ABO & RH

BLOOD
GROUP
Here is where your presentation begins
ABO SYSTEM
 Discovered by Karl Landsteiner in 1901

 The ABO system is the most important of all blood groups in transfusion medicine.

 ABO gene is located in “chromosome 9”

 ABO Antigen
 Found on RBCs, lymphocytes, platelets, tissue cells, bone marrow and other organs.
 Developed in utero 5-6 weeks gestation; full expression occurs between 2-4 years of age.

Formation of ABO antigens:

Gene Glucosyltransferases Immunodominant Antigen

Sugar
H a-2-L-fucosyltransferase L-fucose H

A a-3-N- acetylgalactosaminyltransferase N-acetyl-D- A

galactosamine
B A-3-D-galactosyltransferase D-galactose B
ABO Antibodies
Naturally occurring; predominantly IgM
Production initiated at birth
Detectable titers: 3-6 months, peaks at 5-10 years

Blood Group Antibody produced Characteristics

A Anti-B IgM
• Naturally occurring
B Anti-A • React at room
temperature
• Cannot cross placenta
AB --- ---

O Anti-A Mostly IgM (some IgG)

Anti-B
Forward Grouping
-Using known sources of commercial anti-sera to detect antigens on an individual’s RBC

Blood Group Antigen Reaction with Interpretation

Anti-A Anti-B Anti-A,B

A A + - + A

B B - + + B

AB AB + + + AB

O NONE - - - O
Reverse Grouping
-Using reagent cells with known A and B antigens and testing the serum of the patient for ABO
group antibodies

Blood Group Antibody Reaction with Interpretation

A cells B cells

A Anti-B - + A

B Anti-A + - B

AB NONE - - AB

O Anti A & Anti B + + O

ABO Discrepancies

1. Group I Discrepancies
2. Group II Discrepancies
3. Group III Discrepancies
4. Group IV Discrepancies
Group I Discrepancies
-Associated with unexpected reaction in reverse grouping due to weakly reacting or missing
antibodies.
• Newborns
• Patients with Leukemia
• Patients with congenital or acquired agammagloblulinemia or immunodeficiency disease
• Elderly patients
• Patients with bone marrow or stem cell transplantations
Group II
-Associated with unexpected reactions in the forward grouping due to weakly reacting or
missing antigens.

• Subgroups of A and/or B
• Leukemia
• Hodgkin’s disease
• Acquired B
Group III
-Thesediscrepancies between forward and reverse groupings are caused by protein or plasma
abnormalities and result in rouleaux formation or pseudoagglutination, attributable to:

• Elevated levels of globin

• Elevated levels of fibrinogen
• Plasma expanders
• Wharton’s Jelly
Group IV
-These discrepancies between forward and reverse groupings are due to miscellaneous problems
and have the following causes:

• Presence of cold reactive autoantibodies

• Unexpected ABO isoagglutinins
• Unexpected non-ABO alloantibodies
• Cis-AB phenomenon
Rh SYSTEM
 Rhesus Blood Group System

 It is the primary cause of HDFN and significant cause of HTR

 RH gene located on short arm of chromosome 1

Rh Antigens
• Rh antigens are highly immunogenic, the D antigen is most potent
• Well developed at birth

• Exposure to 1ml of Rh positive red cells can stimulate Ab production in an Rh negative

person
Rh Antibody
• Most Rh antibodies are IgG, produced through pregnancy and incompatible transfusions

• Causes HTR and HDFN

Rh Typing
1. Slide typing
• Rapid method; reagent: anti-D antiserum
• Positive test: Agglutination visible within 2 minutes

2. Tube typing
• For differentiating Rh negative (absence of D antigen) from weak D
• Method: INDIRECT ANTIGLOBULIN TEST
Patient RBC + anti-D -> wash RBC -> add AHG
Nomenclature of Rh System
1. Fisher-Race (DCE)

2. Wiener (Rh-Hr)

3. Rosenfield (Alpha-Numeric)

4. International Society of Blood Transfusion (ISBT): Numeric Terminology

Fisher-Race (DCE)
• Most commonly used (i.e. WHO)
• They theorized that Rh antigens are controlled by a complex of 3 sets of genes with closely
linked loci
Wiener (Rh-Hr)
• Rh-Hr Terminology
• Rarely used, but good for describing phenotype
• A single gene at the Rh locus leads at the expression of Rh antigens
• Each gene controls production of an agglutinogen composed of three factors (antigens)
Rosenfield (Alpha-Numeric)
• Antigens are designated by number
ISBT: NUMERICAL TERMINOLOGY
• To establish a uniform nomenclature that is both a eye and machine-readable
• Adaptation of six-digit number of each identical antigen belonging to a blood group
WEAK D
• Occurs when D is weakly expressed; more common in blacks

4 Mechanisms of weakened expression of D antigen

1. Genetic cause
2. Position effect or C in Trans
3. Partial D or D mosaic
4. Del