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ABO Blood Grouping
Introduction
Terry Kotrla, MS, MT(ASCP)BB
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ABO Basics Blood group antigens are actually sugars
attached to the red blood cell.
Antigens are built onto the red cell. Individuals inherit a gene which codes
for specific sugar(s) to be added to thered cell.
The type of sugar added determines theblood group.
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This diagram illustrates the terminal
sugar for each blood group.
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ABO Type Frequencies In U.S.
ABO Type Per Cent
O 45%
A 40%
B 11%
AB 4%
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Landsteiners Rule
Individuals will form immune antibodies to
ABO blood group antigens they do not
possess.
Substances are present in nature which are so
similar to blood group antigens which result in
the constant production of antibodies to blood
group antigens they do not possess. Critical for understanding compatibility
between ABO blood groups.
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Inheritance
Blood group antigens are codominant,
if the gene is inherited, it will be
expressed. Some aberrant genotypes do occur but
due to the rarity will not be discussed.
Understanding of basic inheritanceimportant.
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Genetics
Two genes inherited, one from each parent.
Individual who is A or B may be homozygousor heterozygous for the antigen.
Heterozygous: AO or BO Homozygous: AA or BB
Phenotype is the actual expression of thegenotype, ie, group A
Genotype are the actual inherited genes whichcan only be determined by family studies, ie,
AO.
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Example of Determining
Genotype
Moms phenotype is group A, genotype AO
Dads phenotype is group B, genotype BO
B O
A AB 25% AO 25% (Group A)
O BO 25% (Group B) OO 25% (Group O)
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Other Examples
Mom Dad Offspring Blood
Group
AA BB 100% AB
BO OO 50% each of B
or O
OO OO 100% O
OO AO 50% each of A
or O
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Group O
Approximately 45% of the
population is group O.
No A or B antigens present,think of as 0 antigens present.
These individuals form potent
anti-A and anti-B antibodies
which circulate in the bloodplasma at all times.
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Group A
Approximately 40% of the
population is group A.
No B antigens present. These individuals form
potent anti-B antibodies
which circulate in the
blood plasma at all times.
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Group B
Approximately 11% of the
population is group B.
No A antigens present. These individuals form potent
anti-A antibodies which
circulate in the blood plasma
at all times.
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Group AB
Approximately 4% of thepopulation is group AB.
Both A and B antigens
present.
These individuals possessno ABO antibodies.
NOTE: This slide is inerror as it only illustratespresence of one antigennot 2.
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Hemolysis
If an individual is transfused with an
incompatible blood group destruction of the red
blood cells will occur.
This may result in the death of the recipient.
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Summary
Blood Group Antigens on cell Antibodies in
plasma
Transfuse with
group
A A Anti-B A or O
B B Anti-A B or O
AB A and B none AB, A, B or O
O None Anti-A & B O
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Rh (D) Antigen
Of next importance is the Rh type.
Term Rh is a misnomer.
Rh is a blood group system with manyantigens, one of which is D. Re-education of public is difficult.
Rh refers to the presence or absence of
the D antigen on the red blood cell.
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Rh (D) Antigen (continued)
The most important patient population to
consider is females of child-bearing age.
If immunized to Rh (D) antigen the antibodycan cross the placenta and destroy Rh (D)
positive fetal cells resulting in death.
This is why Rh negative women are given
Rhogam after birth of Rh positive baby.
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Blood Typing
There are 2 components to blood typing:
Test unknown cells with known antibodies
Test unknown serum/plasma with known rbcs The patterns are compared and the
blood group is determined.
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Slide Blood Typing
Very rudimentary method for determining bloodgroups.
CANNOT be used for transfusion purposes as
false positives and negatives do occur. A false positive is when agglutination occurs
not because the antigen is present, but cellsmay already be clumpled.
A false negative is one in which the cells arenot clumped because there are too many cellsor not enough reagent.
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Slide Blood Typing - continued
The slide is divided into halves.
On one side a drop of anti-A is added, this will attachto and cause clumping of rbcs possessing the A
antigen. On the other side a drop of anti-B is added which will
cause clumping of rbcs with the B antigen.
A drop of rbcs is added to each side and mixed wellwith the reagent.
The slide is tilted back and forth for one minute andobserved for agglutination (clumping) of the rbcs
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Interpretation of Slide Typing
Testing with Anti-A Anti-Serum
If an rbc contains the A
antigen the red blood cells will
be agglutinated by anti-A, a
positive reaction.
If an rbc does not have the A
antigen there will be no
clumping, a negative reaction.
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Interpretation of Slide Typing
Testing with Anti-B Anti-Serum
If an rbc contains the B antigen
the red blood cells will be
agglutinated by anti-B, a positive
reaction.
If an rbc does not have the B
antigen there will be no clumping
by anti-B, a negative reaction.
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Slide Blood Typing Group A
An unknown rbc suspension is added to known anti-sera.
The left hand of the slide contains anti-A which reactswith the unknown cell.
The right hand side contains anti-B which does notreact with the cell.
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Slide Blood Typing Group B
An unknown rbc suspension is added to known anti-sera.
The left hand of the slide contains anti-A does not reactwith the unknown cell.
The right hand side contains anti-B which reacts withthe cell.
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Slide Blood Typing Group O
The left hand of the slide contains anti-A does
not react with the unknown cell.
The right hand side contains anti-B does not
react with the unknown cell.
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Slide Blood Typing Group AB
The left hand of the slide contains anti-A which
reacts with the unknown cell.
The right hand side contains anti-B which
reacts with the unknown cell.
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Summary of Slide Typing
Anti-A Anti-B Blood Group
NEG NEG O
POS NEG A
NEG POS B
POS POS AB