IMUNOHEMATOLOGI

PRIHATINI
PATOLOGI KLINIK
FKUWKS 2015
 DASAR GOLONGAN ABO
Ag golongan darah ,gula yg lekat sel
darah merah(sdm).
Antigen dibangun utk sdm
Diturunkan gen individu utk gula
spesifik ditambahkan pd sdm
Macam gula ditambahkan menentukan
gol darah
Gambaran gula pada golongan darah
 Dasar golongan darah
Semua gol darah mempunyai H.
Bila hanya H ditambahkan sdm orang
punya gol O .
Bila N-acetylgalactosamine ditambah
pada H, orang punya gol A.
Bila D-galactose ditambah H, orang
punya gol B.
Bila kedua N-acetylgalactosamine dan
D-galactose ditambahkan orang punya
gol AB.
Golongan darah di USA
ABO Type Per Cent
O 45%

A 40%

B 11%

AB 4%
 Landsteiners Rule
Individuals will form immune antibodies to
ABO blood group antigens they do not
possess.
Substances are present in nature which are so
similar to blood group antigens which result in
the constant production of antibodies to
blood group antigens they do not possess.
Critical for understanding compatibility
between ABO blood groups.
 Antibody clinical significance
Immunizations are frequently done to protect
us from disease.
Receive Hepatitis B immunization.
Actual bits of hepatitis virus injected.
Body recognizes as foreign and produces
an immune antibody.
Subsequent exposure to real Hepatitis B
virus will result in destruction of the virus
by immune antibodies.
ABO antibodies are immune and will result in
destroying incompatible cells which may
result in the death of the recipie
 Inheritance
Blood group antigens are codominant, if
the gene is inherited, it will be expressed.
Some aberrant genotypes do occur but due
to the rarity will not be discussed.
Understanding of basic inheritance
important.
 Genetics
Two genes inherited, one from each parent.
Individual who is A or B may be homozygous
or heterozygous for the antigen.
Heterozygous: AO or BO
Homozygous: AA or BB
Phenotype is the actual expression of the
genotype, ie, group A
Genotype are the actual inherited genes
which can only be determined by family
studies, ie, AO.
 Golongan ABO
B O
A AB 25% AO 25% (Group
A)
O BO 25% (Group OO 25% (Group
B) O)

Moms phenotype is group A,

genotype AO
Dads phenotype is group B,
genotype BO
 CONTOH LAIN
Mom Dad Offspring
Blood Group
AA BB 100% AB
BO OO 50% each of B
or O
OO OO 100% O
OO AO 50% each of A
or O
 GOLONGAN O
Kira-kira 45% populasi gol O.
Tak terdapat Ag A atau B , pikirkan Ag
0
Invidu poten anti-A & anti-B
antibodies yg beredar
dlm darah setiap saat
 GOLONGAN O
For red blood cell transfusions Group O
individuals CAN ONLY RECEIVE Group O.
Transfusion of any other blood group will
probably result in death of the recipient due
to the anti-A and anti-B antibodies present in
their blood plasma.
As DONORS, this blood group is considered
the universal donor since there are no A or
B antigens present this blood can be
transfused safely to all other blood groups.
 GOLONGAN A
Approximately 40% of
the population is group A.
No B antigens present.
These individuals form
potent anti-B antibodies
which circulate in the
blood plasma at all times
 GOLONGAN A
For red blood cell transfusions Group A
individuals can receive either Group A or
Group O
Transfusion of Group B will result in death of
the recipient due to the anti-B antibodies
present in their blood plasma reacting with
the B antigens present on the transfused red
blood cells
 GOLONGAN B
Approximately 11% of the population is group
B.
No A antigens present.
These individuals form
potent anti-A antibodies
which circulate in
the blood plasma at all time
 GOLONGAN B
For red blood cell transfusions Group B
individuals can receive either Group B or
Group O
Transfusion of Group A will result in death of
the recipient due to the anti-A antibodies
present in their blood plasma reacting with
the A antigens present on the transfused red
blood cells
 GOLONGAN AB
Approximately 4% of the population is group
AB.
Both A and B antigens present.
These individuals possess
no ABO antibodies.
NOTE:
This slide is in error
as it only illustrates
presence of one antigen not 2.
 GOLONGAN AB
For red blood cell transfusions Group AB can
receive ANY blood Group.
Considered the Universal Recipient.
Because they have no anti-A, can receive
group A, no anti-B, can receive group B.
So even though the rarest blood group,
finding compatible blood is not a problem.
 HEMOLYSIS
If an individual is transfused with an
incompatible blood group destruction of the
red blood cells will occur.
This may result in the death of the recipient.
 RINGKASAN
Blood Group Antigens on cell Antibodies in Transfuse with
plasma group
A A Anti-B A or O
B B Anti-A B or O
AB A and B None AB, A, B or
O
O None Anti-A & B O
 Rh (D) Antigen (1)
Of next importance is the Rh type.
Term Rh is a misnomer.
Rh is a blood group system with many antigens,
one of which is D.
Re-education of public is difficult.
Rh refers to the presence or absence of the D
antigen on the red blood cell.
 Rh (D) Antigen (2)
Unlike the ABO blood group system,
individuals who lack the D antigen do not
naturally make it.
Production of antibody to D requires exposure
to the antigen.
The D antigen is very immunogenic, ie,
individuals exposed to it will very likely make
an antibody to it.
For this reason all individuals are typed for D,
if negative must receive Rh (D) negative b
 Rh (D) Antigen (3)
The most important patient population to
consider is females of child-bearing age.
If immunized to Rh (D) antigen the antibody
can cross the placenta and destroy Rh (D)
positive fetal cells resulting in death.
This is why Rh negative women are given
Rhogam after birth of Rh positive baby.
 Hemolytic Disease of the Newborn
How it Occurs

1. child is Rh pos
2. during pregnancy fetal Rh pos rbcs escape
into maternal circulation
3. Mother produces antibodies to Rh (D)
antigen;
4. Second pregnancy with Rh (D) pos child
results in destruction of fetal D pos rbcs
 Rh (D) Antigen (continued)
For transfusion purposes Rh (D) negative
individuals must receive Rh negative blood.
Rh (D) positive individuals can receive EITHER
Rh (D) negative or Rh (D) positive blood.
VERY IMPORTANT concept to remember when
determining blood compatibility
 Blood Typing
There are 2 components to blood typing:
Test unknown cells with known antibodies
Test unknown serum/plasma with known rbcs
The patterns are compared and the blood
group is determined.
 Slide Blood Typing
Very rudimentary method for determining
blood groups.
CANNOT be used for transfusion purposes as
false positives and negatives do occur.
A false positive is when agglutination occurs
not because the antigen is present, but cells
may already be clumpled.
A false negative is one in which the cells are
not clumped because there are too many cells
or not enough reagent.
 Slide Blood Typing (2)
The slide is divided into halves.
On one side a drop of anti-A is added, this will
attach to and cause clumping of rbcs possessing
the A antigen.
On the other side a drop of anti-B is added which
will cause clumping of rbcs with the B antigen.
A drop of rbcs is added to each side and mixed
well with the reagent.
The slide is tilted back and forth for one minute
and observed for agglutination (clumping) of the
rbc
 Interpretation of Slide Typing
Testing with Anti-A Anti-Serum
If an rbc does not have
the A antigen there will
If an rbc contains the A
be no clumping, a
antigen the red blood cells
negative reaction
will be agglutinated
by anti-A,
a positive reaction
 Interpretation of Slide Typing
Testing with Anti-B Anti- Serum
If an rbc contains the B
antigen the red blood
cells will be
agglutinated by anti-B, a
positive reaction.
If an rbc does not have
the B antigen there will
be no clumping by anti-
B, a negative reaction.
 Slide Blood Typing Group A
An unknown rbc suspension is added to
known anti-sera.
The left hand of the slide contains anti-A
which reacts with the unknown cell.
The right hand side contains anti-B which does
not react with the cell.
 Slide Blood Typing Group A
An unknown rbc suspension is added to
known anti-sera.
The left hand of the slide contains anti-A does
not react with the unknown cell.
The right hand side contains anti-B which
reacts with the cell.
 Slide Blood Typing Group O
The left hand of the slide contains anti-A does
not react with the unknown cell.
The right hand side contains anti-B does not
react with the unknown cell.
 Slide Blood Typing Group AB
The left hand of the slide contains anti-A
which reacts with the unknown cell.
The right hand side contains anti-B which
reacts with the unknown cell.
 Summary of Slide Typing
Anti-A Anti-B Blood Group
NEG NEG O
POS NEG A
NEG POS B
NEG POS B