BLOOD GROUP SYSTEM

DR NILESH KATE
MBBS,MD
ASSOCIATE PROF
DEPT. OF PHYSIOLOGY
BLOOD GROUPS

OBJECTIVES.
 BLOOD GROUPS
 Introduction
 Classical ABO blood
grouping system
 Rh blood grouping
system
 Clinical applications of
blood groups.
 BLOOD
TRANSFUSION.
 Indications
 Donors & recipient.
 Precautions during
blood transfusion.
 Hazards
 Autologous BT.
 Storage of blood for
transfusion.
Wednesday, November 9, 2016

INTRODUCTION
 Agglutinogens –
Antigens present on cell
membrane of RBC
 Agglutinins – antibodies
against Agglutinogens
present in plasma.
 Agglutination – of RBC is
reaction between these 2

BLOOD GROUPING SYSTEM.
 Major blood group system – based on Agglutinogens on cell
membrane, present widely & causes severe transfusion
reaction
 ABO
 Rh system
 Minor blood group system – based on Agglutinogens but
present in few populations & causes mild transfusion
reaction.
 MNS
 P
 Familial blood group system – found in few families
 KELL. DUFFY, LUTHERAN, BOMBAY LEWIS, DEIGO, KIDD

LANDSTEINER’S LAW
KARL LANDSTEINER 1900
 If an Agglutinogens is
present on surface of RBC
corresponding
agglutinins must be
absent in plasma.
 & if an Agglutinogens is
absent on surface of RBC
corresponding
Agglutinins must be
present in plasma.

CLASSICAL ABO BLOOD
GROUPING SYSTEM
 A & B Agglutinogens- these are complex
oligosaccharides differing in terminal sugar
 In Antigen A – N-acetylgalactosamine & in
Antigen B – galactose.
 Other than RBC also present in salivary
glands, pancreas, kidney, liver, lung, testes also
in body fluids like saliva, semen & amniotic
fluid

CLASSICAL ABO BLOOD
GROUPING SYSTEM
 Anti-A (α)and anti-B (β) Agglutinins – IgM
type & cannot cross placenta.
 Absence of these are determined by
Landsteiner’s law
 Act best at low temperature so called Cold
Antibodies.

TYPES OF ABO BLOOD
GROUPS.
BLOOD GROUP ANTIGEN ANTIBODIES
A A ANTI B OR β
B B ANTI A OR α
AB AB ---------------------
O ----------- ANTI A (α) & ANTI B (β)

POPULATION DISTRIBUTION
OF ABO BLOOD GROUPS
BLOOD GROUPS PERCENTAGE (%)
A 20
B 40
AB 08
O 32

INHERITANCE OF ABO BLOOD
GROUPS
PHENOTYPE
(BLOOD GROUP)
GENOTYPE
A AA,AO
B BB,BO
AB AB
O OO

APPERANCE OF ANTIGENS &
ANTIBODIES
 Antigens A & B appears
in 6th
week of fetal life, at
birth 1/5th
of adult level
& rises during puberty
& adolescence.
 Antibodies are absent at
birth, appear 10-15
days after birth, reach
maximum at 10 yrs.

MECHANISM
 Antigens similar to A & B are present in
intestinal bacteria & foods, when newborn
exposed to these absorbed in blood,
stimulate formation of antibodies against
antigens recognized as non-self by immune
system.

DETERMINATION OF ABO
BLOOD GROUPS
 Covered in
Practicals “
Determination of
Blood Groups”

Rh BLOOD GROUPING SYSTEM
 Rh Antigens – called Rh as these were first
discovered in RBC of rhesus monkey.
 Discovered by Landsteiner & weiner in 1940.
 3 types of Rh antigen, C,D & E,
 D IS COMMONEST & causes severe transfusion
reaction.
 Rh antigens are integral membrane proteins & not
found in other tissues.

Rh Antibodies.
 No natural antibodies like
ABO blood groups system
 Rh antibodies are produced
when Rh -ve individual is
transfused with Rh +ve
blood.
 These are IgG type & crosses
placenta.
 Warm Antibodies.

INHERITANCE OF Rh BLOOD
GROUPS

HEMOLYTIC DISEASE OF
NEWBORN.
 Incompatibility of Rh
blood groups between
fetus & mother.

MECHANISM OF HEMOLYTIC DISEASE OF
NEWBORN IN RH INCOMPATIBILITY.
 Entrance of Rh +ve fetal
RBC into Rh –ve mother’s
circulation during first
pregnancy.
 Production of Rh
antibodies.
 Rh incompatibility
reaction during second
pregnancy.

MANIFESTATIONS OF HEMOLYTIC
DISEASE OF NEWBORN.
 Erythroblastosis fetalis.
 Erythroblastosis
 Anaemia.
 Icterus gravis Neonatorum.
 Jaundice
 Enlarged liver & spleen.
 Kernicterus – excess (<18mg%) bilirubin
deposition in brain mainly basal ganglia
 Hydrops fetalis – Grossly edematous
fetus.

PREVENTION OF HEMOLYTIC
DISEASE OF NEWBORN.
 Injecting single dose of
Rh antibodies (anti-D)
to mother soon after
child birth.
 So active antibodies
will not be formed by
mother.

TREATMENT OF HEMOLYTIC
DISEASE OF NEWBORN.
 Replacement of baby’s
Rh+ve blood by Rh –ve
blood.
 This is called Exchange
Transfusion.

CLINICAL APPLICATIONS OF
BLOOD GROUPS.
 In blood transfusion.
 In Preventing Hemolytic Disease.
 In Paternity Disputes.
 In Medicolegal Cases.
 In knowing Susceptibility to Diseases.

BLOOD TRANSFUSION.
 Life saving measure
 Should be carried out
when absolutely
necessary.

INDICATIONS
 Blood loss – Accidents, major operations, rupture
peptic ulcer, rupture aortic aneurysm & rupture
ectopic pregnancy.
 For Quick restoration of haemoglobin.
 Exchange transfusion.
 Blood diseases- Aplastic anaemia, agranulocytosis,
leukemias, purpurae & clotting defects
 Acute poisoning – carbon Monoxide poisoning.

DONORS & RECIPIENT.
 Donor – person who
donate the blood
 Recipient – person who
receives the blood.
 Universal donor – O
Rh Negative.
 Universal recipient –
AB Rh positive

PRECAUTIONS TO BE TAKEN
WHILE SELECTING DONOR.
 Should be Healthy
 Age – 18- 60 yrs
 Contraindicated in
pregnant & lactating
mothers
 Screening for – AIDS, viral
hepatitis, malaria, syphilis.
 Hb & PCV should be
normal

PRECAUTIONS DURING BLOOD
TRANSFUSION.
 Absolute indication.
 Cross matching
 Major – Donor’s RBC +
Recipient plasma
 Minor -Donor’s plasma+
Recipient RBC
 Rh +ve blood should never
be transfused to Rh –ve
person.
 Donor’s blood should always
be screened for diseases.

PRECAUTIONS DURING BLOOD
TRANSFUSION.
 Blood bag/bottle should be checked.
 Blood transfusion should be given at slow rate.
 Proper Aseptic measures.
 Careful watch on recipient condition – for first 10-
15min.
 Should stop if any reaction

HAZARDS OF BLOOD
TRANSFUSION.
 Mismatched transfusion reaction.
 Agglutination of donor’s RBC
 Tissue ischemia – chest pain or back pain
 Haemolysis of agglutinated RBC- Haemoglobinemia
 Haemolytic Jaundice
 Renal vasoconstriction
 Circulatory shock
 Haemoglobinuria.
 Renal tubular damage, acute renal shutdown & Uraemia.

HAZARDS OF BLOOD
TRANSFUSION.
 Circulatory overload - Hypervolemia
 Transmission of blood borne infections – AIDS, viral
hepatitis
 Pyrogenic reactions – fever with chills
 Allergic reactions – skin rashes , asthma
 Hyperkalemia – after excessive transfusion
 Hypocalcaemia – Tetany due to chelation of Ca by citrate
 Reduced tissue oxygenation – stored RBC has low 2,3-DPG
 Haemosiderosis – Iron overload & deposition in liver, heart
 Thrombophlebitis – at Venepuncture site
 Air embolism – entry of air into blood.

AUTOLOGOUS BT.
 Transfusion of
individual own blood
withdrawl & stored
 For elective surgery
 During surgery
 Sports persons

STORAGE OF BLOOD FOR
TRANSFUSION.
 One unit 420 ml mixed with 120 ml ACD ( Acid
citrate dextrose)
 Contents –
 Acid citrate 0.48 gm
 Trisodium citrate – 1.32 gm
 Dextrose – 1.47gm
 Distilled water -100ml
 Dextrose – provide energy for Na-K pump

IMPORTANT FACTS ABOUT
BLOOD TRANFUSION.
 One can safely donate 1 unit of blood every 6
month.
 Blood can be stored for 21 days with above
conditions
 WBC & platelet virtually absent after 24 hrs of
storage.
 After transfusion 80% RBC survive for 24 hrs &
destroyed at a rate of 1% per day.

BLOOD GROUP SYSTEM

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