Blood Groups

Dr. Niranjan Murthy H L Asst Prof of Physiology ESIC-MC & PGIMSR, Bangalore

Antigen: Proteins, Glycoproteins, or Lipids. Substances which induce formation of corresponding antibodies when introduced into the body, with which it reacts specifically. Self antigens and Non-self antigens. Antibodies: Proteins (Immunoglobulins). Substances which are produced when corresponding non-self antigens are introduced into the body, with which it reacts specifically.

Blood Group Systems

26 blood group systems and 228 blood group antigens Proteins, Glycoproteins, or Glycolipids Some antigens are specific and some are seen even on other cells Lewis and Chido/Rogers system antigens are adsorbed from plasma

ABO system Rh system MN system Pi system Kell system Lewis system Duffy system Indian system

ABO system
Landsteiner 1900 A and B antigens Anti-A & Anti-B antibodies A, B, AB and O blood groups A & B are co-dominant alleles O is recessive Genes encode for enzymes that add specific sugars ABO antigens are oligosaccharide chains

 A gene N-acetyl galactosamyl transferase N-acetyl galactosamine B gene Galactosyl transferase Galactose H gene Fucosyl transferase Bombay blood group- hh genotype

Landsteiners law: If an agglutinogen is present on the red cell membrane, the corresponding agglutinin must be absent in plasma; If an agglutinogen is absent on the red cell membrane, the corresponding agglutinin must be present in plasma
Blood group Antigen Antibody

Anti-B

Anti-A

AB

A&B

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Anti-A & Anti-B

 A- Gastric carcinoma O- Peptic ulcer Antibody- on environmental exposure

Newborns dont have significant ABO antibodies.

Rh Blood group system

Landsteiner & Weiner; 1940 Rhesus monkeys C, D, E antigens Rh positive and Rh negative
Blood group Antigen Antibody

Rh positive
Rh negative

D
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------------Anti D on exposure

Functions/Uses
Identification Blood transfusion Crime investigation Paternity issues
Donor -------------Recipient A B AB O A -------------+ --+ --B ---------------+ + --AB -----------------+ --O -------------+ + + +

Adverse effects of blood transfusion

Immunologic Transfusion Reactions: Alloimunization to transfused antigens (a) Alloantibodies reacting with red cell antigens (b) Alloantibodies reacting with leukocyte antigens Alloantibodies reacting with plasma proteins

1. Hemolytic transfusion reactions

1 to 1.4% of all transfusions 86% due to ABO incompatibility 89% due to clerical errors Immediate HTRs: Fever with or without chills, anxiety, back ache, flushing, dyspnoea, tachycardia, hypotension, hemoglobinuria ARF, shock, DIC

PathophysiologyAntigen-Antibody reaction- Immune complexescomplement activation- cytokines & Factor XIIcoagulation Vasoactive substances (Histamine, Serotonin)Shock ARF- Shock, Hemoglobinuria TreatmentHydration Diuresis- mannitol / frusemide Vasoactive drugs- Dopamine Exchange transfusion- for massive DIC

 Delayed HTRs: Extravascular Hemolysis starting from 2-10 days Fever, reduced hematocrit, jaundice, hemoglobinuria IgG coated RBCs are removed by Reticuloendothelial system Kidd & Rh system

2. Pseudo-hemolytic transfusion reactions: - Yersinia infections, Drugs, Mechanical trauma, Freezing, Heating 3. Febrile non-hemolytic transfusion reactions: Alloimunization to leukocyte & platelet antigens Cytokines released from stored leukocytes Chills, fever, nausea vomiting Prevention- leuko-reduced products

4. Transfusion-related acute lung injury: Chills, fever, chest pain, hypotension, cyanosis, pulmonary edema Donor antibodies to recipient granulocytes Treatment- High dose steroids 5. Allergic reactions: Urticaria, Bronchospasm, Angioedema Anaphylactic shock Due to recipient IgE antibodies Treatment- antihistamines

6. Post transfusion purpura 7. Graft versus host disease: transfusion from family members Sharing of HLA haplotypes Proliferation of donor lymphocytes Fever, skin rashes, nausea, bloody diarrhoea, pancytopenia, altered hepatic functions Pretransfusion irradiation

Non-immunologic adverse reactions

1. 2. Volume overload Massive transfusion: Metabolic effects- Hyperkalemia, Hypocalcemia Hypothermia Dilutional effects- dilution of platelet and labile coagulation factors Micro-aggregates and pulmonary microembolization 3. Iron overload

Infectious complications
1. 2. 3. 4. HIV Hepatitis Syphilis Malaria

Blood storage and transfusion protocols

Blood stored in 2-6 C temperature Preservative- Citrate Phosphate Dextrose Adenosine (CPD-A) Duration- 35 days Donor criteria Pretransfusion testing: Major and minor cross matching Screening for transfusion transmissible diseases Screening for atypical antibodies Component transfusion