ABO Blood Typing

Elrey L/ Navarro MD, DPCOM

ABO Basics
 Blood group antigens are actually sugars
attached to the red blood cell.
 Antigens are “built” onto the red cell.
 Individuals inherit a gene which codes
for specific sugar(s) to be added to the
red cell.
 The type of sugar added determines the
blood group.
This diagram illustrates the terminal
sugar for each blood group.
ABO Antigens and Antibodies

Surface Antibodies
Antigens
A A Anti-B
B B Anti-A
AB A, B none
O none Anti-A
Anti-B
 4 Basic Blood Types

 Antigens also called agglutinogens

 Antibodies called agglutinins

Figure 19–6a
The Rh Factor
Surface Antibo-
 Also called D Antigens dies
antigen
Rh+ Rh factor none
 Either Rh positive
Rh- none none
(Rh+) or Rh
-
negative (Rh ) Rh- none Anti Rh
Sens
 Only sensitized
Rh- blood has
anti-Rh antibodies
Determines blood type and
compatibility
Blood Types
 Genetically determined cell surface
markers (antigens) on RBCs, including
• ABO group – glycolipids on RBC surface
• Rh factor – membrane protein
4 Basic Blood Types
 A has surface antigen A
 B has surface antigen B
 AB has both antigens A and B
 O has neither A nor B

 A has type B antibodies

 B has type A antibodies
 O has both A and B antibodies
 AB has neither A nor B antibodies
ABO Antigens and Antibodies

Surface Antibodies
Antigens
A A Anti-B
B B Anti-A
AB A, B none
O none Anti-A
Anti-B
Blood type questions
 Which blood type is the best in
emergency settings (hint: which type can
be given to anyone?)
 Which blood type is the lucky one that
can receive blood from any donor?
Cross-Reaction

Figure 19–6b
Cross-Reaction
 If donor and recipient blood types not
compatible:
• Plasma antibody meets its specific surface
antigen and blood will agglutinate and
hemolyze
Cross-Match Test
 Performed on donor and recipient blood
for compatibility to blood surface
antigens other than ABO and Rh
 Blood typing
 Skip part A
procedures
 Part B: 6 trays with three wells each
Victim Crime scene Suspect 1

A B Rh A B Rh A B Rh

Suspect 2 Suspect 3 Suspect 4

A B Rh A B Rh A B Rh

6 Bottles of “blood” 3 Bottles of antibodies

 Blood Typing Procedures
 For each well Place 1-2 drops of blood from one
bottle in all 3 wells
• 1-2 drops of crime scene in each of the three wells
• 1-2 drops of victim in each of the three wells
• 1-2 drops of suspect 1 in each of the three wells
• 1-2 drops of suspect 2 in each of the three wells
• 1-2 drops of suspect 3 in each of the three wells
• 1-2 drops of suspect 4 in in each of the three wells
 For each tray add:
• 1-3 drops of anti-A serum to one well and stir
• 1-3 drops of anti-B serum to one well and stir
• 1-3 drops of anti-Rh serum to one well and stir
Look for clumping reaction
Landsteiner’s Rule
 Individual’s 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 recipient.
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.
Example of Determining
Genotype
 Mom’s phenotype is group A, genotype AO
 Dad’s phenotype is group B, genotype BO

B O
A AB 25% AO 25% (Group A)
O BO 25% (Group B) OO 25% (Group O)
Other Examples
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
Group O
 Approximately 45% of the
population is group O.
 No A or B antigens present,
think of as “0” antigens present.
 These individuals form potent
anti-A and anti-B antibodies
which circulate in the blood
plasma at all times.
Group 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.
Group 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 times.
Group 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.
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.
Summary
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
 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 (continued)
 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 blood.
Rh (D) Antigen (continued)
 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
Neborn – How it Occurs
 A child is Rh pos
 B during pregnancy fetal Rh pos rbc’s escape into maternal
circulation
 C Mother produces antibodies to Rh (D) antigen
 D Second pregnancy with Rh (D) pos child results in
destruction of fetal D pos rbcs
Blood Typing
 There are 2 components to blood typing:
• Test unknown cells with known antibodies
• Test unknown serum/plasma with known rbc’s
 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 - continued
 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 rbcs
Interpretation of Slide Typing
Testing with Anti-A Anti-Serum
 If an rbc contains the A
antigen the red blood cells will
be agglutinated by anti-A, a
positive reaction.
 If an rbc does not have the A
antigen there will be no
clumping, a negative 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 B
 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

POS POS AB