. No Rare
 Anti-A,B
• Found in the serum of group O individuals
• Reacts with A, B, and AB cells
• Predominately IgG, with small portions being
IgM
• Anti-A,B is one antibody, it is not a mixture of
anti-A and anti-B antibodies
 ABO antibodies
• IgM is the predominant antibody in Group A
and Group B individuals
– Anti-A
– Anti-B
• IgG (with some IgM) is the predominant
antibody in Group O individuals
– Anti-A,B (with some anti-A and anti-B)
 ABO antibody facts
• Complement can be activated with ABO antibodies (mostly IgM, some IgG)
• High titer: react strongly (4+)
Anti-A, Anti-B, Anti-A,B

Clinically Significant Abs class

Yes IgM, less IgG
Thermal range HDNB
4 - 37 Yes
Transfusion Reactions

Extravascular Intravascular
Yes Yes
 ABO Antibodies
• Usually present within the first 3-6 months of
life
• Stable by ages 5-6 years
• Decline in older age & in
hypogammaglobulinemia
• Newborns may passively acquire maternal
antibodies (IgG crosses placenta)
 Nature of antibodies
• Non-red blood cell stimulated
– ABO antibodies
• Red blood cell stimulated
– Antibodies formed as a result of transfusion, etc
– Usually IgG
– Active at 37°C
– Can occur in group O (may occur in group A or B)
– These antibodies also occur in the other Blood Group
Systems