GROUP 2

ABO AND RH GROUPS

BLOOD COMPONENTS AND

PLASMA DERIVATIVES
 INTRODUCTION TO
BLOOD GROUP
SYSTEMS

Importance of blood group compatibility

in transfusion.
Overview of blood group antigens and
antibodies.
 THE ABO BLOOD
GROUP SYSTEM

Discovery and Significance

Discovered by Karl Landsteiner in
1901.
ISBT Number: 001
First system to classify human blood
into four types: A, B, AB, O.
 THE ABO BLOOD
GROUP SYSTEM
ABO Antigens and Antibodies

Antigens: Located on red blood cell (RBC)

membranes.
Antibodies: Naturally occurring in plasma
(Anti-A, Anti-B).
Compatibility matrix for transfusion.
 THE ABO BLOOD
GROUP SYSTEM
Forward and Reverse Grouping
Forward Typing: Detection of antigens on RBCs.
Reverse Typing: Detection of antibodies in
plasma.

Clinical Implications
Hemolytic transfusion reactions (incompatible
blood).
Applications in organ transplantation.
 THE ABO BLOOD
GROUP SYSTEM
ABO Antigens
A antigen and B antigen
Type O individuals express only the H
antigen, a precursor to A and B antigens.
O > A2 > B > A2B > A1 > A1B
Type A and B are formed by enzymatic
addition of sugars.
 THE ABO BLOOD
GROUP SYSTEM
IMMUNODOMINANT SUGARS
A antigen: N-acetyl-D-galactosamine
B antigen: D-galactose
H antigen: L-fucose

LECTINS
A: Dolichos biflorus
B: Griffonia (Bandeiraea) simplicifolia
O: Ulex europaeus
 THE ABO BLOOD
GROUP SYSTEM
Universal Donors and Recipients
Universal RBC Donor: Type O
Universal Plasma Donor: Type AB

Clinical Implications of ABO Subgroups

Subgroups of A (e.g., A1, A2) and B can express
varying antigen densities.
A1 is the most common A subgroup
 THE ABO BLOOD
GROUP SYSTEM
Bombay Phenotype
Absence of the H antigen (Hnull Phenotype)
Results from the inheritance of two doses of
the h gene, producing the hh genotype.
Absence of H, A, and B antigens; no
agglutination with anti-A, anti-B, or anti-H
lectin
 THE ABO BLOOD
GROUP SYSTEM
ABO Discrepancies
Group I
Reverse grouping
Patient’s serum
Group II
Forward grouping
Patient’s red blood cells
 THE ABO BLOOD
GROUP SYSTEM
ABO Discrepancies
Group III
Forward and reverse grouping
Protein or plasma abnormalities —> rouleaux
formation or pseudo-agglutination
Group IV
Forward and reverse grouping
Miscellaneous problems (e.g. Cold-reacting
antibodies)
 THE RH BLOOD
GROUP SYSTEM
ISBT Number: 004
Consists of 56 antigens; there are 5 major antigens
Four naming systems (nomenclature)
 THE RH BLOOD
GROUP SYSTEM

Philip Levine and Rufus Stetson

Karl Landsteiner and

Alexander Weiner
 THE RH BLOOD
GROUP SYSTEM
Rhesus Monkey
 THE RH BLOOD
GROUP SYSTEM
There are four (4) terminologies used to describe the
Rh system.

Two are based on postulated genetic theories

of Rh inheritance:
▪ Fisher–Race: DCE Terminology
▪ Wiener: Rh–Hr Terminology
 THE RH BLOOD
GROUP SYSTEM
The third common terminology used describes only
the presence or absence of a given antigen
▪ Rosenfield: Alphanumeric Terminology

The fourth was established by the ISBT

▪ International Society of Blood Transfusion
(ISBT)
 THE RH BLOOD
GROUP SYSTEM
Phenotype- defined by the serologic detection of
antigen using specific antisera
Genotype- an individual’s actual genetic makeup.

Genetics
Rh Genes:
Rh blood group contains two genes RHD and
RHCE on the short arm of Chromosome 1
RHD: Proteins D or d
RHCE: proteins RhCE, RhCe, RhcE, or Rhce
 THE RH BLOOD
GROUP SYSTEM
Rh Associated Glycoprotein (RHAG) Gene
Resides in Chromosome 6 (locus: 6p11-21.1)
It controls the expression of the Rh-associated
glycoprotein (RhAG)
RhAG is termed co-expressor
 THE RH BLOOD
GROUP SYSTEM
Antigen Characteristics
Rh antigens are immunogenic, and exposure to
foreign antigen through transfusion or pregnancy
can cause an immune response with the production
of corresponding antibodies.
Common Rh antigens: D, C, E, c, and e.
Alleles:
D antigen: does not have an allele
C and c antigens are alleles
E is allelic to e
 THE RH BLOOD
GROUP SYSTEM
D Antigen
Rh antigens are highly immunogenic, the D
antigen is the most potent.
While the D antigen is most immunogenic, c
antigen is the next most likely Rh antigen to
elicit an immune response, followed by E, C,
and e.
 THE RH BLOOD
GROUP SYSTEM
Weak Expression of Rh Antigen
3 main causes of weakened D expression:
Position Effect ( C is trans to D in genotype)
Genetics (weak expression of the D antigen,
resulting in fewer antigenic site)
Partial D (D Mosaic or Rh(D) Variant)
 THE RH BLOOD
GROUP SYSTEM
Position Effect ( C is trans to D in genotype)
The first mechanism, that may result in weakened
expression of D antigen, which was originally
described as a position effect or gene interaction
effect.
The terms "cis" and "trans" are from Latin, which
means "this side of" and "the other side of,"
respectively
 THE RH BLOOD
GROUP SYSTEM
Weak D: Quantitative Changes Due to FEwer D Antigens
Site
The second mechanism, that in result from
inheritance of RHD genes that code for a weakened
expression of the D antigen. The D antigens
expressed appear to be complete but fewer in
number.
 THE RH BLOOD
GROUP SYSTEM
Rh Phenotype Del
a phenotype occurring in individuals whose red
blood cells possess an extremely low number of D
antigen sites that most reagent anti-D are unable to
detect.
Adsorbing and eluting anti-D from the individual’s
red blood cells is often the only way to detect the D
antigen.
 THE RH BLOOD
GROUP SYSTEM
Partial D or D Mosaic

The third mechanism in which D antigen

expression can be weakened is when one or more D
epitopes within the entire D protein is either
missing or altered, termed partial D. the D antigen
is not complete due to one or more epitopes
missing.
 THE RH BLOOD
GROUP SYSTEM
Rh Antibodies
Most commonly found Rh antibodies are considered clinically
significant.
Most of them are IgG immunoglobulins and react optimally at 37℃ or
after antiglobulin testing in any method used for antibody detection.
Rh antibodies are enhanced when testing with enzyme-treated RBCs.
IgG1, IgG2, IgG3, and IgG4 subclasses of Rh antibodies have been
reported.
Rh antibodies do not bind complement. For complement to be fixed (or
the complement cascade activated), two IgG immunoglobulins must
attach to an RBC antigen in close proximity to each other.
 THE RH BLOOD
GROUP SYSTEM
Hemolytic Disease of the Fetus and Newborn
Rh antibodies are primarily IgG and can traverse (cross) the placenta
and because Rh antigens are well developed early in fetal life, Rh
antibodies formed by pregnant women cross the placenta and may coat
fetal RBCs that carry the corresponding antigen.
This results in the fetal cells having a positive direct antiglobulin test;
in HDFN, the coated fetal cells are removed prematurely from the fetal
circulation which can result in anemia.
 BLOOD
COMPONENTS
Whole Blood
Indications: provides blood volume expansion
and RBC mass in acute blood loss
Storage: 1-6 degrees celsius
Volume: 450 to 500 mL
Shelf- life: depends on the anticoagulant (closed
system), 24 hrs open system
 BLOOD
COMPONENTS
Packed RBC
Indication: Increase RBC of symptomatic,
normovolemic patients
Storage: 1-6 degrees celsius
Volume: 250-300 mL
Shelf-life: depends on the anticoagulant (closed
system), 24 hrs open system
 BLOOD
COMPONENTS
RBC Aliquots
Indications: used in infant less than 4 mos of age
Storage: 1-6 degrees celsius
Volume: 10-25 mL/ dose
Shelf-life: 24 hrs
 BLOOD
COMPONENTS
Leukocyte- Reduced RBC
Indications: increased rbc mass in patients with
severe and/ or recurrent febrile transfusion
reactions
Storage: 1-6 degrees celsius
Volume: 180 mL
Shelf- life: Depends on the anticoagulant (closed
system), 24 hrs open system
 BLOOD
COMPONENTS
Washed RBCS
Indications: increase rbc mass of symptomatic
anemic patients with history of allergic, febrile,
urticarial and anaphylactic reaction
Storage: 1-6 degrees celsius
Volume: 180 mL
Shelf-life: 24 hrs
 BLOOD
COMPONENTS
Frozen RBCs
Indications: storage of rare blood and autologous
units
Storage: -65 degrees celsius ( with glycerol), 1-6
degrees celsius (deglycerolized)
Volume: 180 mL
Shelf- life: 10 yrs (with glycerol), 24 hrs
(deglycerolized)
 PLASMA
BLOOD
DERIVED
COMPONENTS
PRODUCTS
Granulocyte Pheresis
Indications: patients with granulocyte
dysfunction or myeloid hypoplasia
Storage: 20-24 degrees celsius
Volume: 200-600 mL
Shelf-life: 24 hrs
 PLASMA
BLOOD
DERIVED
COMPONENTS
PRODUCTS
Irradiated Blood
Indications: Immunosuppressed patients that
might develop GVHD
Storage: 1-6 degrees celsius, 20-24 degrees celsius
Volume: varies
Shelf-life: 28 days (1-6 degrees celsius), 5 days (20-
24 degrees celsius)
 PLASMA DERIVED
PRODUCTS
Platelet concentrate
Indications: for bleeding due to
thrombocytopenia or thrombocytopathy
Storage: 20-24 degrees celsius with agitation
Shelf life: 5 days
 PLASMA DERIVED
PRODUCTS
Fresh Frozen Plasma
Indications: correct multiple coagulation factor
deficiency, reverse effects of warfarin
anticoagulant drug
Storage: -18 or -65 degrees celsius
Volume: 200-375 mL
Shelf-life: -18 (1year) and -65 (7 years)
 PLASMA DERIVED
PRODUCTS
Cryoprecipitate
Indications: Hypofibrinogenemia, hemophilia A,
von Willebrand’s disease and factor 13 deficiency
Storage: -18 degrees celsius
Volume: 10-25 mL
Shelf-life: 1 year