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SYSTEMS
Agaton T. Panopio, Jr., MD, MHPEd
Inheritance
The agglutinogens of the ABO system are genetically determined
and are inherited according to Mendelian laws.
There are three allelic genes inherited:
A, B and O.
Genes A and B are co-dominant (egalitarian); O is recessive.
Inheritance
Genes
Z gene
Regulates activity of the H gene on
the basic precursor on red cells
H gene
Converts the basic precursor to the
H agglutinogen by addition of Lfucose to the terminal galactose
Inheritance
Genes
A gene
Converts the H agglutinogen to the A
agglutinogen by adding N-acetyl
galactosamine to fucose
B gene
Converts the H agglutinogen to the
B agglutinogen by adding D-galactose
to fucose
Inheritance
Genes
O gene
An amorphic gene
Does not give rise to any detectable
gene product
Se gene
Regulates activity of the H gene on
the basic precursor in the body fluids
Inheritance
Inheritance
Inheritance
Inheritance
Inheritance
Inheritance
A, B and H agglutinogens are detectable as early as 37 days of
fetal life.
Agglutinins
Follow Landsteiners Law
In normal healthy adults and in children above the age of 6
months, the serum will contain anti-A agglutinin if the red cell
does not have the A agglutinogen; the serum will contain anti-B
if the red cell does not have the B agglutinogen.
Agglutinins
The agglutinins are naturally occurring in that they result from
unavoidable exposure to group specific substances. They are
of the Ig M variety.
Blood Groups
Agglutinogen
A
B
A and B
H
Agglutinin
anti-B
anti-A
no anti-A,
no anti-B
anti-A, anti-B
Blood Grouping
Forward Typing
Mixing of known typing sera with unknown red cells
Used to identify the agglutinogen
present on red cells
Blood Grouping
Reverse Typing
Blood Groups
Group
A
B
AB
O
Anti-A
Anti-B
+
+
-
B O
Cells
+
+
-
+
+
+
+
Inheritance
Landsteiner-Weiner Theory
Landsteiner and Weiner postulate that an individual may inherit
any one of a possible 8 allelic genes from each parent. These
genes are on one locus of each chromosome and are: r, r, r,
ry, Ro, R1, R2 and Rz
Inheritance
Fisher-Race Theory
Antigens
Chemically, the antigens are lipoproteins and form an integral
part of the red cell membrane. The antigen polypeptide is
attached to membrane lipid.
The Rh antigens are found only on red cell membranes. They are
fully developed at birth and are fully immunogenic.
Antigens
Just like the ABO system, the Rh antigens also have a basic
precursor.
Antigens
Common antigens and their frequency:
e
D
G
c
C
f
E
=
=
=
=
=
=
=
98%
85%
85%
80%
70%
64%
30%
Antigens
In the order of immunogenicity:
D
c
E
C
e
Antibodies
The Rh antibodies are NOT naturally occurring. They only occur
as a result of specific sensitization such as pregnancy,
incompatible blood transfusion, or deliberate immunization via
intravenous injection of incompatible blood.
Rh Grouping
Blood grouping in the Rh system involves forward typing only
since antibodies are not naturally occurring.
There are 3 main typing sera:
anti-D (anti-Rho)
anti-C (anti-rh)
anti-E (anti-rh)
Rh Grouping
Group Anti-D Anti-C Anti-E Anti-c Anti-e
CcDEe
CCDEE
ccDee
CcDEE
CCEE
cde
+
+
+
+
-
+
+
+
+
-
+
+
+
+
-
+
+
+
+
+
+
+
Rh Grouping
Among Filipinos, the incidence of Rh phenotypes is:
cDe = 0%
Cde = 87%
cDE = 2%
CDE = 11%
Multiple myeloma
Waldenstroms macroglobulinemia
Polyagglutination
Red cells are clumped at room
temperature but not at 37o C
Practical Significance
Blood Transfusion
The purpose of a blood transfusion is to provide some benefit to
the recipient. Thus, blood types of both donor and recipient
must be compatible.
In the Philippines, typing sera of the other blood group systems
are not available. Thus aside from blood typing, compatibility
testing must be done.
Compatibility Testing
Involves:
Review of the recipients past blood
records
ABO and Rh typing of recipient and
Antibody screening of recipients and
Cross-matching
Cross-Matching
Major cross-match
Mixing of recipients serum with donors
red cells
Minor cross-match
Mixing of donors serum with patients red cells
Cross-Matching
Phases:
Protein phase
Can detect:
ABO incompatibilities
Cold antibodies (anti-M, antiP1, anti-Lea)
Prozoning anti-Rh antibodies
Cross-Matching
Phases:
Thermo phase
Can detect:
Low titer anti-D
Rh antibodies reactive in
albumin (anti-c, antiE,
some anti-D)
Cross-Matching
Phases:
Anti-globulin phase
Can detect:
Cryptagglutinoids
Antibodies reactive only in antiglobulin
Cross-Matching
Antibodies reactive only in anti-globulin:
Anti-Fya (Duffy)
Anti-Jka (Kidd)
Anti-K (Kell)
Anti-Di (Diego)
Anti-Sc1&2 (Scianna)
Anti-Wra&b (Wright)
Anti-Coa&b (Colton)
Anti-Doa&b (Dombrock)
Maternity/Paternity Exclusion
Five types of paternal exclusion are possible:
Maternity/Paternity Exclusion
Five types of paternal exclusion
Maternity/Paternity Exclusion
ABO system follows Mendelian laws
First law
Factors A or B cannot be present in
a child unless present in one or both
parents
Second law
A parent of group AB cannot have a
child of group O
Maternity/Paternity Exclusion
Mendelian laws
Third law
A parent of group O cannot have a
child of group AB
Maternity/Paternity Exclusion
Maternal exclusion has become important because of the illegal
practice of baby switching, especially in hospitals abroad.