A.

Blood Group
One of the main problems in the blood transfusion is the immunological or
transfusion reactions resulting from the differences between donor and recipient
red blood cells (RBCs). Blood groups have arisen because mutations have
occurred in the genes controlling the surface constituents of the RBCs. These
alterations in the surface structures have not usually affected the function of the
RBC, but when the RBCs of a donor are transfused into a recipient who lacks
these antigens, they may induce an immunological response. (Hatton)
There are 30 major blood group systems together giving hundreds of
possible red cell phenotypes, with approximately 400 RBC group antigens have
been described.(Hatton, Hoffbrand) Erythrocyte blood group antigens are
polymorphic, inherited, carbohydrate or protein structures located on the surface
of the RBC membrane. The protein antigens are primarily located on integral
transmembrane proteins, but a few are on glycosylphosphatidylinositol (GPI)linked proteins. Some antigens are carbohydrates attached to proteins or lipids,
some require a combination of a specific portion of protein and carbohydrate, and
a few antigens are carried on proteins that are adsorbed from the plasma. Many of
the proteins carrying blood group antigens reside in the erythrocyte membrane as
complexes with other proteins.(Hoffman)
Overall blood group, the most essential and quite clearly explained are the
ABO and Rh groups according to their clinical importance.
1. ABO System
The ABO system belongs to carbohydrate blood grouping and is the most
clinically significant, because of the presence of naturally occurring IgM
antibodies (and sometimes IgG). The original observation by Landsteiner that
certain human erythrocyte suspensions were agglutinated by other human
antibodies led to the recognition of ABO polymorphism. This initial observation is
still the cornerstone of modern transfusion practice more than a century later.
(Hoffman)
It consists of three allelic genes: A, B and O. The A and B genes control
the synthesis of specific enzymes responsible for the addition of single
carbohydrate residues ( N-acetyl galactosamine for group A and D-galactose for

group B) to a basic antigenic glycoprotein or glycolipid with a terminal sugar Lfucose on the RBC, known as the H substance.(Hoffbrand)
Table 1. The ABO Blood Group System(Hoffbrand)
Phenotype
Genotype
Antigens
Naturally
Occuring
Antibodies
O
OO
O
Anti-A, anti-B
A
AA or AO
A
Anti-B
B
BB or BO
B
Anti-A
AB
AB
AB
None

The O gene is an amorph and does not transform the H substance, or

called unmodified H antigen,(Hoffbrand, Hatton) but will have circulating IgM
antibodies to the A and B antigens. These antibodies exist even if the patient has
never been exposed to blood of another group; they are thought to arise due to
crossreactivity between the ABO antigens and commonly seen epitopes in bacteria
and/or food products, since they are produced universally in the first year of life.
According to the table above, blood transfusion of group A or B to patients
who have O blood group would resulting in intravascular haemolysis of the
transfused cells. This is due to O blood group antibody reaction with group A or B
antigen, whereas group O possessed the anti-A and anti-B. Transfusion of B
blood group to a patient of group A would have a similar effect.
In the other side, O blood group, featuring only the universal H-antigen,
should not produce a haemolytic response in patients of any ABO group. It
because of its antigen A and antigen B absence and has been termed as the
universal donor group. While the universal donor label is true to some extent,
but in rare group O donors there may be the presence of high-titre antibodies
against groups A and B, which themselves might induce passive haemolysis of the
recipients own red cells. This must be borne in mind when determining safe
donor blood groups for specific recipients.(Hatton) Meanwhile, AB blood group
termed as universal recipientbecause of its none presence of anti-A and anti-B
in the red cells. Therefore, each ABO donors should be could give blood donation
to group AB as long as the crossmatch was done succesly before.
2. Rh System

Rh system belongs to protein blood grouping and is second only to the

ABO system in importance on transfusion medicine. The Rh proteins are
designated RhD (encoded by RHD), which carries the D antigen, and RhCE
(encoded by RHCE), which carries the CE antigens (either ce, cE, Ce, or CE).
RhD differs from the various forms of RhCE by 32 to 35 amino acids. RhD and
RhCE are not glycosylated but form a complex in the RBC membrane with RhAG
(Rh-associated glycoprotein).(Hoffman)
Most Rh antibodies are IgG and do not activate complement. As a result,
primarily extravascular hemolysis, rather than intravascular hemolysis, occurs in
transfusion reactions involving Rh antibodies. The antibodies are almost always
due to RBC immunization from pregnancy or transfusion and usually persist for
years. Most Rh antibodies should be considered as having the potential to be
clinical significant for transfusion reactions. If serum antibody levels fall below
detectable levels, subsequent exposure to the antigen characteristically produces a
rapid secondary immune response.(Hoffman)
Rh antigens, especially D, are highly immunogenic whereas Rh-positive
refers in the presence of D antigen, meanwhile Rh-negative for the absence of D
antigen.(Hoffman) Therefore, the Rh-negative patients (mostly possessed by
western people) only could receive blood donation from Rh-negative donors
rather than from Rh-positive. It is due to its Rh antibodies in Rh-negative recipient
which could react with D antigen from Rh-positive blood donors that resulting in
adverse transfusion reaction (secondary immune response).

Bibliography:

Hoffbrand AV, Moss PAH. Blood Transfusion. In: Essential Hematology. 6 th

Edition. Willey-Blackwell:2011;pp.398-412.
Hoffman R, Benz EJ, Silberstein LE, Heslop H, Weitz J, Anastasi J. Transfusion
Medicine. In: Hematology: Basic Principles and Practice. 6th Edition. Elsevier
Saunders:2013;pp.111-123.
Hatton CSR, Hughes-Jones NC, Hay D, Keeling D. Blood Groups and Blood
Transfusion.

In:

Haematology:

Blackwell:2013;pp.132-134.

Lecture

Notes.

9th

Edition.

Willey-