ABO

Although there are over 600 known red blood

cell antigens organized into 22 blood group

systems, routine blood typing is usually
concerned with only two systems: the ABO and
Rh blood group systems. Antibody screening
helps to identify antibodies against several other
groups of red blood cell antigens.
Some of the other groups are the Duffy, Kell,
Kidd, MNS, and P systems

BLOOD GROUP SYSTEMS

CONVENTIONAL NAME

ISBT SYMBOL ISBT NUMBER

ANTIGENS

ABO

ABO

001

MNSs

MNS

002

37

P1

003

Rh

RH

004

47

Lutheran

LU

005

18

Kell

KEL

006

21

Lewis

LE

007

Duffy

FY

008

Kidd

JK

009

Diego

DI

010

Cartwright

YT

011

BLOOD GROUP SYSTEMS

CONVENTIONAL NAME

ISBT SYMBOL

ISBT NUMBER

ANTIGENS

Xg

XG0

012

Scianna

SC

013

Dombrock

DO

014

Colton

CO

015

LW

016

Chido/Rogers

CH/RG

017

Hh

018

Kx

XK

019

Gerbich

GE

020

Cromer

CROMER

021

10

Knops

KN

022

Indian

IN

023

Ok

OK

024

--

Raph

RAPH

025

--

JMH

JMH

026

--

Landsteiner-Wiener

ABO blood group antigens present on red blood cells

and IgM antibodies present in the serum

Why do we have Anti-A or Anti-B

Antibodies???
Viruses transmitted from the
respiratory tracts of humans to
other humans drag along various
antigens including ABO blood
group antigens.
Prime the newborns immune
system.
Reduces transmissibility of
viruses within a population.

Population Distribution of
Major Blood Groups
O Rh pos
38%
O Rh neg
A Rh pos
34%
A Rh neg
B Rh pos
B Rh neg
AB Rh pos
AB Rh neg

7%
6%
9%
2%
3%
1%

Red blood cell compatibility table

Recipient

Donor

O- O+ A- A+ B- B+ AB- AB+
OO+
AA+
BB+
ABAB+

Plasma compatibility table

Recipient

Donor

O A B A
B
AB
A
B
O

Other Blood Groups

No naturally occurring antibodies
Immune response requires
previous exposure
Weaker titers of univalent antibodies

Why do we care?
Compatibility testing is done to avoid
a hemolytic transfusion reaction

If the Host or Recipient recognizes

he donor RBC surface antigens as foreign
the host will mount an immune response
to the donor RBCs

Major Blood Groups

Rhesus
47 Antigens make up the
Rhesus Blood Group
The most significant is the
D antigen

There is no naturally occurring

Anti D Antibodies
Production of Anti D in the
RH negative recipient
requires previous exposure
to the D antigen
(in utero or by transfusion)

If red cells are administered

to an ABO- or D-incompatible recipient,
the recipient will mount an
antibody response to the foreign
RBC surface antigens
IgM is polyvalent
and fixes complement

Intravascular Clumping of Donor RBC

Clumps and extruded RBC stroma

result in organ dysfunction
and possible death
Incidence 1:38,000 1:70,000
Mortality 1:30

Intravascular hemolysis of donor RBCs

Donor RBCs coated with host antibodies

Stiffer RBC membrane

Susceptible to attack by
splenic macrophages

But no
intravascular clumping

Bits of Donor RBC membrane

lost traversing splenic sinusoids
(extravascular hemolysis)
Spherocytes
Decreased RBC survival
Delayed anemia
Priming for worse reaction

What is compatibility
testing?
Also called pretransfusion testing
Purpose:
To select blood components that will not cause

harm to the recipient and will have acceptable

survival when transfused

If properly performed, compatibility tests

will confirm ABO compatibility between the

component and the recipient and will detect
the most clinically significant unexpected
antibodies

Patient Identification
Must confirm

recipients ID from
bracelet ON the
patient
Full patient name

and hospital number

Name of physician

http://www.usatoday.com/tech/news/techinnovations/2006-07-17-chips-everywhere_x.htm

COMPATIBILITY TESTING
Processing the specimen:
ABO Group determined (forward and
reverse)
D typing determined
Antibody screen will be performed
ABO/Rh identical or compatible blood
will be made available

Sample Identification
The sample should

also have the full

patient name,
hospital number, and
physician
Date and time of
collection,
phlebotomists initials
All of this should be
on the request form
and the sample

Specimen Tubes

Pink Top - EDTA

Red Top no additives

Serological Testing
3 tests:
ABO/Rh
Antibody detection/identification
Crossmatch

ABO/Rh Typing
In the ABO typing, the forward and reverse

MUST match
In the Rh typing, the control must be negative
Both of these will indicate what type of blood
should be given

ABO TYPING
Front or forward type using monoclonal
anti-A and anti-B (commercial)
The sample is diluted to Hct 0.08, the
commercial antibodies added & the
test tube is centrifuged
The RBCs are then examined for
clumping (gross observation, gel
suspension)

Anti A Anti B

Anti A Anti B

Anti A Anti B

AB

Anti A Anti B

ABO TYPING

Back or reverse type with A and B cel

Commercially available A and B cells are
added to two tubes of plasma
AB
A

B
A

A
B

O
B

How do we know whether or not the host (or

recipient) has antibodies to minor blood group
antigens?

Add commercial RBCs with known

important minor antigens on their
surface to host (or recipient) plasma
and centrifuge. Then incubate at
body temperature for 15-30 minutes
Then add rabbit antiglobulin

Antibody screen
Also called the indirect Coombs test or the

indirect antiglobulin test

The antibody screen will detect the
presence of any unexpected antibodies in
patient serum
If antibodies are detected, identification
should be performed using panel cells
(with an autocontrol)
IS
37 (LISS)
AHG

If recipient antibodies have coated

commercial RBC surfaces

Rabbit antiglobulin will bind to the

Antibodies and the RBCs will clump

ANTIBODY SCREENING
Detection of unexpected clinically
significant antibodies against the minor
blood group system antigens
Positive in between 0 - 8% of samples
depending on the population

Possibly significant minor blood groups

MNSs

MNS

002

37

P1

003

Rh

RH

004

47

Lutheran

LU

005

18

Kell

KEL

006

21

Lewis

LE

007

Duffy

FY

008

Kidd

JK

009

Diego

DI

010

Cartwright

YT

011

SCREENING TEST RESULTS

A negative antibody screen allows

blood to be dispensed using an
immediate spin X-match or an
electronic X-match, either of which
confirms ABO compatibility
A positive antibody screen requires a
full antiglobulin phase X-match

Crossmatching
Purpose:
Prevent transfusion reactions
Increase in vivo survival of red cells
Double checks for ABO errors
Another method of detecting antibodies

Crossmatches
According to the AABB Standards:

The crossmatch shall use methods that

demonstrate ABO incompatibility and
clinically significant antibodies to red cell
antigens and shall include an antiglobulin
phase

No agglutination ~ compatible

Agglutination ~ incompatible

Donor RBCs
(washed)

Patient serum

The procedure
Donor cells are

taken from
segments that are
attached to the unit
itself
Segments are a
sampling of the
blood and eliminate
having to open the
actual unit

Crossmatch Procedure
if antibodies are NOT detected:
Only immediate spin (IS) is performed using
patient serum and donor blood suspension
This fulfills the AABB standard for ABO
incompatibility
This is an INCOMPLETE CROSSMATCH
If antibodies ARE detected:
Antigen negative units found and X-matched
All phases are tested: IS, 37, AHG
This is a COMPLETE CROSSMATCH

Will
Verify donor cell ABO compatibility
Detect most antibodies against donor cells

Will Not
Guarantee normal survival of RBCs
Prevent patient from developing an antibody
Detect all antibodies
Prevent delayed transfusion reactions

Type and Screen

Determines the ABO-Rh of the

patient and the presence of

the most commonly found
unexpected
antibodies(elimination of the
crossmatch ).

Type and Screen

If an emergency transfusion is required after type

and
screen
alone,
an
immediate-phase
crossmatch is performed.
Blood given in this manner is more than 99%
effective in preventing incompatible transfusion
reactions due to unexpected antibodies.

Is the Crossmatch Really

If the correct ABO and Rh blood type is given,
Needed?
the possibility of transfusing incompatible
blood is less than 1 chance in 1000.
ABO-Rh typing alone results in a 99.8%
chance of a compatible transfusion,
The addition of an antibody screen increases
the safety to 99.94%, and
A crossmatch increases this to 99.95%.

Physician responsibility in
ordering uncrossmatched
blood
In an emergency (ER or OR), there may not be

enough time to test the recipients sample

It is your judgment that the risk of the patient
dying from from anemia is greater than the
risk of transfusing the patient without pretransfusion testing

What can be given in an

emergency?
Type-Specific, Partially Crossmatched

Blood
An ABO-Rh typing and an immediate-phase

crossmatch
An abbreviated format
Macroscopic agglutination.
This takes 1 to 5 minutes

What can be given in an

emergency?
Type-Specific, Uncrossmatched Blood
The ABO-Rh type
Most ABO type-specific transfusions are
successful.
Caution should be used for patients who have
previously received transfusions or have had
pregnancies.

What can be given in an

emergency?
Type O Rh-Negative (Universal Donor),

Uncrossmatched Blood
Type O blood lacks the A and B antigens
Type O Rh-negative, uncrossmatched packed

RBCs should be used in preference to type O Rhnegative whole blood.

More than two units of type O Rh-negative,
uncrossmatched whole blood, the patient
probably cannot be switched to his or her blood
type .

Specific
Recommended
1. Infuse crystalloids or colloids.
2. Draw a blood sample for typing and
Protocol

crossmatching.
3. If crossmatched blood is not ready to give,
use type-specific or type O Rh-negative cells
or type O Rh-positive cells for males or
postmenopausal females without a history of
transfusions.

Summary
The crossmatch shall use methods that

demonstrate ABO incompatibility and clinically

significant antibodies to red cell antigens
If an emergency transfusion is required after type
and screen alone, an immediate-phase
crossmatch is performed before transfusion (an
abbreviated format )
If crossmatched blood is not ready to give, use
type-specific or type O Rh-negative cells