blood group system
TRANSCRIPT
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DR NILESH KATE
MBBS,MDASSOCIATE PROF
DEPT. OF PHYSIOLOGY
BLOOD GROUPS
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OBJECTIVES. BLOOD GROUPS
Introduction Classical ABO blood
grouping system Rh blood grouping
system Clinical applications of
blood groups.
BLOOD TRANSFUSION. Indications Donors & recipient. Precautions during
blood transfusion. Hazards Autologous BT. Storage of blood for
transfusion.
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INTRODUCTION Agglutinogens –
Antigens present on cell membrane of RBC
Agglutinins – antibodies against Agglutinogens present in plasma.
Agglutination – of RBC is reaction between these 2
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BLOOD GROUPING SYSTEM. Major blood group system – based on Agglutinogens on cell
membrane, present widely & causes severe transfusion reaction ABO Rh system
Minor blood group system – based on Agglutinogens but present in few populations & causes mild transfusion reaction. MNS P
Familial blood group system – found in few families KELL. DUFFY, LUTHERAN, BOMBAY LEWIS, DEIGO, KIDD
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LANDSTEINER’S LAWKARL LANDSTEINER 1900
If an Agglutinogens is present on surface of RBC corresponding agglutinins must be absent in plasma.
& if an Agglutinogens is absent on surface of RBC corresponding Agglutinins must be present in plasma.
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CLASSICAL ABO BLOOD GROUPING SYSTEM
A & B Agglutinogens- these are complex oligosaccharides differing in terminal sugar
In Antigen A – N-acetylgalactosamine & in Antigen B – galactose.
Other than RBC also present in salivary glands, pancreas, kidney, liver, lung, testes also in body fluids like saliva, semen & amniotic fluid
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CLASSICAL ABO BLOOD GROUPING SYSTEM
Anti-A (α)and anti-B (β) Agglutinins – IgM type & cannot cross placenta.
Absence of these are determined by Landsteiner’s law
Act best at low temperature so called Cold Antibodies.
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TYPES OF ABO BLOOD GROUPS.
BLOOD GROUP ANTIGEN ANTIBODIES
A A ANTI B OR β
B B ANTI A OR α
AB AB ---------------------
O -----------ANTI A (α) & ANTI B
(β)
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POPULATION DISTRIBUTION OF ABO BLOOD GROUPS
BLOOD GROUPS PERCENTAGE (%)
A 20
B 40
AB 08
O 32
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INHERITANCE OF ABO BLOOD GROUPS
PHENOTYPE(BLOOD GROUP)
GENOTYPE
A AA,AO
B BB,BO
AB AB
O OO
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APPERANCE OF ANTIGENS & ANTIBODIES
Antigens A & B appears in 6th week of fetal life, at birth 1/5th of adult level & rises during puberty & adolescence.
Antibodies are absent at birth, appear 10-15 days after birth, reach maximum at 10 yrs.
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MECHANISM Antigens similar to A & B are present in
intestinal bacteria & foods, when newborn exposed to these absorbed in blood, stimulate formation of antibodies against antigens recognized as non-self by immune system.
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DETERMINATION OF ABO BLOOD GROUPS
Covered in
Practicals “ Determination of Blood Groups”
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Rh BLOOD GROUPING SYSTEM Rh Antigens – called Rh as these were first
discovered in RBC of rhesus monkey. Discovered by Landsteiner & weiner in 1940. 3 types of Rh antigen, C,D & E, D IS COMMONEST & causes severe transfusion
reaction. Rh antigens are integral membrane proteins & not
found in other tissues.
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Rh Antibodies. No natural antibodies like
ABO blood groups system Rh antibodies are produced
when Rh -ve individual is transfused with Rh +ve blood.
These are IgG type & crosses placenta.
Warm Antibodies.
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INHERITANCE OF Rh BLOOD GROUPS
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HEMOLYTIC DISEASE OF NEWBORN.
Incompatibility of Rh blood groups between fetus & mother.
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MECHANISM OF HEMOLYTIC DISEASE OF NEWBORN IN RH INCOMPATIBILITY.
Entrance of Rh +ve fetal RBC into Rh –ve mother’s circulation during first pregnancy.
Production of Rh antibodies.
Rh incompatibility reaction during second pregnancy.
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MANIFESTATIONS OF HEMOLYTIC DISEASE OF NEWBORN.
Erythroblastosis fetalis. Erythroblastosis Anaemia.
Icterus gravis Neonatorum. Jaundice Enlarged liver & spleen.
Kernicterus – excess (<18mg%) bilirubin deposition in brain mainly basal ganglia
Hydrops fetalis – Grossly edematous fetus.
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PREVENTION OF HEMOLYTIC DISEASE OF NEWBORN.
Injecting single dose of Rh antibodies (anti-D) to mother soon after child birth.
So active antibodies will not be formed by mother.
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TREATMENT OF HEMOLYTIC DISEASE OF NEWBORN.
Replacement of baby’s Rh+ve blood by Rh –ve blood.
This is called Exchange Transfusion.
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CLINICAL APPLICATIONS OF BLOOD GROUPS.
In blood transfusion. In Preventing Hemolytic Disease. In Paternity Disputes. In Medicolegal Cases. In knowing Susceptibility to Diseases.
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BLOOD TRANSFUSION. Life saving measure Should be carried out
when absolutely necessary.
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INDICATIONS Blood loss – Accidents, major operations, rupture
peptic ulcer, rupture aortic aneurysm & rupture ectopic pregnancy.
For Quick restoration of haemoglobin. Exchange transfusion. Blood diseases- Aplastic anaemia, agranulocytosis,
leukemias, purpurae & clotting defects Acute poisoning – carbon Monoxide poisoning.
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DONORS & RECIPIENT. Donor – person who
donate the blood Recipient – person who
receives the blood. Universal donor – O
Rh Negative. Universal recipient –
AB Rh positive
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PRECAUTIONS TO BE TAKEN WHILE SELECTING DONOR.
Should be Healthy Age – 18- 60 yrs Contraindicated in
pregnant & lactating mothers
Screening for – AIDS, viral hepatitis, malaria, syphilis.
Hb & PCV should be normal
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PRECAUTIONS DURING BLOOD TRANSFUSION.
Absolute indication. Cross matching
Major – Donor’s RBC + Recipient plasma
Minor -Donor’s plasma+ Recipient RBC
Rh +ve blood should never be transfused to Rh –ve person.
Donor’s blood should always be screened for diseases.
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PRECAUTIONS DURING BLOOD TRANSFUSION.
Blood bag/bottle should be checked. Blood transfusion should be given at slow rate. Proper Aseptic measures. Careful watch on recipient condition – for first 10-
15min. Should stop if any reaction
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HAZARDS OF BLOOD TRANSFUSION.
Mismatched transfusion reaction. Agglutination of donor’s RBC Tissue ischemia – chest pain or back pain Haemolysis of agglutinated RBC- Haemoglobinemia Haemolytic Jaundice Renal vasoconstriction Circulatory shock Haemoglobinuria. Renal tubular damage, acute renal shutdown & Uraemia.
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HAZARDS OF BLOOD TRANSFUSION.
Circulatory overload - Hypervolemia Transmission of blood borne infections – AIDS, viral
hepatitis Pyrogenic reactions – fever with chills Allergic reactions – skin rashes , asthma Hyperkalemia – after excessive transfusion Hypocalcaemia – Tetany due to chelation of Ca by citrate Reduced tissue oxygenation – stored RBC has low 2,3-DPG Haemosiderosis – Iron overload & deposition in liver, heart Thrombophlebitis – at Venepuncture site Air embolism – entry of air into blood.
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AUTOLOGOUS BT. Transfusion of
individual own blood withdrawl & stored
For elective surgery During surgery Sports persons
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STORAGE OF BLOOD FOR TRANSFUSION.
One unit 420 ml mixed with 120 ml ACD ( Acid citrate dextrose)
Contents – Acid citrate 0.48 gm Trisodium citrate – 1.32 gm Dextrose – 1.47gm Distilled water -100ml
Dextrose – provide energy for Na-K pump
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IMPORTANT FACTS ABOUT BLOOD TRANFUSION.
One can safely donate 1 unit of blood every 6 month.
Blood can be stored for 21 days with above conditions
WBC & platelet virtually absent after 24 hrs of storage.
After transfusion 80% RBC survive for 24 hrs & destroyed at a rate of 1% per day.
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Thank You