1. ABO Blood Grouping Introduction Terry Kotrla, MS, MT(ASCP)BB

2. 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.

3. This diagram illustrates the terminal sugar for each blood group.

4. ABO Type Frequencies In U.S. ABO TypePer Cent O45% A40% B11% AB4%

5. 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.

6. 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.

7. 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.

8. 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.

9. Example of Determining Genotype Mom’s phenotype is group A, genotype AO Dad’s phenotype is group B, genotype BO BO AAB 25%AO 25% (Group A) OBO 25% (Group B)OO 25% (Group O)

10. Other Examples MomDadOffspring Blood Group AABB100% AB BOOO50% each of B or O OO 100% O OOAO50% each of A or O

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. Summary Blood GroupAntigens on cellAntibodies in plasma Transfuse with group AAAnti-BA or O BBAnti-AB or O ABA and BnoneAB, A, B or O ONoneAnti-A & BO

17. 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.

18. 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.

19. 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.

20. 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

21. 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.

22. 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.

23. 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

24. 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.

25. 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.

26. 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.

27. 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.

28. 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.

29. 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.

30. Summary of Slide Typing Anti-AAnti-BBlood Group NEG O POSNEGA POSB AB