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Sistema ABO y Rh

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Definición del sistema ABO y el RH

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Sistema ABO y Rh

  1. 1. Instituto Politécnico Nacional
 Escuela Superior de Medicina Grupos sanguíneos: sistemas ABO y Rh Grupo: 4CM12 • Pérez Bautista Fco. Javier
  2. 2. Introducción Los eritrocitos, poseen moléculas en su superficie que funcionan como antígenos, se clasifican en sistemas ABO, Rh, Lewis, Kid, Duffy, Kell, MNS Y otros mas. 250 antígenos eritrocitarios, agrupados en mas de 26 sistemas.
  3. 3. Sistema ABO Fue identificado por Landsteiner en 1901,quíen observó que eritrocitos de algunos individuos aglutinaban cuando se mezclaban con suero de otros, pero no su propio suero. Se encuentran distribuidos en todas las células del cuerpo. En algunos individuos se encuentran en las secreciones. La especificidad de grupo sanguíneo esta dada por un carbohidrato. La participación de este de este sistema en el rechazo hiperagudo de órganos y tejidos trasplantados es determinante.
  4. 4. Sistema Rh Fueron descritos por Weiner y Landsteiner en 1940. Se identificó primero en lo monos Rhesus, de ahí su nombre. Incluye cinco antígenos: D, E, e, C, c. El antígeno D sólo está presente en los eritrocitos, y no en otras células ni en las secreciones, este antígenos define la diferencia entre una persona Rh+ y Rh- . Induce la formación de IgG. Esta relacionada con la Eritroblastosis fetal y la anemia hemolítica autoinmune.
  5. 5. Antigenos ABO (sistema histo-sanguineo)
  6. 6. ABO El grupo de antigenos ABO es de importacnia médica. Son los más inmunogenos de todos los antigenos sanguineos Una incompatibilidad del grupo sanguineo es la causa de muerte más común en una transfución
  7. 7. Antígenos del grupo ABO 4 antígenos, A, B, AB, A1 La determinación del antígeno, esta dada por una secuencia de oligosacáridos. Sus moléculas acarreadoras son glicoproteinas y glicolipidos expresados en la superficie del globulo rojo Codificado por el Locus ABO, con tres formas alélicas A,B,O Frecuencia de los Ag en sangre- A: 43% Caucasicos, 27% Negros, 28% Asiaticos B: 9% Caucasicos, 20% Negros , 27% Asiasiticos A1: 34% Caucasicos, 19% Negros, 27% Asiaticos Fenotipicamente el más comun es el O a nivel mundial.
  8. 8. Grupo Sanguineo Antigenos Presentes en las Celulas Anticuerpos Presentes en Suero Genotipos A Antigeno A Anti-B AA/AO B Antigeno B Anti-A BB/BO AB Antigeno A y Antigeno B No AB O No Anti-A y Anti-B OO
  9. 9. Los anticuerpos anti-A y anti-B de las personas con grupos sanguíneos A y B son predominantemente del tipo IgM. Las personas con grupo sanguíneo O son de tipo IgG predominantemente. Tanto los anticuerpos anti-A y anti-B tipo IgM como los tipo IgG aglutinan los eritrocitos principalmente a temperatura ambiente (20°C a 24°C) o por debajo de ésta, y activan eficientemente el complemento a 37°C. Anticuerpos contra ABO
  10. 10. Determinación del Grupo Sanguíneo Se realiza mediante un examen de laboratorio, el procedimiento se llama tipificacion ABO Consiste en mezclar sangre con anticuerpos, de tipo A y B. Si hay aglutinación, significa que hubo reaccion contra uno de los Ab. • Resultados Si usted tiene sangre tipo A, únicamente puede recibir sangre tipo A y tipo O. Si usted tiene sangre tipo B, únicamente puede recibir sangre tipo B y tipo O. Si usted tiene sangre tipo AB, puede recibir sangre tipo A, B, AB y O. Receptor universal
  11. 11. Formación del sistema ABO Se detectan sobre los eritrocitos entre la quinta y sexta SDG. Los antígenos ABO presenta cambios durante el desarrollo fetal y del individuo. Se van adicionando los azúcares terminales sobre la cadena de oligosacáridos en la membrana de los eritrocitos. Entre los 2 y 4 años de edad, los antígenos A y B están completamente desarrollados y permanecen constantes durante toda la vida.
  12. 12. El gen H, ubicado en el cromosoma 19, une una molécula de L-fucosa a la galactosa terminal (Gal) de un precursor común, dando origen al antígeno H. Los individuos que son homocigóticos para el gen nulo (h/h) no producen antígeno H y desarrollan anticuerpos anti-H; no producir el antígeno H, tampoco producen los antígenos A o B, y su suero contiene anti-A, anti-B y anti- H (fenotipo de Bombay).
  13. 13. El gen ABO, ubicado en el cromosoma 9, posee tres alelos, estos varían de acuerdo a las sustituciones de nucleótidos. El alelo A codifica para la enzima transferasa A. El alelo B codifica para la enzima transferasa B. El alelo O sólo difiere del alelo A en la deleción de un nucleótido (guanina G en la posición 261).
  14. 14. El gen Se, ubicado también en el cromosoma 19, codifica para la enzima fucosiltransferasa. Esta enzima cataliza la producción de antígeno H en secreciones del organismo;produciendo antígeno H en las secreciones, el cual a su vez es procesado como antígeno A y/o B. Depende del genotipo ABO del individuo.
  15. 15. Presencia de antígenos ABH en otras células La presencia de los antígenos A y B se ha demostrado sobre las células epidérmicas, células del líquido amniótico, células sinusoidales del bazo y espermatozoides, al igual que en las paredes celulares del endotelio de los capilares, venas y arterias. Los antígenos A y B también están presentes sobre linfocitos. En las plaquetas se pueden detectar antígenos A, B y H, que se adquieren por adsorción de glicolípidos del plasma.
  16. 16. Enfermedades asociadas al sistema ABO
  17. 17. Factor Rh
  18. 18. Teorías del Rh Fisher y Race en 1943. Cromosoma 1 existen 3 locus estrechamente relacionados D, C y E con do pares de alelos C, c y E,e.
 El grupo de alelos del complejo= Haplotipo. Wiener en 1951. Múltiples alelos en un solo locus y cada alelo codifica un antígeno distinto. Tippet en 1986. Existencia de dos genes estrechamente relacionados: RhD y RhCE. Colin y colaboradores 1990 secuenciaron los dos genes del Rh, RhD y RhCE explicando el polimorfismo Rh positivo/Negativo.
  19. 19. Sistema Rh Constituido por unos 45 antígenos Naturaleza protéica Principales son D,C,E,c y e. Gene RhD codifica para antígeno D. Codominante. No produce Anticuerpos naturales Anticuerpos son generalmente de clase IgG
  20. 20. Bioquímica del complejo Rh Proteínas transmembrana expresadas en la superficie del eritrocito codificadas por genes que se encuentran en:
 -Brazo corto del cromosoma 1 (RHD- RHCE)
 RhD expresa antígeno D
 RhCE expresa antígenos C o c junto con E y e
 -Cromosoma 6 (RhAG)
 Precursor para la expresión de los antígenos del sistema.

  21. 21. Los antígenos de la familia Rh aparecen en las etapas tempranas de la diferenciación eritropoyética.
 Los antígenos del Rh se expresan a partir de la sexta semana de vida intrauterina. Función desconocida – Transportadores catiónicos.
  22. 22. LA EXPRESIÓN DE LAS PROTEÍNAS DEL SISTEMA DEL RH COMO MARCADOR POBLACIONAL
  23. 23. En mitad del S.XX se describieron las variantes de proteínas séricas y eritrocíticas, reveladas por electroforesis en gel de almidón (separar las moléculas de acuerdo a tamaño y carga eléctrica).
  24. 24. Los marcadores genéticos tienen ventajas sobre diferentes características como lo son: color de piel, tipo de cabello, etc. 1.- El ambiente interviene poco en su expresión 2.- Permanecen sin cambios 3.- Se conoce su modo de herencia
  25. 25. El sistema Rh-Hr está constituido por los genes C, c, D, E y e que codifican para Ag C, c, D, E y e. El gen D es el más antigénico y es incompatible (materno-fetal).
  26. 26. LOS AB Y LA ENFERMEDAD Los aloanticuerpos que reconocen a los Ag Rh son isotipo IgG y se identifican mediante la prueba indirecta de antiglobulina. Rh producirán Ab anti-Rh posterior a la sensibilización con el Ag Rh.
  27. 27. AB maternos El feto produce mínimas cantidades de Ab por la inmadurez de sus sistema inmunitario. La transferencia placentaria de Ab maternos confiere al feto cierta inmunidad pasiva. Las gammaglobulinas IgG son transportadas al feto mediante transcitosis. La transferrina (Proteína Materna) atraviesa la membrana placentaria llevando hierro al embrión o feto donde la superficie placentaria tiene receptores a esta proteína.
  28. 28. ENFERMEDAD HEMOLÍTICA DEL RECIEN NACIDO 1.- Roturas microscópicas dela membrana fetal. 2.- Llegan pequeñas cantidades de sangre fetal a la sangre materna. 3.- Si el feto es Rh+ y la madre Rh-. 4.- Las células de la sangre fetal pueden estimular la formación de Ab anti-Rh por el sistema inmunitario de la madre.
  29. 29. 5.- Estos pasan a la sangre fetal y causan HEMÓLISIS de las células sanguíneas fetales Rh+, ictericia y anemia del feto.
  30. 30. Prevención Administración de inmunoglobulina anti-RhD a la madre para prevenir la enfermedad fetal. Inducir rápidamente a parto. Identificación del grupo sanguíneo y rastreo de Ab irregulares en la consulta prenatal.

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