1 st yr M.D.S Dpt of Prosthodontics Contents Introduction Classification of blood groups Agglutinogens and Agglutinins Landsteiners Laws ABO blood grouping sysytem ABO antigens ABO antibodies Types of ABO blood groups ABO inheritance Determination of blood groups References
Introduction In 1901 Karl Landsteiner published his discovery of a blood group system and he grouped red cells into three categories; A,B and O A fourth blood group , AB was discovered later by Decastello and Sturli. Based on the type of antigen present or absent, various blood grouping systems are known Classification Major blood grouping systems: - ABO blood grouping system - Rh (CDE) blood grouping system Minor blood grouping systems: - MNS blood group system - P blood group system Familial blood group systems: - Only in a few families. Ex: Kell, Duffy, Lutheran, Lewis, Deigo, Kidd etc. Agglutinogens and Agglutinins Agglutinogens refer to antigens present on the cell membranes of RBCs Agglutinins: antibodies against the agglutinogens, are present in plasma Approximately 300 red cell antigens have now been identified 18 blood group systems have been recognized
Blood grouping systems Landsteiner law If an agglutinogen is present on the red cell membrane of an individual the corresponding agglutinin must be absent in the plasma If an agglutinogen is absent from the cell membrane of RBCs of an individual, the corresponding agglutinin must be present in the plasma ABO blood grouping system It was the first to be recognized and most important Based on the presence of antigens called A and B agglutinogens on the cell membrane of RBCs H antigen is also present usually in all individuals but it is non- antigenic Almost everybody over the age of 6 months has clinically significant anti-A and/or anti-B in their serum ABO antigens A,B and H antigens are glycoproteins and the differences in terminal sugars determine the specificity of these antigens L- fucose for H L- fucose + N- acetyl-D- galactosamine for A L- fucose + D- galactose for B 15 amino acids make up the protein backbone and four sugars form side chains off this backbone A & B antigens are also present in many other tissues like salivary glands, pancreas, kidneys, liver, lungs and testis and in body fluids like saliva, semen and amniotic fluid H antigen- non antigenic
- L fucosyl transferase produced by H gene, attaches fucose and yields H activity (group O) N- acetyl- galactosaminyl transferase produced by A gene transfers N-acetylgalactosamine and results in A activity - galactosyl transferase produced by B gene attaches galactose and confers B activity Expression of ABH antigens on red cells is controlled by genes that reside at two loci ABH antigens results from action of enzymes (tranferases) on the appropriate precursor substance The substrate is a product of H gene (chromosome 19) and converted to A or B by the action of A or B- transferases (chromosome 9) Variants of A and B antigens The principal sub groups of A are A1 and A2 A1 constitute 80% of those in gp A A1 individuals agglutinated by Dolichos biflorus lectin but not agglutinated by anti-H lectin, Ulex europaeus A2 individuals are agglutinated by Ulex europaeus Variants of B are less common, but are recognized ABO antibodies Individuals develop antibodies or agglutinins against A or B antigen missing from their red blood cells Anti A / agglutinin and Anti B/ agglutinins are present in the plasma O people also possess an antibody referred to as anti-A,B which reacts with either A or B red blood cells Bacteria with similar sugar moieties that confer A,B and H reactivity provide antigenic stimulus Anti A and anti B are globulins of IgM type In individuals in O group, antibodies are of both IgM and IgG classes and agglutinins act best at low temperature ( 5- 20 degrees Celsius) and are called as cold antibodies Two kinds of Anti-H also exist Oh (Bombay) group and other in group A1 and A1B individuals Bombay blood is very rare but the antibody is active at 37 degree Celsius and only Bombay blood can be transfused
Types of ABO blood groups Group A: A agglutinogen - B agglutinin -A1 and A2 sub groups Group B: B agglutinogen- A agglutinin Group AB: A and B agglutinogen - A1B and A2B sub groups Group O: both anti A and anti B in plasma
ABO inheritance The inheritance pattern of ABO genes follows Mendalian autosomal genetics Four major alleles are located at the ABO locus on chromosome 9 6 common phenotypes described- A1, A2,B, A1B,A2B and O Most blood group genes are co-dominant (A and B) O gene is a silent allele or amorph, with no obervable expression Co dominance: A state in which two diffrent alleles are equally expressed Silent genes or amorphs: those with no observable expression Determination of ABO blood grouping ABO blood group can be determined by mixing one drop of suspension of red cells with a drop each of anti serum A and antiserum B seperately on a glass slide Anti serum A will cause agglutination of RBCs having antigen A and anti serum B will cause agglutination of RBCs having B antigen Population distribution of Blood groups in India A group B group AB group O group References Berne and Levy Physiology- Koeppan, Stanten Guyton and Hall text book of medical physiology- Hall Text book of Physiology- A.K.Jain Haematology clinical and lab practise Bick, Bennet, Bynes, Cline Wintrobes clinical haematology- Less, Foester