Download - BLOOD GROUP SYSTEM
DR NILESH KATE
MBBS,MDASSOCIATE PROF
DEPT. OF PHYSIOLOGY
BLOOD GROUPS
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