BLOODGROUPANTIGENSAND

ANTIBODIES
Over20bloodgroupsystemshavingapproximately

400bloodgroupantigensarecurrentlyrecognised.
TheABOandRhesus(Rh)bloodgroupsystemsareof
majorclinicalsignificance.
lessimportantbloodgroupsystemsare:Lewissystem,
Psystem,Isystem,MNSsystem,Kell andDuffy
system,andLuthern system.

ABOSYSTEM
consistsof3majorallelicgenes:A,BandO,locatedonthe

longarmofchromosome9.
Therearefourmaintyprs ofbloodgroup A,B,AB,andO.
AntigensofABOsystemare:A(A1,A2),BandH.
InadditiontoRBC,theyarealsoexpressedonWBC,
plateletsandvariousbodysecretions.
AcctoLandsteinerslaw,antiAorantiBantibodiesare
alwayspresentinplasmaofindividualwholack
correspondingantigenontheirredcells.
TheseantibodiesareusuallyofIgM class.

 AnOgroupindividualwhoinheritsAorBgenesbut

failstoinheritHgenefromeitherparentiscalledOh
phenotypeorBombaybloodgroup.
TheseindividualscontainantiA,antiBandantiH.
Therefore,Ohbloodgrouppersonsshouldbe
transfusedonlywithOhblood.

RHESUSSYSTEM
TheRh allelicgenesareCorc,DordandEore,

locatedonchromosome1.
Theimportanceofthissystemliesinhigh
immunogenecity ofRh Dantigen,whichcancause
severehemolytic reaction.
ThepresenceofDineitherhomozygousor
heterozygousstatemaketheindividualRh positive,
whileRh neg individualsarehomozygousford(d/d).
Rh antigensareexpressedonRBCsonlyandnoton
anyothertissue.
TherearenonaturallyoccurringRh antibodies

Pretransfusioncompatibilitytesting
ABOandRh(D)groupingofthepatient(recipient).
Antibodyscreeningofthepatientsserumtodetectthe
presenceofclinicallysignificantantibodies.
SelectingthedonorbloodofthesameABOandRh
group.
Crossmatchingthepatientsserumagainstdonorred
cellstoconfirmdonorrecipientcompatibility.

ComplicationsofBloodTransfusion
Immunologictransfusionreactions againstredblood

cells(haemolyticreactions),leucocytes,plateletsor
immunoglobulins.
Nonimmunetransfusionreactions
Circulatoryoverloadinmassivetransfusion
transmissionofaninfectiousagent.

Haemolytictransfusionreactions
maybeimmediateordelayed,
intravascularorextravascular

ABOincompatibility:
Veryrapidcelldestruction
Intravascularhaemolysis
naturallyoccurringantibodies,antiAandantiB,fix
complement.
symptomsincluderestlessness,anxiety,flushing,chest
orlumbarpain,tachypnoea,tachycardiaandnausea,
followedbyshockandrenalfailure.

Rh incompatibility:
Extravascular haemolysis
anaemiaduetodestructionofredcellsintheRE
system
Theclinicalmanifestationsarerelativelylesssevere
andusuallyconsistofmalaiseandfeverbutshockand
renalfailuremayrarelyoccur

Transfusionrelatedacutelung
injury(TRALI)
Transfusionofdonorplasmacontaininghighlevelsof

antiHLAantibodieswhichbindtoleucocytesof
recipient.
leucocytesthenaggregateinpulmonary
microcirculation.
increasedvascularpermeabilityresultinginacute
pulmonaryoedema

 Febrilereaction:attributedtoimmunologicreaction

againstwhitebloodcells,platelets,orIgA class
immunoglobulins.
Graftversushostdisease: mediatedbydonorT
lymphocytes

Circulatoryoverload:
resultinpulmonarycongestionandacuteheartfailure
Riskfactors:chronicanaemia,ininfantsandelderly.
onsetmaybeimmediate,ormaybedelayedupto24
hours.
Massivetransfusion:
dilutional thrombocytopeniaand
dilutionofcoagulationfactors.

Transmissionofinfection:
hepatitis(HBV,HCV),
CMVinfection,
syphilis,
malaria,
toxoplasmosis,
infectiousmononucleosis,
Brucellosisand
AIDS(HIVinfection)

Thrombophlebitis:
associatedwithvenesection
ifitisdoneinthesaphenous veinoftheanklerather
thantheveinsofthearm
ifthetransfusioniscontinuedlongerthan12hoursata
singlesite
Transfusionhaemosiderosis:
inthalassaemia major
liver,myocardiumandendocrineglandsareall
damaged.

Bloodcomponents
packedRBCs,
platelets,
freshfrozenplasma(FFP)and
cryoprecipitate.

Collection
procedureconsistsofinitialcentrifugationatlow

speedtoseparatewholebloodintotwoparts:packed
RBCsandplateletrichplasma(PRP).
Subsequently,PRPiscentrifugedathighspeedtoyield
twoparts:randomdonorplateletsandFFP.
Cryoprecipitates areobtainedbythawingofFFP
followedbycentrifugation.
Apheresis isdirectcollectionoflargeexcessof
plateletsfromasingledonor.

Applications
1.PackedRBCs:
normovolaemic patientsofanaemia
withoutcardiacdisease.
OneunitofpackedRBCs raisehaemoglobinby1g/dl
2.Platelets:
Patientwithplateletcountbelow10,000/l.
raiseplateletcountby5,000to10,000/l

3.Freshfrozenplasma:
FFPcontainsplasmaproteinsandcoagulationfactorsthat
includealbumin,proteinCandSandantithrombin.
indicatedinpatientsofcoagulationfailureandTTP
EachunitofFFPraisescoagulationfactorsbyabout2%
4.Cryoprecipitate:
plasmaproteins,fibrinogen,factorVIIIandvWF
patientsrequiringfibrinogen,factorVIIIandvWF
Transfusionofsingleunitofcryoprecipitateyieldsabout80
IUoffactorVIII

HAEMOLYTICDISEASEOF
NEWBORN
passageofIgG antibodiesfromthematernal

circulationacrosstheplacentaintothefetal
circulation.
HDNcanoccurfromincompatibilityofABOorRh
bloodgroupsystem.
ABOincompatibilityismuchmorecommonbutthe
HDNinsuchcasesisusuallymild,
RhDincompatibilityresultsinmoresevereformof
theHDN

HDNduetoRhDincompatibility
Rh incompatibilityoccurswhenaRhnegativemotheris

sensitisedtoRhpositiveblood
SensitisationoccurspassageofRhpositivefeatlred cells
acrosstheplacentaintothecirculationofRhnegative
mother
Normally,duringpregnancyveryfewfoetalredcellscross
theplacentabuthaemorrhageduringparturitioncauses
significantsensitisationofthemother.
95%casesofRhHDNareduetoantiD,
somecasesareduetocombinationofantiDwithother
immuneantibodiesoftheRh systemsuchasantiCand
antiE,andrarelyanticalone

HDNduetoABOincompatibility
NaturallyoccurringantiAandantiBantibodies

whichareusuallyofIgM classdonotcrossthe
placenta.
whileimmuneantiAandantiBantibodieswhichare
usuallyofIgG classmaycrosstheplacentaintofoetal
circulationanddamagethefoetalredcells

CLINICALFEATURES
severeformmayresultinintrauterinedeathfrom

hydrops foetalis
Moderatedisease severeanaemiaandjaundicedueto
unconjugated hyperbilirubinaemia.
Whenthelevelofunconjugated bilirubin exceeds20
mg/dl,itmayresultindepositionofbilepigmentin
thebasalgangliaoftheCNScalledkernicterus.
Milddisease severeanaemiawithorwithoutjaundice.

LABORATORYFINDINGS
Anaemiawithreticulocytosis,
IncreasednucleatedRBCandpolychromasia
elevatedserumbilirubin
positivedirectCoombstest
Mothersblood IndirectCoombstest antiD

antibodies.

Treatment
Exchangetransfusion
Phototherapy convertsunconjucated bilirubin into

solubleform,thatisexcretedinurine.
Infusionofbile bindsfreebilirubin inplasmaand
thusdecreasestheriskofkernicterus.

Prevention
AllRh Dve womenaregivenRhIg within72hrsof

deliveryofRh +ve infant.

Rh HDN

ABOHDN

Frequency

Lesscommon

Morecommon

Bloodgroup
Mother
Fetus

Rh neg
Rh positive

O
AorB

Pregnancyaffected

Usuallysecond

Usuallyfirst

Severity

Severe

Mild

Bloodsmear

Erythroblastosis

Spherocytosis

DCT

StronglyPositive

Weaklypositiveor
Negative

Prevention

Rh immuneglobulin

Notavailable