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dr. Husnil Kadri, M.Kes

dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

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Page 1: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

dr. Husnil Kadri, M.Kes

Page 2: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

ABO BLOOD GROUP

History1. Landsteiners discovered the ABO Blood Group

System in 19012. He and five co-workers began mixing each

others red blood cells and serum together and accidentally performed the ABO groupings.

3. Main Phenotypes (A, B, AB, O)ABO gene located on long arm of chromosome 9

Page 3: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

• Karl Landsteiner discovered that blood clumping was an immunological reaction which occurs when the receiver of a blood transfusion has antibodies against the donor blood cells.

•Karl Landsteiner's work made it possible to determine blood types and thus paved the way for blood transfusions to be carried out safely. For this discovery he was awarded the Nobel Prize in Physiology or Medicine in 1930.

History of Blood Groups and Blood Transfusions (Cont.)

Page 4: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

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Inheritance of ABO GroupsAllele from the mother

Allele from the father

Genotype ofoffspring

Blood types ofoffspring

A A AA A

A B AB AB

A O AO A

B A AB AB

B B BB B

B O BO B

O O OO O

Page 5: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

http://learn.genetics.utah.edu/units/basics/blood/types.cfm

Page 6: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Blood Transfusions

A blood transfusion is a procedure in which blood is given to a patient through an intravenous (IV) line in one of the blood vessels. Blood transfusions are done to replace blood lost during surgery or a serious injury. A transfusion also may be done if a person’s body can't make blood properly because of an illness.

Rh + Can receive + or - Rh - Can only receive -

Page 7: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

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Significance of ABO Group

• ABO mismatched transfusions:– Rare– May be life threatening– Can be caused by technical or clerical error– Intravascular haemolysis– More severe in group O patients

Page 8: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

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The Rh(D) Antigen

• RH is the most complex system, with over 45 antigens

• Discovered in 1940 after work on Rhesus monkeys

• Subsequently discovered to be unrelated to monkeys

• RH gene located on short arm of chromosome 1

Page 9: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

• Rh antigens are transmembrane proteins with loops exposed at the surface of red blood cells.

• They appear to be used for the transport of carbon dioxide and/or ammonia across the plasma membrane.

• RBCs that are "Rh positive" express the antigen designated D.

Page 10: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

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Simple Genetics of Rh(D)

• 86% of caucasians are Rh(D) pos

• The antithetical antigen d has not been found

• The d gene is recessive:– Dd, dD, DD, persons are Rh(D) pos– Only dd persons are Rh(D) neg

Page 11: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

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Distribution of Rh(D) Types

Population Rh(D) pos Rh(D) neg

Caucasian 86% 14%

African-American

95% 5%

Oriental >99% <1%

Page 12: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

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Significance of Rh(D)

• 80% of Rh(D) neg persons exposed to Rh(D) pos blood will develop anti-D

• Anti-D can also be stimulated by pregnancy with an Rh(D) positive baby– Sensitisation can be prevented by the use of anti-D

immunoglobulin, antenatally and post natally

• Rh(D) neg females of childbearing potential should never be given Rh(D) positive blood products

Page 13: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

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Inheritance of ABO and Rh(D)

Mother

Group A AO

Rh(D) pos Dd

Father

Group B BO

Rh(D) pos Dd

Group A AO

Rh(D) pos Dd

Group B BO

Rh(D) pos Dd

Group O OO

Rh(D) neg dd

Page 14: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

                                                                           

• A person with Rh- blood can develop Rh antibodies in the blood plasma if he or she receives blood from a person with Rh+ blood, whose Rh antigens can trigger the production of Rh antibodies.

•A person with Rh+ blood can receive blood from a person with Rh- blood without any problems.

Page 15: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Why is an Rh incompatibility so dangerous during pregnancy?

• Most anti-A or anti-B antibodies are of the IgM class (large molecules) and these do not cross the placenta.

•In fact, an Rh−/type O mother carrying an Rh+/type A, B, or AB foetus is resistant to sensitisation to the Rh antigen.

•Her anti-A and anti-B antibodies destroy any foetal cells that enter her blood before they can elicit anti-Rh antibodies in her.

Page 16: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

•This phenomenon has led to an effective preventive measure to avoid Rh sensitisation. •Shortly after each birth of an Rh+ baby, the mother is given an injection of anti-Rh antibodies (or Rhogam).

•These passively acquired antibodies destroy any foetal cells that got into her circulation before they can elicit an active immune response in her.

Rh incompatibility during pregnancy (cont.)

Page 17: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

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The ABO Antigens

• Added to Proteins or Lipids in Red Cells• Substrate Molecule is H (fucose)• A antigen is N-acetyl-galactosamine

(GalNAc)• B antigen is Galactose (Gal)• A and B genes code for transferase

enzymes

Page 18: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

H antigen

• The H antigen is the foundation upon which A and B antigens are built

• A and B genes code for enzymes that add an immunodominant sugar to the H antigen– Immunodominant sugars are present at the

terminal ends of the chains and confer the ABO antigen specificity

Page 19: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Formation of the H antigen

Glucose

Galactose

N-acetylglucosamine

Galactose

H antigen

RBC

Fucose

Page 20: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

A and B Antigen

• The “A” gene codes for an enzyme (transferase) that adds N-acetylgalactosamine to the terminal sugar of the H antigen– N-acetylgalactosaminyltransferase

• The “B” gene codes for an enzyme that adds D-galactose to the terminal sugar of the H antigen– D-galactosyltransferase

Page 21: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Formation of the A antigen

Glucose

Galactose

N-acetylglucosamine

Galactose

RBC

FucoseN-acetylgalactosamine

Page 22: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Formation of the B antigen

Glucose

Galactose

N-acetylglucosamine

Galactose

RBC

FucoseGalactose

Page 23: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Genetics

• The H antigen is found on the RBC when you have the Hh or HH genotype, but NOT from the hh genotype

• The A antigen is found on the RBC when you have the Hh, HH, and A/A, A/O, or A/B genotypes

• The B antigen is found on the RBC when you have the Hh, HH, and B/B, B/O, or A/B genotypes

Page 24: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Blood Group O people have red blood cells rich in H antigen. Why?

Neither the A or B genes have converted the H antigens to A or B antigens - just a whole bunch of H!

O allele at the ABO locus (amorph) It does not It does not alter the structure of H substance.alter the structure of H substance.

Page 25: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Donor Nucleotides & Immundominant Sugars responsible for H, A, and B Ags specificity

Gene Glcosyltransferase Nucleotide Immunodominant sugar

Antigen

H L- fucosyl trnsferas

Guanosine

GDP-FUCL-fucose H

A N acetylgalactosaminyl

transferase

Uridine

UDP-GALNAC

N-acetyl-D-galactoseamine

A

B D- galactosyl transferase

Uridine

UDP-GALD-galactose B

Page 26: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

ABO Antigens in Secretions

• Secretions include body fluids like plasma, saliva, synovial fluid, etc

• Blood Group Substances are soluble antigens (A, B, and H) that can be found in the secretions. This is controlled by the H and Se genes

Page 27: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Secretor Status

• The secretor gene consists of 2 alleles (Se and se)

• The Se gene is responsible for the expression of the H antigen on glycoprotein structures located in body secretions

• If the Se allele is inherited as SeSe or Sese, the person is called a “secretor”– 80% of the population are secretors

Page 28: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Secretors

• Secretors express soluble forms of the H antigen in secretions that can then be converted to A or B antigens (by the transferases)

• Individuals who inherit the sese gene are called “nonsecretors”

Secretions include saliva, urine, tears, bile, amniotic fluid, breast milk, exudate, and digestive fluids.

Page 29: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Lewis (Le)

• The Lewis Blood Group System is mentioned here because it is related to secretor status

• Lewis antigens are plasma antigens formed by tissues and are released into plasma where they adsorb onto the RBCs

• Consists of 2 antigens– Lea

– Leb

Page 30: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

ABO Subgroups

• ABO subgroups differ in the amount of antigen present on the red blood cell membrane– Subgroups have less antigen

• Subgroups are the result of less effective enzymes. They are not as efficient in converting H antigens to A or B antigens (fewer antigens are present on the RBC)

• Subgroups of A are more common than subgroups of B

Page 31: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Subgroups of A

• The 2 principle subgroups of A are: A1 and A2

– Both react strongly with reagent anti-A

– To distinguish A1 from A2 red cells, the lectin Dolichos biflorus is used (anti-A1)

– 80% of group A or AB individuals are subgroup A1

– 20% are A2 and A2B

Page 32: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

B Subgroups

• B subgroups occur less than A subgroups

• B subgroups are differentiated by the type of reaction with anti-B, anti-A,B, and anti-H

• B3, Bx, Bm, and Bel

Page 33: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Other ABO conditions

• Bombay Phenotype (Oh)• Inheritance of hh• The h gene is an amorph and results in

little or no production of L-fucosyltransferase

• Originally found in Bombay (now Mumbai)

• Very rare (130 worldwide)

Page 34: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

ABO antibodies

• group A serum contains anti-B

• group B serum contains anti-A

• group AB serum contains no antibodies

• group O serum contains anti-A, anti-B, and anti-A,B

Page 35: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Anti-A1

• Group O and B individuals contain anti-A in their serum

• However, the anti-A can be separated into different components: anti-A and anti-A1

• Anti-A1 only agglutinates the A1 antigen, not the A2 antigen

• There is no anti-A2.

Page 36: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Anti-A,B

• Found in the serum of group O individuals

• Reacts with A, B, and AB cells

• Predominately IgG, with small portions being IgM

• Anti-A,B is one antibody, it is not a mixture of anti-A and anti-B antibodies

Page 37: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

ABO antibodies

• IgM is the predominant antibody in Group A and Group B individuals– Anti-A– Anti-B

• IgG (with some IgM) is the predominant antibody in Group O individuals– Anti-A,B (with some anti-A and anti-B)

Page 38: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

ABO Antibodies

• Usually present within the first 3-6 months of life

• Stable by ages 5-6 years

• Decline in older age

• Newborns may passively acquire maternal antibodies (IgG crosses placenta)

Page 39: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Laboratory Testing:

ABO typing

Page 40: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

ABO Blood GroupsABO

GroupAntigen Present

Antigen Missing

Antibody Present

A A B anti-B

B B A anti-A

O None A and B anti-A, anti-B, anti-A,B

AB A and B None None

Page 41: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

The ABO Blood Group System

                                                                                                             

               Laboratory  Determination of

the ABO System

                                                                      

Page 42: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

Serology: This is a direct detection of the ABO antigens. It is the main method used in blood transfusion centres and hospital blood banks.

This form of testing involves two components:

a) Antibodies that are specific at detecting a particular ABO antigen on RBCs.          b) Cells that are of a known ABO group that are agglutinated by the naturally occurring antibodies in the person's serum.

Page 43: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

• Illustration of the forward and reverse grouping reaction patterns of the ABO groups using a blood group tile

http://www.bh.rmit.edu.au/mls/subjects/abo/resources/genetics1.htm

Page 44: dr. Husnil Kadri, M.Kes ABO BLOOD GROUP History 1.Landsteiners discovered the ABO Blood Group System in 1901 2.He and five co-workers began mixing each

RESOURCES

• Aldahr MHS. ABO Blood Group. Faculty of Applied Medical Sciences Blood Bank Medical Tecnology. download 2011

• Giacobbe. ABO & Rh(D) Blood Groups. Anatomy & Physiology. Unit 9 – Circulatory System.download 2011

• Musani MI. Blood groups and Rhesus factor. Download 2011

• Trimpe T. Blood Basics. Forensic Science.2006• Wilkins RN. ABO Blood Group System. University of

Mississippi Medical Center. Download 2011.