AN INTRODUCTION TO BLOOD GROUP AND CROSSMATCH

AN INTRODUCTION TO AN INTRODUCTION TO BLOOD GROUP AND BLOOD GROUP AND

CROSSMATCHCROSSMATCH

Abdullah Ahmed Meshi, BMSc., MT, (CLS).Abdullah Ahmed Meshi, BMSc., MT, (CLS).

Chief of Blood BankChief of Blood Bank

Member of International Society of Blood Member of International Society of Blood TransfusionTransfusion

Member of British Blood Transfusion SocietyMember of British Blood Transfusion Society

King Fahd Central HospitalKing Fahd Central Hospital

Jazan, KSA, 2003Jazan, KSA, 2003

INTRODUCTIONINTRODUCTION

• HISTORY OF BLOOD GROUPS.HISTORY OF BLOOD GROUPS.

• BLOOD GROUP SEROLOGY.BLOOD GROUP SEROLOGY.

• BLOOD GROUP SYSTEMS.BLOOD GROUP SYSTEMS.

• COMPATIBLITY TEST.COMPATIBLITY TEST.

• SELECTION OF APPROPRIATE UNIT FOR SELECTION OF APPROPRIATE UNIT FOR TRANSFUSION.TRANSFUSION.

HISTORY OF BLOOD GROUPSHISTORY OF BLOOD GROUPS

• Karl Landsteiner discovered the 1Karl Landsteiner discovered the 1stst human blood human blood group system, ABO in 1900.group system, ABO in 1900.

• Karl Landsteiner and his student A. Wiener Karl Landsteiner and his student A. Wiener discovered the 2discovered the 2ndnd most important blood group most important blood group system, Rh system in 1939.system, Rh system in 1939.

BLOOD GROUP SEROLOGYBLOOD GROUP SEROLOGY

• Antigen (Ag)Antigen (Ag)– Any substance recognized as foreign by the body which Any substance recognized as foreign by the body which

stimulates the immune system to mount a response stimulates the immune system to mount a response against it.against it.

• Antibody (Ab)Antibody (Ab)– A protective protein produced by the immune system as A protective protein produced by the immune system as

a result of stimulation by a foreign protein.a result of stimulation by a foreign protein.

• Immunoglobulin (Ig)Immunoglobulin (Ig)– An antibody molecule synthesized by plasma cells in An antibody molecule synthesized by plasma cells in

response to an antigen.response to an antigen.

Antigens on Red Blood cellsAntigens on Red Blood cells

RBC RBC

Antigen (Ag)

Antigen – Antibody ReactionAntigen – Antibody Reaction

Immunoglobulin (Antibody)Immunoglobulin (Antibody)

Immunoglobulin (Antibody)Immunoglobulin (Antibody)

Blood Group SystemsBlood Group Systems

• ABO system• Rh system• Other systems:

– Kell system– Lewis system– MNSs system– Duffy system– Kidd system– Lutheran system

ABO Blood Group System

• Two Ag (A and B) make all four blood groups.

RBC with A Ag only

RBC with B Ag only

A group B group

ABO Blood Group SystemABO Blood Group System

• Two Ag (A and B) make all four blood groups.Two Ag (A and B) make all four blood groups.

RBC with A and B Ag

RBC without A and B Ag

AB group O group

ABO Blood Group SystemABO Blood Group System

• Two antibodies are (naturally) developed in this system.

• Type A individual develop anti-B antibodies.

• Type B individual develop anti-A antibodies.

• Type AB individual develop NO antibodies.

• Type O individual develop anti-A and anti-B antibodies.

Antigen (Ag) on RBCs

Antibody (Ab) in Plasma

Blood Group

A AgAnti-BA

B AgAnti-AB

A & B AgNo AbAB

No AgAnti-A &

Anti-BO

ABO Blood Group SystemABO Blood Group System

Rh Blood Group SystemRh Blood Group System• Five antigens are present (D, C, c, E, and e).Five antigens are present (D, C, c, E, and e).• No (No (NaturallyNaturally) developed antibodies in this ) developed antibodies in this

system, but developed as an system, but developed as an immune responseimmune response. . • DD AgAg is the most significant Ag in Transfusion is the most significant Ag in Transfusion

practice.practice.• If If DD AgAg present on RBC, it is called ( present on RBC, it is called (Rh PositiveRh Positive).).• If D If D AgAg is not present on RBC, it is called ( is not present on RBC, it is called (Rh Rh

NegativeNegative). ). • If If Rh NegRh Neg patient receive patient receive Rh PosRh Pos RBCs, 50-75% RBCs, 50-75%

he/she will form Anti-D. he/she will form Anti-D.

Combination Between ABO & Rh SystemCombination Between ABO & Rh System

ABO GroupD Ag PresentD Ag absence

AA Rh PosA Rh Neg

BB Rh PosB Rh Neg

ABAB Rh PosAB Rh Neg

OO Rh PosO Rh Neg

Other Blood Group SystemOther Blood Group System

Blood Group systemAntigen Present

Lewis systemLea & Leb

MNSs systemM, N, S, & s

Kell systemK, k, Kpa, Kpb,Jsa & Jsb

Duffy systemFya & Fyb

Kidd systemJka & Jkb

Lutheran systemLua & Lub

Blood Grouping TechniqueBlood Grouping Technique

Blood Grouping TechniqueBlood Grouping Technique

Compatibility TestingCompatibility Testing

• Compatibility testing is consist of:– Review of patient’s past transfusion history and

records.

– ABO and Rh typing of recipient and donor.

– Antibody screening of recipient and donor.

– The crossmatch test.

• Crossmatch test is only part of compatibility test.

Crossmatch TestCrossmatch Test

• XM is an in-vitro procedure to determine serologic XM is an in-vitro procedure to determine serologic compatibility between the donor’s RBC and the recipient’s compatibility between the donor’s RBC and the recipient’s serum.serum.

• 1 drop of 3-5% donor RBC suspension in NS + 2 drops of 1 drop of 3-5% donor RBC suspension in NS + 2 drops of recipient serum.recipient serum.

• There are two main functions of XM test:There are two main functions of XM test:– Final check of ABO compatibility between donor and patient.Final check of ABO compatibility between donor and patient.– Detects most antibodies in patient’s serum directed against Detects most antibodies in patient’s serum directed against

antigens on the donor cells.antigens on the donor cells.

1.1. Incorrect ABO grouping of the patient or donor.Incorrect ABO grouping of the patient or donor.

2.2. An alloantibody in the patient’s serum reacting with the An alloantibody in the patient’s serum reacting with the corresponding antigen on donor RBCs.corresponding antigen on donor RBCs.

3.3. An autoantibody in the patient’s serum reacting with the An autoantibody in the patient’s serum reacting with the corresponding antigen on donor RBCs.corresponding antigen on donor RBCs.

4.4. Prior coating of the donor RBCs with Ab/C resulting in Prior coating of the donor RBCs with Ab/C resulting in a positive antihuman globulin test (AGT).a positive antihuman globulin test (AGT).

5.5. Abnormalities in the patient’s serum.Abnormalities in the patient’s serum.

6.6. Contamination in the test system.Contamination in the test system.

Causes of Incompatible Crossmatch Causes of Incompatible Crossmatch

P1 Xg

D C E c e CwV K k Kpa Kpb Jsa Jsb

M N S s Fya Fyb Jka Jkb Lea Leb Lua LubP1 Xga

# IS 37 AHGCCC

1 r'r DL0176 0 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 + 0 + + 0 0 + 0 + 0 0 1 0 0 0 2+

2 R1R1W DW0410 + + 0 0 + + 0 0 + + + 0 + + 0 + + + 0 + 0 0 + 0 + + + 2 0 4+ 4+

3 R1R1 DC0331 + + 0 0 + 0 0 0 + 0 + 0 + + + 0 + + 0 0 + + 0 0 + 0 + 3 0 4+ 4+

4 R2R2 DE1143 + 0 + + 0 0 0 0 + 0 + + + + 0 0 + 0 0 + 0 0 0 0 + + 0 4 0 4+ 4+

5 r"r DM0187 0 0 + + + 0 0 0 + 0 + 0 + + + 0 + + + + + 0 + 0 + 0 0 5 0 0 0 2+

6 rrK DK0425 0 0 0 + + 0 0 + + 0 + 0 + + + + + + + + + 0 + 0 + + + 6 0 0 0 2+

7 rr DN1081 0 0 0 + + 0 0 0 + 0 + 0 + + 0 + + 0 + + 0 + 0 0 + + + 7 0 0 0 2+

8 rr DN1082 0 0 0 + + 0 0 0 + 0 + 0 + + + + + 0 + 0 + 0 + 0 + + + 8 0 0 0 2+

9 rr DN1085 0 0 0 + + 0 0 0 + 0 + 0 + 0 + 0 + + 0 + + 0 + 0 + + + 9 0 0 0 2+

10 R0r DT0231 + 0 0 + + 0 + 0 + 0 + 0 + 0 + 0 + 0 0 + + 0 0 0 + + 0 10 0 4+ 4+

11 R1r DH0127 + + 0 + + 0 0 + + 0 + 0 + + + + 0 0 + 0 + 0 + 0 + + 0 11 0 4+ 4+PC Autocontrol PC 0 0 0 2+

Patient 0 + 0 + + 0 0 0 + 0 + 0 + + 0 0 + 0 0 + + 0 + 0 + + 0

D C E c e CwV K k Kpa Kpb Jsa Jsb

M N S s Fya Fyb Jka Jkb Lea Leb Lua LubP1 Xga

Donor Rh

ID##

Kell Test MethodsLutheranMNSs Duffy Kidd LewisRh-hr

Antibody Identification TestAntibody Identification Test

Selection of Appropriate Unit for TransfusionSelection of Appropriate Unit for Transfusion

• Selection of whole blood for transfusion.

• Selection of RBCs for transfusion.

• Selection of platelet and fresh frozen plasma for transfusion.

Selection of Whole Blood for TransfusionSelection of Whole Blood for Transfusion

Patient Patient GroupGroup

11stst Choice ChoiceAlternativesAlternativesWith Approval of With Approval of

ConsultantConsultant

O PosO PosO PosO PosO NegO Neg------------

O NegO NegO NegO Neg------------O PosO Pos

A PosA PosA PosA PosA NegA Neg------ ------

A NegA NegA NegA Neg------------A PosA Pos

B PosB PosB PosB PosB NegB Neg------------

B NegB NegB NegB Neg------------B PosB Pos

AB PosAB PosAB PosAB PosAB NegAB Neg------------

AB NegAB NegAB NegAB Neg------------AB PosAB Pos

Selection of RBCsSelection of RBCs

Patient Patient GroupGroup

11stst Choice ChoiceAlternativesAlternativesWith Approval With Approval of Consultantof Consultant

O PosO PosO PosO PosO NegO Neg------------

O NegO NegO NegO Neg------------O PosO Pos

A PosA PosA PosA PosA Neg, O Pos, O NegA Neg, O Pos, O Neg------ ------

A NegA NegA NegA NegO NegO NegA Pos, O PosA Pos, O Pos

B PosB PosB PosB PosB Neg, O Pos, O NegB Neg, O Pos, O Neg------------

B NegB NegB NegB NegO NegO NegB Pos, O PosB Pos, O Pos

AB PosAB PosAB PosAB PosAB Neg, O Pos, O Neg, A AB Neg, O Pos, O Neg, A Pos, A Neg, B Pos, B NegPos, A Neg, B Pos, B Neg

------------

AB NegAB NegAB NegAB NegO Neg, A Neg, B NegO Neg, A Neg, B NegAB Pos, A Pos, AB Pos, A Pos, B Pos, O PosB Pos, O Pos

Selection of Platelets and Fresh Frozen Plasma Selection of Platelets and Fresh Frozen Plasma

Patient GroupPatient Group11stst Choice ChoiceAlternativesAlternatives

O O O O A, B, ABA, B, AB

A A A A ABAB

B B B B ABAB

ABABABABABAB

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