DR NILESH KATE

MBBS,MDASSOCIATE PROF

DEPT. OF PHYSIOLOGY

BLOOD GROUPS

OBJECTIVES. BLOOD GROUPS

Introduction Classical ABO blood

grouping system Rh blood grouping

system Clinical applications of

blood groups.

BLOOD TRANSFUSION. Indications Donors & recipient. Precautions during

blood transfusion. Hazards Autologous BT. Storage of blood for

transfusion.

Monday, May 1, 2023

INTRODUCTION Agglutinogens –

Antigens present on cell membrane of RBC

Agglutinins – antibodies against Agglutinogens present in plasma.

Agglutination – of RBC is reaction between these 2

Monday, May 1, 2023

BLOOD GROUPING SYSTEM. Major blood group system – based on Agglutinogens on cell

membrane, present widely & causes severe transfusion reaction ABO Rh system

Minor blood group system – based on Agglutinogens but present in few populations & causes mild transfusion reaction. MNS P

Familial blood group system – found in few families KELL. DUFFY, LUTHERAN, BOMBAY LEWIS, DEIGO, KIDD

Monday, May 1, 2023

LANDSTEINER’S LAWKARL LANDSTEINER 1900

If an Agglutinogens is present on surface of RBC corresponding agglutinins must be absent in plasma.

& if an Agglutinogens is absent on surface of RBC corresponding Agglutinins must be present in plasma.

Monday, May 1, 2023

CLASSICAL ABO BLOOD GROUPING SYSTEM

A & B Agglutinogens- these are complex oligosaccharides differing in terminal sugar

In Antigen A – N-acetylgalactosamine & in Antigen B – galactose.

Other than RBC also present in salivary glands, pancreas, kidney, liver, lung, testes also in body fluids like saliva, semen & amniotic fluid

Monday, May 1, 2023

CLASSICAL ABO BLOOD GROUPING SYSTEM

Anti-A (α)and anti-B (β) Agglutinins – IgM type & cannot cross placenta.

Absence of these are determined by Landsteiner’s law

Act best at low temperature so called Cold Antibodies.

Monday, May 1, 2023

TYPES OF ABO BLOOD GROUPS.

BLOOD GROUP ANTIGEN ANTIBODIES

A A ANTI B OR β

B B ANTI A OR α

AB AB ---------------------

O -----------ANTI A (α) & ANTI B

(β)

Monday, May 1, 2023

POPULATION DISTRIBUTION OF ABO BLOOD GROUPS

BLOOD GROUPS PERCENTAGE (%)

A 20

B 40

AB 08

O 32

Monday, May 1, 2023

INHERITANCE OF ABO BLOOD GROUPS

PHENOTYPE(BLOOD GROUP)

GENOTYPE

A AA,AO

B BB,BO

AB AB

O OO

Monday, May 1, 2023

APPERANCE OF ANTIGENS & ANTIBODIES

Antigens A & B appears in 6th week of fetal life, at birth 1/5th of adult level & rises during puberty & adolescence.

Antibodies are absent at birth, appear 10-15 days after birth, reach maximum at 10 yrs.

Monday, May 1, 2023

MECHANISM Antigens similar to A & B are present in

intestinal bacteria & foods, when newborn exposed to these absorbed in blood, stimulate formation of antibodies against antigens recognized as non-self by immune system.

Monday, May 1, 2023

DETERMINATION OF ABO BLOOD GROUPS

Covered in

Practicals “ Determination of Blood Groups”

Monday, May 1, 2023

Rh BLOOD GROUPING SYSTEM Rh Antigens – called Rh as these were first

discovered in RBC of rhesus monkey. Discovered by Landsteiner & weiner in 1940. 3 types of Rh antigen, C,D & E, D IS COMMONEST & causes severe transfusion

reaction. Rh antigens are integral membrane proteins & not

found in other tissues.

Monday, May 1, 2023

Rh Antibodies. No natural antibodies like

ABO blood groups system Rh antibodies are produced

when Rh -ve individual is transfused with Rh +ve blood.

These are IgG type & crosses placenta.

Warm Antibodies.

Monday, May 1, 2023

INHERITANCE OF Rh BLOOD GROUPS

Monday, May 1, 2023

Monday, May 1, 2023

HEMOLYTIC DISEASE OF NEWBORN.

Incompatibility of Rh blood groups between fetus & mother.

Monday, May 1, 2023

MECHANISM OF HEMOLYTIC DISEASE OF NEWBORN IN RH INCOMPATIBILITY.

Entrance of Rh +ve fetal RBC into Rh –ve mother’s circulation during first pregnancy.

Production of Rh antibodies.

Rh incompatibility reaction during second pregnancy.

Monday, May 1, 2023

MANIFESTATIONS OF HEMOLYTIC DISEASE OF NEWBORN.

Erythroblastosis fetalis. Erythroblastosis Anaemia.

Icterus gravis Neonatorum. Jaundice Enlarged liver & spleen.

Kernicterus – excess (<18mg%) bilirubin deposition in brain mainly basal ganglia

Hydrops fetalis – Grossly edematous fetus.

Monday, May 1, 2023

PREVENTION OF HEMOLYTIC DISEASE OF NEWBORN.

Injecting single dose of Rh antibodies (anti-D) to mother soon after child birth.

So active antibodies will not be formed by mother.

Monday, May 1, 2023

TREATMENT OF HEMOLYTIC DISEASE OF NEWBORN.

Replacement of baby’s Rh+ve blood by Rh –ve blood.

This is called Exchange Transfusion.

Monday, May 1, 2023

CLINICAL APPLICATIONS OF BLOOD GROUPS.

In blood transfusion. In Preventing Hemolytic Disease. In Paternity Disputes. In Medicolegal Cases. In knowing Susceptibility to Diseases.

Monday, May 1, 2023

BLOOD TRANSFUSION. Life saving measure Should be carried out

when absolutely necessary.

Monday, May 1, 2023

INDICATIONS Blood loss – Accidents, major operations, rupture

peptic ulcer, rupture aortic aneurysm & rupture ectopic pregnancy.

For Quick restoration of haemoglobin. Exchange transfusion. Blood diseases- Aplastic anaemia, agranulocytosis,

leukemias, purpurae & clotting defects Acute poisoning – carbon Monoxide poisoning.

Monday, May 1, 2023

DONORS & RECIPIENT. Donor – person who

donate the blood Recipient – person who

receives the blood. Universal donor – O

Rh Negative. Universal recipient –

AB Rh positive

Monday, May 1, 2023

PRECAUTIONS TO BE TAKEN WHILE SELECTING DONOR.

Should be Healthy Age – 18- 60 yrs Contraindicated in

pregnant & lactating mothers

Screening for – AIDS, viral hepatitis, malaria, syphilis.

Hb & PCV should be normal

Monday, May 1, 2023

PRECAUTIONS DURING BLOOD TRANSFUSION.

Absolute indication. Cross matching

Major – Donor’s RBC + Recipient plasma

Minor -Donor’s plasma+ Recipient RBC

Rh +ve blood should never be transfused to Rh –ve person.

Donor’s blood should always be screened for diseases.

Monday, May 1, 2023

PRECAUTIONS DURING BLOOD TRANSFUSION.

Blood bag/bottle should be checked. Blood transfusion should be given at slow rate. Proper Aseptic measures. Careful watch on recipient condition – for first 10-

15min. Should stop if any reaction

Monday, May 1, 2023

HAZARDS OF BLOOD TRANSFUSION.

Mismatched transfusion reaction. Agglutination of donor’s RBC Tissue ischemia – chest pain or back pain Haemolysis of agglutinated RBC- Haemoglobinemia Haemolytic Jaundice Renal vasoconstriction Circulatory shock Haemoglobinuria. Renal tubular damage, acute renal shutdown & Uraemia.

Monday, May 1, 2023

HAZARDS OF BLOOD TRANSFUSION.

Circulatory overload - Hypervolemia Transmission of blood borne infections – AIDS, viral

hepatitis Pyrogenic reactions – fever with chills Allergic reactions – skin rashes , asthma Hyperkalemia – after excessive transfusion Hypocalcaemia – Tetany due to chelation of Ca by citrate Reduced tissue oxygenation – stored RBC has low 2,3-DPG Haemosiderosis – Iron overload & deposition in liver, heart Thrombophlebitis – at Venepuncture site Air embolism – entry of air into blood.

Monday, May 1, 2023

AUTOLOGOUS BT. Transfusion of

individual own blood withdrawl & stored

For elective surgery During surgery Sports persons

Monday, May 1, 2023

STORAGE OF BLOOD FOR TRANSFUSION.

One unit 420 ml mixed with 120 ml ACD ( Acid citrate dextrose)

Contents – Acid citrate 0.48 gm Trisodium citrate – 1.32 gm Dextrose – 1.47gm Distilled water -100ml

Dextrose – provide energy for Na-K pump

Monday, May 1, 2023

IMPORTANT FACTS ABOUT BLOOD TRANFUSION.

One can safely donate 1 unit of blood every 6 month.

Blood can be stored for 21 days with above conditions

WBC & platelet virtually absent after 24 hrs of storage.

After transfusion 80% RBC survive for 24 hrs & destroyed at a rate of 1% per day.

Monday, May 1, 2023

Thank You