THE ABO BLOOD GROUP

SYSTEM

BY: CARRIZA DARCY C. GILO,

RMT, IMT(ASCPi)
 HISTORY

 Discovered by Karl Lansteiner

 Only blood group system in w/c individuals
predictably have Abs in their serum to Ags that are
absent from their RBC
 Occurs w/o exposure to RBCs by transfusion or
pregnancy
 Severe, fatal
 ABO forward & reverse grouping tests are
required to be performed on all donor & patients
 ABO forward & reverse grouping are reciprocal; one
serves as a check on the other
 HISTORY
 Bacteria are chemically similar to A & B antigens
– exposure serves as a source of stimulation of anti-A & anti-
B
 Other blood group systems do not regularly have in their
serum “naturally occurring” Abs to Ags
 Frequency: O – 45%, A – 40%, B – 11%, AB – 4%

Blood group Whites Blacks

O 45% 49%
A 40% 27%
B 11% 19%
AB 4% 4%
 FORWARD GROUPING
(FRONT TYPE)

 Uses known antisera (anti-A, anti-B) to detect

antigens on individual’s RBCs

Px RBC w/ anti-A Px RBC w/ anti-B Interpretation

0 0 O
4+ 0 A
0 4+ B
3+ 3+ AB
 REVERSE GROUPING
(BACK TYPE)

 Uses known reagent RBCs to detect ABO Abs in

the patient’s serum

Px serum w/ A1cells Px serum w/ B cellsInterpretation

4+ 4+ O
0 3+ A
3+ 0 B
0 0 AB
 ABO ANTIBODIES

 Naturally occurring Abs

 Predominantly IgM, react @ RT (20-24 oC),
activate complement @ 37 oC
 Production is initiated @ birth; detection
is low until individual is 3-6 months of age
 Peaks b/n 5 & 10 years of age, declines in
later life
 Elderly people have lower levels of anti-A
& -B
 ABO ANTIBODIES

 Most Abs in the cord blood is of

maternal origin; perform only
forward grouping from newborn
infants
 Predominant Abs in group O
serum is IgG
 INHERITANCE OF THE ABO
BLOOD GROUPS

 Inheritance is based on
Mendelian theory
 One position or locus on each
chromosome 9 is occupied by A,
B or O gene
 O gene is an amorph
 A & B are phenotypes, AA, BO &
OO denote genotypes
 INHERITANCE OF THE ABO
BLOOD GROUPS

 L-fucose – responsible for H

specificity
 N-acetylgalactosamine –
responsible for A specificity
 D-galactose - responsible for B
specificity
 hh genotype – bombay phenotype or
Oh & lacks expression of ABH Ags
 ABO DISCREPANCIES

 Occur when unexpected reactions are

observe in the forward & reverse
grouping
 Resolve by repeating the test on the
same sample by using saline suspension
of RBCs if the initial test was performed
using RBCs suspended in the serum
 If the same error occurred, new sample
should be obtained; ABO grouping is
repeated
 ABO DISCREPANCIES

 Must acquire information regarding px’s age,

Dx, transfusion Hx, medications, Hx of
pregnancy
 Divided into 4 major categories
 Sources of errors:
– Inadequate ID of blood specimens, test tubes or
slides
– Cell suspension is too heavy or too light
– Clerical errors
– A mix-up in samples
– Missed observation of hemolysis
 ABO DISCREPANCIES

 Sources of errors:
– Failure to add reagents
– Failure to follow manufacturer’s
instructions
– Uncalibrated centrifuge
– Contaminated reagents
– Warming during centrifugation
 ABO DISCREPANCIES:
GROUP 1 DISCREPANCIES

 Unexpected reactions in the reverse

grouping due to weakly reaacting or missing
Abs
 Seen in:
– Newborns
– Elderly patients
– w/ leukemias
– Using immunosuppressive drugs
– w/ congenital agammaglobulinemia or
immunodeficiency diseases
 ABO DISCREPANCIES:
GROUP 1 DISCREPANCIES

 Seen in:
– w/ BM transplantations
– w/ existing ABO Abs (been diluted by
plasma transfusion or exchange)
– ABO subgroups
 Resolution:
– By incubating the px serum w/ A1 & B cells
@ RT for approximately 15-30 minutes
– If still no reaction, incubate again @ 4 oC for
15-30 minutes
 ABO DISCREPANCIES:
GROUP 2 DISCREPANCIES

 Unexpected reactions in forward

grouping due to weakly reacting or
missing Ags
 Causes:
– Subgroups of A or B
– Leukemias
– Hodgkin’s disease
– Acquired “B” phenomenon (diseases of
digestive tracts
 ABO DISCREPANCIES:
GROUP 2 DISCREPANCIES

 Resolution:
– incubating @ RT for up to
30 minutes
– If negative, incubate
again @ 4oC for 15-30
minutes
 ABO DISCREPANCIES:
GROUP 3 DISCREPANCIES

 Occur b/n forward & reverse grouping

caused by CHON or plasma abnormalities
& result in rouleaux formation or
pseudoagglutination
 Seen in:
– Elevated levels of globulin (multiple myeloma)
– Elevated levels of fibrinogen
– Plasma expanders (dextran,
polyvinylpyrrolidone)
– Wharton’s jelly in cord blood samples
 ABO DISCREPANCIES:
GROUP 3 DISCREPANCIES

 Resolution:
– By washing the px’s RBC
several times w/ saline
dilution or saline replacement
technique
 ABO DISCREPANCIES:
GROUP 4 DISCREPANCIES

 Occur b/n forward & reverse groupings

due to miscellaneous problems
 Seen in:
– Cold reactive autoAbs
– Has circulating RBCs of more than
one ABO group due to RBC
transfusion of marrow transplantation
– Unexpected ABO isoagglutinins
– Unexpected non-ABO alloAbs
 ABO DISCREPANCIES:
GROUP 4 DISCREPANCIES

 Resolution:
– Px’s RBC could be incubated @ 37 oC
for a short period, then wash w/ saline
@ 37 oC 3 times & retype
– If negative, px’s RBC can be treated
w/0.01 M dithiothreitol DTT) to disperse
IgM-related agglutination
– If serum, the reagent RBCs & serum
can be warmed to 37 oC, mix, then
tested, read @ 37 oC
 ABO DISCREPANCIES:
GROUP 4 DISCREPANCIES

 Resolution:
– If reverse typing is negative,
performed autoabsorption