Transcript
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BLOOD GROUPS & BLOOD GROUPS & TYPES TYPES
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HISTORICALHISTORICAL 1919thth CENTURY: Boer War CENTURY: Boer War Massive deaths of people:Massive deaths of people:
Many infectionsMany infections Severe blood lossSevere blood loss
Attempts to transfuse blood began.Attempts to transfuse blood began. They had confusing results.They had confusing results. Some people recovered fully.Some people recovered fully. Others died.Others died.
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WHY? WHY? WHY?WHY? WHY? WHY? Either all should die Either all should die Or all should live.Or all should live. Why this difference?Why this difference? This question haunted a This question haunted a
researcher called researcher called Karl Karl Landsteiner.Landsteiner.
He worked hard to find out He worked hard to find out why.why.
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KARL LANDSTEINER, NOBEL KARL LANDSTEINER, NOBEL LAUREATE, 1930.LAUREATE, 1930.
1868
1943
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KARL LANDSTEINERKARL LANDSTEINER Wondered about this phenomenon.Wondered about this phenomenon. Studied this extensively.Studied this extensively. Discovered Blood Groups and types Discovered Blood Groups and types
single handedly.single handedly. Framed the Landsteiner’s Law in Framed the Landsteiner’s Law in
1904.1904. Continued to research on Blood Continued to research on Blood
groups and types till his death in groups and types till his death in 1943.1943.
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LANDSTEINER’S LAWLANDSTEINER’S LAW1.“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: LANDSTEINER’S LAW: APPLICABILITYAPPLICABILITY
The first law is applicable to all The first law is applicable to all groups and types of blood.groups and types of blood.
It is a logical conclusion.It is a logical conclusion. The second part is a fact, but not The second part is a fact, but not
necessarily true always.necessarily true always. It is a fact for ABO Blood groups.It is a fact for ABO Blood groups. The Rh, M,N and other groups or The Rh, M,N and other groups or
types do not follow the second types do not follow the second part of the Landsteiner’s Law.part of the Landsteiner’s Law.
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ABO BLOOD GROUPSABO BLOOD GROUPS
The most common type of The most common type of blood grouping in use.blood grouping in use.
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AGGLUTINOGENSAGGLUTINOGENS 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)AGGLUTINOGENS (Contd) Some individuals will have Some individuals will have
Erythrocytes with an agglutinogen Erythrocytes with an agglutinogen called as “A”.called as “A”.
Others have one called “B”Others have one called “B” The third type of agglutinogen is non The third type of agglutinogen is non
antigenic and it is called “H”antigenic and it is called “H” H doesn’t cause production of H doesn’t cause production of
antibodies.antibodies. So those having H antigen are called So those having H antigen are called
O group individuals.O group individuals.
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A AND B, INDIVIDUALSA AND B, INDIVIDUALS Those having the Those having the A agglutinogenA agglutinogen
on their erythrocytes are called on their erythrocytes are called A blood group people.A blood group people.
Those having theThose having the B agglutinogen B agglutinogen are called the B blood group are called the B blood group people.people.
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Some have both the Some have both the A and B A and B agglutinogensagglutinogens on their on their erythrocytes and they are called erythrocytes and they are called AB type.AB type.
Others have Others have neither A nor B neither A nor B agglutinogensagglutinogens. They have the . They have the non antigenic H on their RBCs non antigenic H on their RBCs and are called O group people.and are called O group people.
AB & O INDIVIDUALSAB & O INDIVIDUALS
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AGGLUTININSAGGLUTININS The antibodies to the agglutinogens The antibodies to the agglutinogens
are called Agglutinins.are called Agglutinins. These are present naturally in ABO These are present naturally in ABO
groups.groups. They are always present in the They are always present in the
plasma of the individual.plasma of the individual. There are two types of agglutinins in There are two types of agglutinins in
the ABO blood system:the ABO blood system: Anti A or Anti A or αα: Alpha: Alpha Anti B or Anti B or ββ: Beta: Beta
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AGGLUTININS (Contd)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 GROUPSABO BLOOD GROUPSGROUPGROUP AGGLUTINOGEN/S AGGLUTINOGEN/S
ON RBCON RBCAGGLUTININ/S AGGLUTININ/S
IN PLASMAIN PLASMAAA AA ββ
BB BB αα
ABAB Both A & BBoth A & B NoneNone
OO Neither A nor BNeither A nor B Both Both αα and and ββ
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ABO BLOOD GROUP TESTABO BLOOD GROUP TEST Why test?Why test? To determine the blood To determine the blood
groups.groups. How is the test done?How is the test done? The erythrocytes of the The erythrocytes of the
patient are exposed to the two patient are exposed to the two different types of anti sera.different types of anti sera.
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Antisera are solutions containing the Antisera are solutions containing the respective agglutinins.respective agglutinins.
Anti A agglutinin is present in Antisera AAnti A agglutinin is present in Antisera A Anti sera B contains Beta agglutinin or Anti sera B contains Beta agglutinin or
anti B agglutinin.anti B agglutinin. In this test the patients erythrocytes are In this test the patients erythrocytes are
exposed separately to both these exposed separately to both these antisera.antisera.
Agglutination is seen in one or more of Agglutination is seen in one or more of the solutions.the solutions.
ABO BLOOD GROUP TESTABO BLOOD GROUP TEST
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AGGLUTINATIONAGGLUTINATION Agglutination or clumping is seen Agglutination or clumping is seen
whenever the respective whenever the respective agglutinogens and agglutinins are agglutinogens and agglutinins are mixed.mixed.
Agglutinogen A + Agglutinin Alpha = Agglutinogen A + Agglutinin Alpha = Agglutination.Agglutination.
Agglutinogen B + Agglutinin Beta = Agglutinogen B + Agglutinin Beta = Agglutination.Agglutination.
Both agglutinogens + Both antisera = Both agglutinogens + Both antisera = Agglutination.Agglutination.
No agglutinogens = No agglutination.No agglutinogens = No agglutination.
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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 either of the two antisera, then the person is of the group O.
ABO BLOOD GROUP TESTABO BLOOD GROUP TEST
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By doing this test we can By doing this test we can determine the blood group of determine the blood group of individuals.individuals.
Knowing one’s blood group helps Knowing one’s blood group helps us in times of need. If a patient is us in times of need. If a patient is of Group A, he can receive blood as of Group A, he can receive blood as transfusion from group A or group transfusion from group A or group O individuals. He cannot receive it O individuals. He cannot receive it from Group B or Group AB people.from Group B or Group AB people.
ABO BLOOD GROUP TESTABO BLOOD GROUP TEST
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Why? Why? Because the agglutinogens in Because the agglutinogens in
the donor’s blood can the donor’s blood can agglutinate with the agglutinate with the agglutinin in the recipient’s agglutinin in the recipient’s blood and cause hemolysis. blood and cause hemolysis.
This is called transfusion This is called transfusion mismatch and can be fatal.mismatch and can be fatal.
ABO BLOOD GROUP TESTABO BLOOD GROUP TEST
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UNIVERSAL DONOR & UNIVERSAL DONOR & RECEPIENTSRECEPIENTS
The blood group O can be given to The blood group O can be given to any other of the ABO group any other of the ABO group persons and so is called the persons and so is called the “Universal Donor”“Universal Donor”
The blood group AB persons lack The blood group AB persons lack agglutinins and so can receive agglutinins and so can receive blood from any of the ABO group blood from any of the ABO group persons. So this AB group is called persons. So this AB group is called as the “Universal Recipient” as the “Universal Recipient”
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DONATIONS…DONATIONS… AA Blood group person can donate Blood group person can donate
blood to A and AB groups.blood to A and AB groups. BB Blood group person can donate Blood group person can donate
blood to B and AB groups.blood to B and AB groups. ABAB Blood group person can Blood group person can
donate blood only to AB group.donate blood only to AB group. O O blood group person can donate blood group person can donate
blood to O, A, B and AB groups.blood to O, A, B and AB groups.
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ABO BLOOD GROUP TEST: ABO BLOOD GROUP TEST: SUMMARYSUMMARY
RED CELLS
ANTISERA ALPHA
ANTISERA BETA
A AGGLUTINATION
NO AGGLUTINATIO
NB NO AGG. AGGLUTINATIO
NAB AGGLUTINATIO
NAGGLUTINATIO
NO NO
AGGLUTINATION
NO AGGLUTINATIO
N
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CROSS MATCHINGCROSS MATCHING This is a test done just This is a test done just
before the blood is before the blood is transfused.transfused.
It helps rule out other group It helps rule out other group mismatches.mismatches.
It has two parts: It has two parts: MajorMajor & & Minor Minor cross matching.cross matching.
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MAJOR CROSS MATCHINGMAJOR CROSS MATCHING The effects of the recipient’s The effects of the recipient’s
serum agglutinins on the serum agglutinins on the donors erythrocytes.donors erythrocytes.
This is called major because This is called major because about 300 ml of the Blood cells about 300 ml of the Blood cells of the donor are sent into the of the donor are sent into the circulation of the recipient.circulation of the recipient.
Donor’s Erythrocytes+ Donor’s Erythrocytes+ Recipient’s plasma= ?Recipient’s plasma= ?
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MINOR CROSS MATCHINGMINOR CROSS MATCHING The Effect of the donor’s serum The Effect of the donor’s serum
agglutinins on the recipient’s agglutinins on the recipient’s erythrocytes.erythrocytes.
This is called minor because these This is called minor because these agglutinins get diluted by the agglutinins get diluted by the larger volume of the recipient’s larger volume of the recipient’s plasma.plasma.
Donor’s Serum + Recipient’s Donor’s Serum + Recipient’s ErythrocytesErythrocytes
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PERCENTAGE OF BLOOD PERCENTAGE OF BLOOD GROUPSGROUPS
WESTERN POPULATION
42
9
46
3
ABOAB
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PERCENTAGE OF BLOOD PERCENTAGE OF BLOOD GROUPSGROUPS
ASIAN POPULATION
25
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5
ABOAB
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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 Rh Positive and Negative peoplepeople
People who have the Rh People who have the Rh agglutinogen on their RBC agglutinogen on their RBC membranes are called membranes are called Rh Positive.Rh Positive.
Those who do not have the Rh Those who do not have the Rh agglutinogen are called agglutinogen are called Rh Negative Rh Negative people.people.
Rh-ve peopleRh-ve people do not NATURALLY do not NATURALLY carrycarry the corresponding the corresponding Anti-Rh Anti-Rh antibodyantibody..
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DISTRIBUTION OF Rh DISTRIBUTION OF Rh TYPESTYPES
CAUCASIAN POPULATION15
85
Rh+veRh-ve
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DISTRIBUTION OF Rh DISTRIBUTION OF Rh TYPESTYPES
ORIENTAL POPULATION
95
5
Rh+veRh-ve
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Rh or D Agglutinins Rh or D Agglutinins Anti-D agglutinins or antibodies Anti-D agglutinins or antibodies do not do not
occur naturally.occur naturally. They are produced by the Immune They are produced by the Immune
systems as and when it is exposed to systems as and when it is exposed to the D antigens.the D antigens.
So these Anti D agglutinins are found So these Anti D agglutinins are found only in some of the Rh Negative only in some of the Rh Negative people.people.
Those who have been Those who have been exposed to the exposed to the Rh or D antigenRh or D antigen
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Exposure to Antigens: How?
The Rh+ve people will never The Rh+ve people will never manufacture Anti D antibodies.manufacture Anti D antibodies.
Only Rh – ve individuals can Only Rh – ve individuals can develop these Agglutinins.develop these Agglutinins.
When these Rh-ve people receive When these Rh-ve people receive Rh+ve blood by mistake, they get Rh+ve blood by mistake, they get exposed to the antigen.exposed to the antigen.
Then they will develop the Then they will develop the antibody.antibody.
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In case of an In case of an Rh-ve womanRh-ve woman, if , if she is married to an she is married to an Rh+ve manRh+ve man, , she can conceive an she can conceive an Rh+ve childRh+ve child..
In this case, the D antigen In this case, the D antigen present on the erythrocytes of present on the erythrocytes of the fetus does not go into the the fetus does not go into the maternal circulation maternal circulation throughout throughout the pregnancy the pregnancy (due to the Feto-(due to the Feto-Placental barrier)Placental barrier)
Exposure to Antigens: Exposure to Antigens: How?How?
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During the delivery of the baby, During the delivery of the baby, some some blood of the fetus spillsblood of the fetus spills over into the maternal circulation.over into the maternal circulation.
The maternal circulation is The maternal circulation is exposed to the exposed to the D antigensD antigens from from the fetal erythrocytes.the fetal erythrocytes.
The maternal circulation The maternal circulation slowly slowly develops Anti D antibodiesdevelops Anti D antibodies..
The first child is howeverThe first child is however spared spared..
Exposure to Antigens: Exposure to Antigens: How?How?
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ERYTHROBLASTOSIS FETALISERYTHROBLASTOSIS FETALIS
The second child in such a woman, if The second child in such a woman, if also Rh+ve, can develop a disease also Rh+ve, can develop a disease called as called as Erythroblastosis fetalisErythroblastosis fetalis..
This is due to the This is due to the Anti D antibodies Anti D antibodies developed in the mother.developed in the mother.
These antibodies These antibodies traverse through traverse through the placentathe placenta, enter the fetal , enter the fetal circulation and cause circulation and cause agglutinationagglutination of the erythrocytes of the fetus.of the erythrocytes of the fetus.
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PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF ERYTHROBLASTOSIS FETALISERYTHROBLASTOSIS FETALIS
PLACENTA
MATERNALCIRCULATION
FETAL CIRCULATION
Anti-D Antibodies Agglutination of RBCs
HemolysisHemoglobin in Plasma
Bilirubin
Jaundice
Blocks RenalTubules
Renal Failure Kernicterus
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NORMAL JAUNDICED
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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
hours after preterm or term birth
ERYTHROBLASTOSIS FETALIS or ERYTHROBLASTOSIS FETALIS or ICTERUS GRAVIS NEONATORUMICTERUS GRAVIS NEONATORUM
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ERYTHROBLASTOSIS:ERYTHROBLASTOSIS:PREVENTIONPREVENTION
All pregnant women to be tested All pregnant women to be tested for Rh.for Rh.
If any are If any are Rh-veRh-ve, their husbands , their husbands also to be tested for Rh.also to be tested for Rh.
The first baby’s blood to be The first baby’s blood to be tested for Rh.tested for Rh.
If Rh+ve, then the mother to be If Rh+ve, then the mother to be givengiven Rhogam injection Rhogam injection within within 24 24 hrshrs after delivery. after delivery.
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TREATMENT OF TREATMENT OF ERYTHROBLASTOSISERYTHROBLASTOSIS
EXCHANGE TRANSFUSION.EXCHANGE TRANSFUSION. The entire blood of the fetus is The entire blood of the fetus is
replaced by O Rh-ve blood.replaced by O Rh-ve blood. This is done in small installments.This is done in small installments. Once it is done, slowly the baby Once it is done, slowly the baby
will recover, as erythropoiesis will recover, as erythropoiesis occurs while these O –ve cells die.occurs while these O –ve cells die.
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EXCHANGE TRANSFUSION EXCHANGE TRANSFUSION
NOMAD:2006: BP:BldgpsINOMAD:2006: BP:BldgpsI 4848
AFTER SUCCESSFUL THERAPYAFTER SUCCESSFUL THERAPY
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USES OF BLOOD GROUPSUSES OF BLOOD GROUPS CLINICAL:CLINICAL:
For transfusion of bloodFor transfusion of blood To prevent Erythroblastosis fetalisTo prevent Erythroblastosis fetalis
MEDICOLEGAL:MEDICOLEGAL: Determination of suspected parentageDetermination of suspected parentage Can say whether one could or could Can say whether one could or could
not have been the father of a child.not have been the father of a child. DNA fingerprinting is more specific.DNA fingerprinting is more specific.
GENETIC STUDIES: EPIDEMIOLOGY.GENETIC STUDIES: EPIDEMIOLOGY.
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INCOMPATIBLE INCOMPATIBLE TRANSFUSIONS CAUSE…TRANSFUSIONS CAUSE…
MILD REACTIONS SUCH AS:MILD REACTIONS SUCH AS: Chills and rigorsChills and rigors FeverFever Inapparent Hemolysis.Inapparent Hemolysis. Post transfusion Jaundice. Post transfusion Jaundice. Severe transfusion reactions.Severe transfusion reactions.
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SEVERE TRANSFUSION SEVERE TRANSFUSION REACTIONSREACTIONS
Violent Backaches.Violent Backaches. Tightness in the chest.Tightness in the chest. Jaundice.Jaundice. Oliguria.Oliguria. Renal Shutdown/Failure.Renal Shutdown/Failure. AnuriaAnuria DeathDeath
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