KRVNE GRUPE

BLOOD TYPING
Blood types are base on the presence of agglutinogens (antigens)
present on the red blood cell surface. Also, based on presence of
agglutinins (antibodies) in the plasma.
The ABO and Rh systems are based on antigen-antibody type
interactions.
Determined by antigens (agglutinogens) on surface of RBCs
Antibodies (agglutinins) can bind to RBC antigens, resulting in
agglutination (clumping) or hemolysis (rupture) of RBCs
Groups - ABO and Rh
Agglutinogens surface of RBCs contain genetically determined assortment of antigens
Blood group based on presence or absence of various antigens - At
least 24 blood groups and more than 100 antigens ABO and Rh
Osim aglutinogena,pripadnici pojedine krvne grupe imaju u svojoj
krvnoj plazmi i specifina protutijela,a kako su ona odgovorna za
reakciju aglutinacije eritrocita,nazivaju se aglutinini.Tako pripadnik
grupe A ima anti-B aglutinine(koji reaguju protiv eritrocita sa
aglutinogenima B),pripadnik grupe B ima anti-A aglutinine,pripadnik
grupe AB nema aglutinina,dok pripadnik grupe O ima i anti-A i anti-B
aglutinine
Leukocytes blood types
1. Common antigens of leukocytes (HLA system)
2. Antigens of granulocytes.
3. Antigens of lymphocytes.

Serum blood types

There are more than 20 immunoglobulin blood
cells, albumin and globulin blood types (Gm (1),
Gm (2), Inv (1), Inv (2), Inv (3)).
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

 Krvne grupe
ABO i Rh sistem
Antigeni na membrani eritrocita (oligosaharidi) A, B, AB
Krvne grupe A, B, AB i O (bez antigena)
Prirodna antitijela k.grupe A su anti-B, B anti-A , O anti-A i anti-
B, AB nema antitijela
Rh (D antigen) Rh pozitivna, bez antigena Rh negativna

Based on A and B antigens

Type A blood has only antigen A
Type B blood has only antigen B
Type AB blood has antigens A and B
Universal recipients neither anti-A or anti-B
antibodies
Type O blood has neither antigen
Universal donor
Reason for antibodies presence not clear
Antigens and antibodies
of AB0 system
Antigens Antibodies
I group H alpha, beta
II group A beta
III group B alpha
IV group AB -

In the membrane of
erythrocytes present
agglutinogens (H, A, B)
In plasma present
agglutinins (alpha, beta)
 When serum containing anti-A or anti-B agglutinins is
added to blood, agglutination will occur between the
agglutinin and the corresponding agglutinogens
4 Basic Blood Types Positive reactions indicate agglutination.
Antigens on surface of RBCs
Screened by immune system
Plasma antibodies attack (agglutinate) foreign
antigens

Surface Antigens
Are cell surface proteins that identify cells to immune
system
Normal cells are ignored and foreign cells attacked

A (surface antigen A)
B (surface antigen B)
AB (antigens A and B)
O (neither A nor B)
 RBC membranes bear 30 types glycoprotein antigens that
are

Blood Plasma Antibodies Perceived as foreign if transfused blood is

mismatched
Unique to each individual
Promoters of agglutination and are called
agglutinogens
Presence or absence of each antigen is used to classify
blood cells into different groups

Humans have 30 varieties of naturally occurring RBC

antigens
Antigens of the ABO and Rh blood groups cause vigorous
transfusion reactions
Other blood groups (MNS, Duffy, Kell, and Lewis) are
usually weak agglutinogens

Type A:type B antibodies

Type B: type A antibodies
Type O: both A and B antibodies
Type AB:neither A nor B
 Types A, B, AB, and O
Based on the presence or absence of two agglutinogens (A ABO Blood Groups
and B) on the surface of the RBCs
Blood may contain anti-A or anti-B antibodies (agglutinins)
that act against transfused RBCs with ABO antigens not
normally present GENOTIPOVI KRVNE GRUPE AGLUTINOGENI AGLUTININI
OO O - Anti-A i Anti-B
Anti-A or anti-B form in the blood at about 2 months of age OA ili AA A A Anti-B
Odmah poslije roenja u plazmi gotovo i da nema OB ili BB B B Anti-A
AB AB AiB -
aglutinina.Dva do osam mjeseci poslije roenja,organizam
djeteta poinje da stvara aglutinine.Titar je maksimalan
izmeu 8 i 10 godina ivota,a zatim postepeno opada do
kraja ivota.
Aglutinini su gama-globulini,ba kao i druga antitijela,a
stvara ih ista vrsta elija koja stvara i antitijela prema bilo
kojim drugim antigenima.To su veinom lgM- i lgG-
imunoglobulini.
Ovi aglutinini se stvaraju kod osoba koje nemaju
odgovarajue aglutinogene tako to mala koliina antigena
grupe A i grupe B ulazi u organizam putem hrane,bakterija i
na druge naine,pa te supstance izazivaju stvaranje anti-A
odnosno anti-B aglutinina.
 KRVNE GRUPE OAB-SISTEMA
Prije otkria krvnih grupa uvijek je dolazilo do velikih problema usljed transfuzije krvi meu
osobama nesrodnih krvnih grupa.esto je dolazilo do aglutinacije(sljepljivanje),a zatim i do
hemolize(izumiranja ili raspadanja)eritrocita.Takvi procesi su uzrokovali zaepljenje krvnih
kapilara i opu disfunkcionalnost krvi,te time dovodili do smrti.Ovaj problem rijeava jedan
austrijski lijenik i patolog po imenu Karl Landsteiner koji je otkrio krvne grupe a neto kasnije i
Rh-sistem.
Krvna grupa je klasifikacija krvi bazirana na prisutnosti ili nedostatku naslijeene antigenske
supstance na povrini eritrocita.
Krvne grupe se nasljeuju od roditelja i ne mjenjaju se u toku ivota.
Krv razliitih osoba esto ima razliita antigenska imunska svojstva,tako da antitijela krvne
plazme jedne krvi reaguju sa antigenima povrine eritrocita druge krvi.
Na povrini elijske membrane krvnih elija ovjeka naeno je barem 30 antigena koje se esto
susreu i stotine drugih koji se susreu rijetko,a svaki od njih moe ponekad prouzrokovati
reakciju antigen-antitijelo.Veina njih su slabi antigeni i znaajniji su uglavnom za izuavanje
nasljeivanja gena u cilju odreivanja oinstva itd.
Meutim,dvije posebne grupe antigena mnogo ee od drugih uzrokuju transfuzione
reakcije.To su tzv.OAB-sistem i Rh-sistem.

ANTIGENI A I B ILI AGLUTINOGENI A I B

Dva antigena,tip A i tip B,nalaze se na povrini eritrocita velikog djela ljudske populacije.ovjek
moe na svojim elijama imati jedan antigen,oba ili nijedan od njih.
Kada je posredi transfuzija krvi od ovjeka ovjeku,krv davalaca i primalaca obino se klasifikuje u
etiri glavne krvne grupe sistema OAB zavisno od prisutnosti ili odsutnosti dvaju aglutinogena.Te
etiri glavne krvne grupe su:
GRUPA A-na membrani eritrocita ima aglutinogen A
GRUPA B-na membrani eritrocita ima aglutinogen B
GRUPA AB-na membrani eritrocita ima i aglutinogen A i aglutinogen B
GRUPA 0-na membrani eritrocita nema ni aglutinogen A ni aglutinogen B.
Nasljeivanje aglutinogena

Dva gena,jedan na svakom od dva parna hromosoma,determiniu krvne grupe

OAB-sistema.Ova dva gena su alelomorfni geni koji mogu biti bilo koji od tri
tipa,ali samo po jedan tip na svakome hromosomu:ili tip O,ili tip A ili tip B.Gen
tip O je ili nefunkcionalan,ili je slabo funkcionalan,tako da ne uzrokuje pojavu O-
aglutinogena na elijama dok gen tipa A i gen tipa B uzrokuju pojavu jakih
aglutionogena na elijama.est moguih kombinacija gena su: OO,OA,OB,AA,BB I
AB.Ove kombinacije gena su genotipovi.Svaki ovjek pripada jednom od tih est
razliitih genotipova.
 ABO BLOOD GROUP
History
1. Landsteiners discovered the ABO Blood Group System in 1901 He and five co-workers began mixing each others
red blood cells and serum together and accidentally performed the first forward and reverse ABO groupings.

2. Landsteiners Rule: If an antigen (Ag) is present on a patients red

blood cells the corresponding antibody (Ab) will NOT be present in the
patients plasma, under normal conditions.

Importance of ABO There are two principles

1-almost all normal healthy individuals above 3-6 months of
age have naturally occurring Abs to the ABO Ags that
they lack
These Abs termed naturally occurring because they
were thought to arise without antigenic stimulation
2- These naturally occurring Abs are mostly IgM class.
That means that, they are Abs capable of agglutinating saline/ low
protein suspended red cell without enhancement and may activate complement cascade.
Major ABO Blood Group

Forward blood grouping using anti-sera and red blood cells

ABO Antigen Antigen Antibody

Group Present Missing Present
A A B Anti-B
B B A Anti-A
O None A and B Anti-A&B
AB A and B None None
If an antigen (Ag) is present on a patients red blood cells
the corresponding antibody (Ab) will NOT be present in the
patients plasma, under normal conditions.
ABO BLOOD GROUP (Forward blood grouping )
Determination of ABO antigens found on patient red blood cells using reagent anti-sera. Serum from BG B
aggl A RBCs, that an Ab to A Ag was present in Grp B serum, serum from A agg Grp B RBCs

Patient Red Cells Tested With

Patient Anti-A Anti-B Interpretation

1 0 0 O

2 4+ 0 A

3 0 4+ B

4 4+ 4+ AB
Reverse Grouping (Confirmatory grouping)
Patient Serum Tested With reagent red blood cells
Serum from GRP O individual aggl both A and B cells indicate the presence of Abs to both A and B in group O serum

A1 Cells B Cells Interpretation

Patient

1 4+ 4+ O

2 0 4+ A

3 4+ 0 B

4 0 0 AB
FORWARD & REVERSE ABO BLOOD GROUPING

Reaction of Cells Tested Reaction of Serum

With Tested Against ABO
Group
Anti-A Anti-B A1 Cells B Cells
1 0 0 + + O

2 + 0 0 + A

3 0 + + 0 B

4 + + 0 0 AB
 ABO INHERITANCE

T2 Dad = A/O Mom

and
B O
Mom = B/O
A A/B A/O
Dad
O O/B O/O
 ABO groups of the offspring from the various possible ABO
mating

Phenotypes Genotype offspring

AxA AAxAA A (AA)
AAxAO A (AA or AO)
AOxAO A (AA or AO),O(OO)

BxB BBxBO B (BB or BO)

AxAB AAxAB AB (AB) or A (AA)

AOxAB AB (AB), A (AA, AO), B(BO)
 Inheritance
Definition
Isoagglutinins: are defined as antibodies that agglutinate blood cells of some individuals of the same species
Glycosyltransferases: are enzyme that facilitate the transfer of carbohydrate (sugar) molecules onto carbohydrate precursor molecules
Immunodominant sugar: is the sugar molecule that complete the antigenic determinant when combined with the precursor substance
The inheritance of the ABO blood group was demonstrated that each individual inherits one ABO gene from each parent and these two genes determine
which Ags are present on RBCs membrane
One position or Locus, on each chromosome number nine is occupied by an A, B, or an O gene
A Locus termed H and the final product of the genes at that locus, H antigen, was necessary for the expression of normal ABO antigens (Allele: any alternate
form of a gene that can occupy a given chromosomal location (locus).
ABH Ags of the RBC membrane are found partly as glycolipids, but primarily as glycoproteins. It may also occur in the secretion as glycoproteins.
Ags belonging to ABH blood group system are present on RBCs and other body cells and body fluids.

The presence of A,B, and O Ags on RBCs depends upon the allelic genes, A,B, and O
An H genes at a separate locus codes for the precursor substance on which the A and B gene products act
The products of the A and B genes are enzymes that act as a specific transferases
H gene products is an enzyme that produce H substance
The O gene is a silent allele
It does not alter the structure of H substance.
 Formation of A1B& H Antigen
The ABO genes do not code for the production of ABO antigens, BUT rather produce specific glycosyl transferases
ABO produces a specific glycosyl transferases that add sugars to a basic precursor substance on the RBCs
A donor nucleotide derivative supplies the sugar that confers (gives) ABO specificity (is the sugar molecule that complete the
antigenic determinant when combined with the precursor substance )

The formation of ABH antigens results from the interaction of ABO genes with several other separate, independent blood
groups.
The inheritance of at least one H gene (HH or Hh) elicits (obtain) the production of an enzyme called, -2-L-Fucosyl
transferase, which transfers the sugar from the Guanosine diphosphate L-fucose (GDP-Fuc) donor nucleotide to the terminal
galactose of the precursor chain.
The H substance must be formed for the other sugars to be attached in response to an inherited A and /or B genes
A Locus termed H and the final product of the genes at that locus, H antigen, was necessary for the expression of normal ABO
antigens (Allele: any alternate form of a gene that can occupy a given chromosomal location (locus).

ABH Ag
There are two potential precursors substance (PS) both are comprised of identical sugar (galactos-N- acetyl gluctosamin -
galactose -glucose) but different in linkage.
Type I PS has a terminal galactose (Gal) linked to a subterminal N acetylgucoseamine (GlcNAc) in 1-3 linkage
Type II PS, has the same sugar combine in 1-4 linkage
ABH Ags on RBCs are derived from Type II chains.

ABO Genetics
Genes at three separate loci control the occurrence and location of A and B antigens

1. Hh genes H and h alleles

H allele codes for a fucosyltransferase enzyme that adds a fucose on
Type 2 chains (primarily) to form the H antigen onto which A and B
antigens are built on red blood cells.
h allele is a silent allele (amorph)

A, B and H antigens are built on oligosaccharide chains of 4 types. The most

common forms are Type 1 and Type 2.

Type 1: #1 carbon of Gal is attached to the #3 carbon of GlcNAc.

Type 2: #1 carbon of Gal is attached to the #4 carbon of GlcNAc.

2- Se genes Se and se alleles
Se allele codes for a fucosyltransferase enzyme that adds fuscos onto
Type 1 chains (primarily) in secretory glands. Controls expression of
H antigens in secretions (i.e. saliva, body fluids, etc.)
se allele is an a morph

3. ABO genes A, B and O alleles

A and B alleles code for (glycosyltransferase) a fucosyltransferase
enzymes that add a sugar onto H antigens to produce A and B
antigens
O allele does not code a functional enzyme
ABO Genetics

Occurance
a. The presence or absence of the ABH antigens on the red blood cell membrane is controlled
by the H gene

b. Presence or absence of the ABH antigens in secretions is indirectly controlled by the

Se genes. 1. Controls presence of H,
A, and B antigens on
1. Hh gene H and h both RBCs and in
alleles (h is an a morph) Secretions
2. Se gene Se and se 2. Controls presence of H
antigen in the secretions
alleles (se is an amorph)
3. Inherit 1 gene from each
3. ABO genes A, B and O parent that codes for an
alleles enzyme that adds a
sugar to the H antigen
 H Antigen
H antigen is the foundation upon which A and B antigens are built. A and B
genes code for enzymes that add an immunodominant sugar to the H
antigen.
The H gene codes for an enzyme (fucosylytranferase) that adds a Fucose to
the terminal sugar of a Precursor Substance (PS*). The biochemical structure
below constitutes the H Antigen. (h gene is an amorph.)
H gene acts on
a Precursor
substance(PS)*
by adding
*PS = oligosaccharide chain
Fucose attached to either glycosphingo-
lipid, Type 2 chain (on RBC) or
glycoprotein, Type 1 chain (in
secretions)
 Formation of the
A Antigen

The A gene codes

for an enzyme that
adds GalNAc
(N-Acetyl-D
galactosamine)
to the terminal
sugar of the
H Antigen. The biochemical structure
constitutes the A antigen.
 Formation of the
B Antigen

B gene codes for an

enzyme that adds
D-Galactose
to the terminal sugar
of the H Antigen.

The biochemical structure

constitutes the B Antigen.
The H antigen is found on
the RBCs when there is an Hh
or HH genotypes but NOT
with the hh genotype.

The A antigen is found on

the RBCs when there is Hh,
HH, and A/A, A/O or A/B
genotypes.

The B antigen is found on

the RBCs when there is Hh,
HH, and B/B, B/O or A/B
genotypes.
 Amount of H Antigen According to Blood Group

Neither the A or B genes have converted the H

Blood Group O people antigens to A or B antigens - just a whole bunch of
have red blood cells H!

rich in H antigen. O allele at the ABO locus (amorph)

Why? It does not alter the structure of H
substance.

Greatest O > A2 > B > A2B > A1 > A1B Least

Amount of H Amount of H
 Donor Nucleotides & Immundominant Sugars responsible
for H, A, and B Ags specificity

Gene Glcosyltransferase Nucleotide Immunodominant sugar Antigen

Guanosine
H L- fucosyl trnsferas L-fucose H
GDP-FUC

N acetylgalactosaminyl Uridine
A N-acetyl-D- A
transferase UDP- galactoseamine
GALNAC

Uridine
B D- galactosyl D-galactose B
transferase UDP-GAL
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.
ABO Type Frequencies In U.S.
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 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.

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
Moms phenotype is group A, genotype AO
Dads 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.
 Rh-KRVNA GRUPA(FAKTOR)
Osim aglutinogena koji pripadaju ABO-sistemu krvnih
grupa,eritrociti ovjeka sadre i druge aglutinogene.U
zavisnosti od toga da li njihovi eritrociti sadre Rh-
aglutinogen,postoje osobe koje su Rh-pozitivne,odnosno
Rh-negativne.Oko 92% ljudi ima Rh-antigen u
eritrocitima,pa se ta grupa oznaava kao Rh-
pozitivna,dok 8% ljudi nema Rh-antigen pa se oznaavaju
kao Rh-negativni.
Postoji jedna velika razlika izmeu OAB-sistema i Rh-
sistema.U sistemu OAB,aglutinini koji uzrokuju
transfuzione reakcije stvaraju se spontano,dok se u Rh-
sistemu aglutinini gotovo nikad ne stvaraju
spontano.Umjesto toga,osoba mora biti jako izloena Rh-
antigenu,obino transfuzijom krvi ili kada budua Rh-
negativna majka nosi plod sa tim antigenom,prije nego
to stvori dovoljno aglutinina koji bi izazvali znaajnu
transfuzionu reakciju.
 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.

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.

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.

First studied in rhesus monkeys

Types
Rh positive: Have these antigens present on surface of RBCs
Rh negative: Do not have these antigens present
Hemolytic disease of the newborn (HDN)
Mother produces anti-Rh antibodies that cross placenta and cause agglutination and hemolysis of fetal RBCs
Rh-antigeni-''Rh-pozitivne'' i ''Rh-negativne'' osobe

Postoji est estih tipova Rh-antigena od kojih se svaki zove Rh-faktor.Ovi

antigeni se oznaavaju kao C,D,E,c,d,e.ovjek od svakog roditelja nasljeuje po
jedan antigen od svakog od tri para antigena(tj.moe da ima najmanje tri,a
najvie est antigena Rh-sistema).
D-antigen je najire rasprostranjen u ljudskoj populaciji i,uz to,on je i znatno
antigeniniji od drugih Rh-antigena.Zato se za svakoga ko ima taj tip antigena
kae da je Rh-pozitivan,dok se za osobu koja nema D-antigen kae da je Rh-
negativna.Meutim,treba zapamtiti da i neki od drugih Rh-antigena ipak mogu
prouzrokovati transfuzione reakcije,mada obino znatno blae.
 The Rh Factor
Also called D antigen
Either Rh positive (Rh+) or Rh negative (Rh)
Only sensitized Rh blood has anti-Rh antibodies

There are 45 different Rh agglutinogens (Rh factors)

C, D, and E are most common
Rh+ indicates presence of D

System D (rhesus).
There are 6 main ntigens of rhesus system.
System Fisher-Race. According to that system there are such antigens: D, C, E; d, c, e.
In USA present Winner system: Rho; rh'; rh"; Hro; hr'; hr".

Rho(D); rh'(C); rh"(E); Hro(d); hr'(c); hr"(e).

ntigen Rho(D) the main ntigen of rhesus system. . D is by far the most antigenic, and the term "Rh-positive" as it is generally used means that the
individual has agglutinogen D.
Anti-Rh antibodies are not spontaneously formed in Rh individuals
Anti-Rh antibodies form if an Rh individual receives Rh+ blood
A second exposure to Rh+ blood will result in a typical transfusion reaction
 Erythroblastosis Fetalis
Hemolytic Disease
Rh blood group
People whose RBCs have the Rh antigen
are Rh+
People who lack the Rh antigen are Rh-
Normally, blood plasma does not contain
anti-RH antibodies
Hemolytic disease of the newborn (HDN)
if blood from Rh+ fetus contacts Rh-
mother during birth, anti-Rh antibodies
made
Affect is on second Rh+ baby

Copyright 2009, John Wiley & Sons, Inc.

Hemolytic Disease of the Neborn How it Occurs
A child is Rh pos
B during pregnancy fetal Rh pos rbcs 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
 Homeostatic Imbalance: Hemolytic Disease of the
Newborn
Also called erythroblastosis fetalis
Rh mother becomes sensitized when
exposure to Rh+ blood causes her body to
synthesize anti-Rh antibodies
Anti-Rh antibodies cross the placenta and
destroy the RBCs of an Rh+ baby
The baby can be treated with prebirth
transfusions and exchange transfusions
after birth
RhoGAM serum containing anti-Rh can
prevent the Rh mother from becoming
sensitized
 Typing Blood
Odreivanje krvnih grupa se zasniva na utvrivanju
prisustva aglutinogena u ispitivanim
eritrocitima.Krvne grupe odreuju se standardnim
test-serumima krvnih grupa ABO sistema.Postoje tri
standardna seruma:anti ''a'',anti ''b'' i anti ''ab''.
Single drops of blood are mixed with different
antisera
Agglutination with an antisera indicates the
presence of that antigen on the RBC

Copyright 2009, John Wiley & Sons, Inc.

 Tehnika odreivanja krvnih grupa na ploici

Ako se krvna grupa odreuje na licu mjesta,tj.u bolesnikoj sobi ili na terenu,krv se uzima od bolesnika neposredno prije
odreivanja krvne grupe.Kad se krvna grupa odreuje u laboratoriji,iz vene bolesnika uzima se 5ml krvi u sterilnu i suhu epruvetu.Za
sam postupak potrebno je pripremiti:
-boice sa test-serumima anti ''a'',anti ''b'' i anti ''ab'';
-porcelanske ploice s udubljenjima koja su obiljeena slovima A,B,O;
-pipete ili staklene cijevice koje se koriste za mijeanje krvi sa serumom,predhodno stavljenim na ploicu;
-sterilna elina pera,brisevi od vate i boice s eterom za dezinfikovanje jagodice prsta.
Na suhu i istu ploicu stave se dvije kapi test-seruma,i to na sljedei nain:na mjesto koje je obiljeeno sa A stavlja se test-serum
anti ''a'',na mjesto obiljeeno sa B stavlja se test-serum anti ''b'' a na mjesto obiljeeno sa O stavlja se test-serum anti ''ab''.Krv se
uzima iz jagodice prsta i mjea se sa test-serumima.Zatim se saeka pet minuta da bi mogla nastati aglutinacija te se onda itaju
rezultati:
-ako se na sva tri udubljenja ne pojavi aglutinacija,osoba pripada O-grupi,tj.opti je davalac krvi;
-ako nema aglutinacije na udubljenju obiljeenom sa B,a nastupila je na udubljenju obiljeenom sa A i O,krvna grupa te osobe je A;
-ako nema aglutinacije na udubljenju obiljeenim sa A,a nastala je na udubljenju B i O,ta osoba je krvne grupe B;
-ako se na sva tri udubljenja pojavi aglutincija,ta osoba pripada AB-grupi,tj.opti je primalac.
Umjesto na ploici,odreivanje krvne grupe moe se izvesti i na specijalnom papiru,na kome aglutinacija ostaje trajno i slui kao
dokument.
 Tehnika odreivanja krvnih grupa u epruveti
Ova metoda za odreivanje krvnih grupa primjenjuje se u svim bolnicama i ustanovama
za transfuziju krvi.Princip rada je isti kao i na ploici,samo to se aglutinacija ispituje u
epruveti umjesto na ploici.Princip rada je sljedei:
U jednu epruvetu se stave dvije kapi test-seruma anti ''a'',u drugu anti ''b'',i u treu
epruvetu dvije kapi test-seruma ''ab''.Zatim se u svaku epruvetu stavi jedna kap
fiziolokog rastvora da bi se serum razblaio i da bi se izbjegla pojava
pseudoaglutinacije.U svaku epruvetu se stavi i 2%-na suspenzija eritrocita iz krvi osobe
kojoj se odreuje krvna grupa.U etvrtu epruvetu stavi se serum krvi osobe kojoj se
odreuje krvna grupa i 2%-na suspenzija poznatih eritrocita krvne grupe B.Sve epruvete
se promukaju i ostave se dva sata na sobnoj temperaturi kako bi nastala aglutinacija.Ako
postoji centrifuga,epruvete se centrifugiraju dva minuta,a zatim se itaju rezultati.
Ako aglutinacija ne postoji u prve tri epruvete-krvna grupa je O.
Ako aglutinacija postoji u prvoj i treoj epruveti-krvna grupa je A.
Ako aglutinacija postoji u drugoj i treoj epruveti-krvna grupa je B.
Ako aglutinacija postoji u sve tri epruvete-krva grupa je AB.
 Blood Typing
slajd tehnika

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.

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

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.

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
Blood Type Test
Determines blood type and compatibility

Figure 197
 Transfusions
Whole-blood transfusions are used when blood loss is substantial
Packed red cells (plasma removed) are used to restore oxygen-carrying capacity
Transfusion of incompatible blood can be fatal

Before the transfusion we must do the test on individual blood compatibility

in AB0 system
in DCE system
Biological test

Transfusion Reactions
Occur if mismatched blood is infused
Donors cells
Are attacked by the recipients plasma agglutinins
Agglutinate and clog small vessels
Rupture and release free hemoglobin into the bloodstream
Result in
Diminished oxygen-carrying capacity
Hemoglobin in kidney tubules and renal failure
BLOOD TYPES
Bloo Type Type of Recei Blood Presen Type Rece
d of Antibo ve? Type ce of of ive?
Typ Antige dy? D Antib
e n? Antige ody?
A A Anti-B A, O n?
antigen Rh
B B Anti-A B, O Positive Yes None +
antigen and -
AB Both A None A, B, Rh
and B AB, O Negativ No Anti-D - only
antigen e
BLOOD GROUPS
Type O 45% Type A 42%

Type B 10% Type AB 3%

ABO BLOOD TYPING

Blood
Type RBC Serum
Being Agglutinogens Reaction
Tested
Anti-A Anti-B
AB A and B + +
B B +
A A +
O None
Blood being tested Serum
Anti-A Anti-B
Type AB (contains
agglutinogens A and B;
agglutinates with both
sera)
RBCs

Type A (contains
agglutinogen A;
agglutinates with anti-A)

Type B (contains
agglutinogen B;
agglutinates with anti-B)

Type O (contains no
agglutinogens; does not
agglutinate with either
serum)
Figure 17.16
 INTERREAKCIJA
I pored kompatibilnosti krvi davaoca i krvi primaoca, prije
transfuzije se radi interreakcija: - Plazma primaoca + eritrociti
davaoca i - Plazma davaoca + eritrociti primaoca

Ako nema aglutinacije krv se moe dati

Cross-Match Test -performed on donor and recipient blood for

compatibility
Without cross-match, type O is universal donor

Cross-Reaction - Also called transfusion reaction

Plasma antibody meets its specific surface antigen
Blood will agglutinate and hemolyze
If donor and recipient blood types not compatible
Restoring Blood Volume

Death from shock may result from low blood volume

Volume must be replaced immediately with
Normal saline or multiple-electrolyte solution that mimics plasma electrolyte
composition
Plasma expanders (e.g., purified human serum albumin, hetastarch, and
dextran)
Mimic osmotic properties of albumin
More expensive and may cause significant complications
Red blood cells
Provide intravascular volume and O2 carrying capacity.
Transfusion of red cells can be life-saving in situations of acute
intravascular volume loss, e.g. trauma, surgery
Red blood cells
Although red cells have a limited life-span, transfusion to another
individual is a form of tissue transplantation, with similarities to
kidney, heart and bone marrow transplantation

Compatibility between donor and recipient is vital or rejection will

occur
Red Cells
Carry on the surface of their membrane many different proteins
which differ between individuals
These are the red cell antigens
Inherited
Over 400 different systems of red cell antigens
Only 2 very important: ABO and Rhesus
ABO blood group system
4 blood groups: A, B, AB and O
O is recessive, so O = 0,0
A= AA or AO, B=BB or BO, AB= AB

O= 45%, A= 40%,B=12%, AB= 3%

ABO blood group system
ABO unusual antigens: carbohydrate, not protein
Naturally occuring antibodies from age 6 months
IgM antibodies in plasma, dont cross placenta
IgM antibodies fix complement to C9, so transfusion reactions very
severe
ABO blood group
Can type cells as A, B or AB, using antibodies: anti-A and anti-B.
If react with neither =group O

Can type serum as double check

O serum will contain anti-A and anti-B
AB serum will not contain any antibody
A will contain anti-B, B will contain anti-A
Rhesus blood group system
Complex series of C,D and E antigens
D/d by far most important
D is a null gene, no protein product, so no anti-d possible
D is dominant, so D = DD or Dd
15% population dd = d = d negative
Rhesus blood group system
Women who are rhesus negative (dd) have babies that carry paternal
antigens, such as D.
If mother exposed to D red cells will make IgG anti-D
Anti-D crosses placenta and haemolyses babies red cells: can result in
in-utero death and need for in-utero blood transfusion
Rhesus blood group
It is so vital that women of childbearing age are not exposed to wrong
rhesus type blood that everyone receives rhesus, as well as ABO,
compatible blood.

All women have rhesus blood type determined at each conception.

Anti-D given to D negative mothers to prevent sensitisation
Other blood groups
Many in number
Infrequent problem
Only likely to have been sensitised if had previous blood transfusion
(occasionally by pregnancy)
Can cause major problems with finding compatible blood
Group and Save
Determine ABO group: cells and serum

Determine Rh D status, using two different reagents

Screen serum for presence of preformed antibodies to any blood

group
 Importance of ABO system
ABO compatibility between donor cell and patient
serum is the essential foundation of pre-transfusion
testing
It is the only system with expected antibodies
Whether they are IgG or IgM, ABO antibodies can
activate complement readily
This means that incompatibilities can cause life threatening
situations (transfusion reactions)
 ABO and H Antigen Genetics
Genes at three separate loci control the occurrence and location of
ABO antigens.
The presence or absence of the A, B, and H antigens is controlled
by the H and ABO genes.
The presence or absence of the ABH antigens on the red blood cell
membrane is controlled by the H gene.
The presence or absence of the ABH antigens in secretions is
indirectly controlled by the Se gene.
H Antigen
The H gene codes for an enzyme that adds the sugar fucose to the
terminal sugar of a precursor substance (PS)
The precursor substance (proteins and lipids) is formed on an
oligosaccharide chain (the basic structure)
 Type I and Type II Precursors
There are two potential precursors substances for ABH antigens
Type I and Type II

Both are comprised of identical sugars but the linkage of the

terminal sugars differs in the two types

Type I precursor has a terminal galactose linked to a subterminal

N-acetylgluosamine in a 1-3 linkage. These same sugars
combine in a 1-4 linkage in type II precursor.

ABH Ags on red cells are derived from Type II chains whereas
the ABH Ags in plasma are made from both types I & II
precursors
 RBC Precursor Structure

RBC

Glucose

Galactose
Precursor
Substance
(stays the N acetylglucosamine
same)
Galactose
 Formation of the H antigen

RBC

Glucose

H antigen Galactose

N-acetylglucosamine

Galactose

Fucose
 H antigen
The H antigen is the foundation upon which A and B
antigens are built.
A and B genes code for enzymes that add a sugar to the
H antigen
A and B Antigen
The A gene codes for an enzyme (transferase) that adds
N-acetylgalactosamine to the terminal sugar of the H
antigen 1-3 N-acetylgalactosaminyltransferase

The B gene codes for an enzyme that adds D-

galactose to the terminal sugar of the H antigen 1-3 D-
galactosyltransferase.
Formation of the A antigen

RBC

Glucose

Galactose

N-acetylglucosamine

Galactose

N-acetylgalactosamine
Fucose
Formation of the B antigen

RBC

Glucose

Galactose

N-acetylglucosamine

Galactose

Galactose
Fucose
 Genetics
The H antigen is found on the RBC when you have the Hh or
HH genotype, but NOT from the hh genotype
The A antigen is found on the RBC when you have the Hh, HH,
and A/A, A/O, or A/B genotypes
The B antigen is found on the RBC when you have the Hh, HH,
and B/B, B/O, or A/B genotypes.

The O allele
Why do Group O individuals have more H antigen than
the other groups?
The O gene is a silent allele. It does not alter the structure of
the H substance.that means more H antigen sites.
 A A

Group O Group A
A A

Group O Group A

Fewer A
Many H
H antigen
antigen sites
sites

Most of the H antigen sites in a

Group A individual have been
converted to the A antigen
 Other ABO conditions
Bombay Phenotype (Oh)
Inheritance of hh
The h gene is an amorph and results in little or no
production of L-fucosyltransferase
Very rare
 Bombay
The hh causes NO H antigen to be produced
Results in RBCs with no H, A, or B antigen (patient types as O)
Bombay RBCs are NOT agglutinated with anti-A, anti-B, or anti-
H (no antigens present)
Bombay serum has strong anti-A, anti-B and anti-H, agglutinating
ALL ABO blood groups
What blood ABO blood group would you use to transfuse this
patient??
Another Bombay
Group O RBCs cannot be given because they still have the H
antigen
You have to transfuse the patient with blood that contains NO
H antigen
ABO Antibodies
 ABO antibodies

RBC Phenotype Frequency (%) Serum Ab

A 43 Anti-B

B 9 Anti-A

AB 4 --------

O 44 Anti-A,B
 ABO antibody facts
Complement can be activated with ABO antibodies (mostly IgM,
some IgG)
High titer: react strongly (4+)

Anti-A, Anti-B, Anti-A,B

Clinically Significant Abs class
Yes IgM, less IgG
Thermal range HDNB
4 - 37 Yes
Transfusion Reactions
Extravascular Intravascular
Yes Yes
The Rhesus (Rh) Blood Group system
Rh Genetics: The genes that control the system are
autosomal codominant located on the short arm of
chromosome 1.

D antigen 85% Rh Positive

d antigen 15%
C antigen 70% Rh Negative
c antigen 80%
E antigen 30%
e antigen 98%

The presence or absence of D Ag determines if the person is

Rh+ or Rh-
 Rh Deleted : Red cells that express no Ags at the C &
E loci (D)
Number of D Ags greatly increase
Anti-D IgG Abs can agglutinate these cells

RH null: individual that appears to have no Rh

antigens ( -, -, -)
Must use autologous blood products
No D, C, c, E, e antigens present on the RBC membrane
 Rh antibodies
Rh Abs
Clinically Significant Abs class
Yes IgG
Thermal range HDNB
4 - 37 Yes

Transfusion Reactions
Extravascular Intravascular

Yes No
 Hemolytic disease of the Newborn (HDN)

Usually related to D antigen exposure and the

formation of anti-D
Usually results from D negative female and D
positive male producing and offspring.
The baby will probably be D positive.

1st pregnancy not effected, the 2nd pregnancy and

on will be effected-results in still birth, severe
jaundice, anemia related to HDN.
To prevent this occurrence the female is
administered RH-IG.
 Rh factor
First pregnancy

Rh factor can cause Placenta

complications in some
pregnancies.
Rh+ antigens

Mother is exposed to Rh
antigens at the birth of
her Rh+ baby.
 Mother makes anti-Rh+ Possible
antibodies. Anti-Rh+ subsequent
antibodies pregnancies

During the mothers next

pregnancy, Rh
antibodies can cross the
placenta and endanger
the fetus.
 Weak D Phenotype
Most D positive RbCs react macroscopically with Reagent anti-
D at immediate spin
These patients are referred to as Rh positive

Reacting from 1+ to 3+ or greater

HOWEVER, some D-positive rbcs DO NOT react (do NOT

agglutinate) at Immediate Spin using Reagent Anti-D.
These require further testing (37oC and/or AHG) to determine the
D status of the patient.
 Cross-matching involves mixing a sample of the
recipient's serum with a sample of the donor's red blood
cells and checking if the mixture agglutinates ,or forms
clumps.

If agglutination is not obvious by direct vision, blood

bank technicians usually check for agglutination with a
microscope .If agglutination occurs, that particular
donor's blood cannot be transfused to that particular
recipient .
 Blood group test
Sample is fresh blood or EDTA blood (anticoagulant)
Put 10 of anti A on one side of a slide and put 10 of anti B
on the other side
Put 10 of blood tested in each side and mix the blood with
the reagent added.
results:
+A & + B = AB
+A & - B = A
-A&+B=B
-A & - B = O
Multiple Alleles and Blood
Genetics
Multiple alleles

Homologous chromosomes
Chromosomes occur in
pairs. (homologous mean
same)

The different alleles of a

gene occupy the same
positions on each
chromosome
Blood Genetics
The human ABO gene is on chromosome 9.

Everyone has two copies of chromosome 9 so you have

two ABO genes.

One copy is inherited from our mother, the other from

our father.
Alleles
There are three versions (called alleles) of this blood
type gene: A, B, and O.

A persons blood type is determined by which allele

he/she inherits from each parent.
Pheno vs. Geno
The genetic makeup of an organism is called the genotype.

The phenotype is the visible properties of an organism.

In this case, the A, B, and O allele combination a person has is their

genotype

Their blood type is their phenotype.

Dominant vs. Recessive Genes
The A allele is dominant and so is the B allele.

Together though, the A and B alleles are co-dominant.

The O allele is recessive.

Determining the Genotype
Human blood type is controlled by three alleles : IA, IB
and i.
Alleles IA and IB are dominant over i
IA and IB are codominant

Phenotype (blood type) Genotypes

A IA IA or IAi
B IB IB or IBi
AB IA IB
O ii
Blood Types
The alleles we discussed code for blood type.

What they REALLY code for is a specific enzyme.

That enzyme creates specific antigens on your RBC.

Antigens
An antigen is a protein (encoded from the right enzyme) that sits
on the surface of your RBC.
There are 2 different blood antigens, A and B.
If you have the A antigen, you have type A blood.
If you have the B antigen, you have type B blood.
Antibodies
Blood plasma is packed with proteins called antibodies.
The body produces a wide variety of antibodies that will recognize
and attack foreign molecules.
A persons plasma does not contain any antibodies that will bind to
molecules that are part of his or her own body.
ABO Blood Grouping System
Blood group A
If you belong to the blood
group A, you have A antigens
on the surface of your RBCs
and B antibodies in your
blood plasma.

Blood group B
If you belong to the blood
group B, you have B antigens
on the surface of your RBCs
and A antibodies in your
blood plasma.
Blood group AB
If you belong to the blood group
AB, you have both A and B
antigens on the surface of your
RBCs and no A or B antibodies at
all in your blood plasma.

Blood group O
If you belong to the blood group
O (null), you have neither A or
B antigens on the surface of
your RBCs but you have both A
and B antibodies in your blood
plasma.
Blood Transfusions
It is important to carefully match the donor and recipient blood types.
If the donors blood cells have antigen that are different from those
of the recipient, antibodies in the recipients blood recognize the
donor blood as foreign.
This triggers an immune response resulting in blood clotting or
agglutination.
http://duongchan.files.wordpress.com/2007/05/abobloodsystem.jpg
Blood types and transfusions
People who are Type A blood produce antibodies to
agglutinate cells which carry Type B antigens. They
recognise them as non-self
The opposite is true for people who are Type B
Neither of these people will agglutinate blood cells
which are Type O as they do not carry any antigens
for the ABO system. Type O cells pass incognito
Donor-recipient compatibility
Recipient
Type A B AB O
A
Donor B
AB
O

Note:
Type O blood may be transfused into all the
= Agglutination
other types = the universal donor.
= Safe transfusion Type AB blood can receive blood from all the
other blood types = the universal receivers.
 Donor-recipient compatibility

Blood group O is called

"universal donor"
because it has no
antigens on RBC.

Blood group AB are

called "universal
receivers because it
has no anti- bodies in
the plasma.
 Problem 1: Multiple Alleles
Show the cross between a mother who has type O
blood and a father who has type AB blood.

i i
GENOTYPES:
- IAi (2) IBi (2) IA IAi IAi
- ratio 1:1
PHENOTYPES:
IB IBi IBi
- type A blood (2); type B
blood(2)
- ratio 1:1
 Problem 2: Multiple Alleles
Show the cross between a mother who is heterozygous
for type B blood and a father who is heterozygous for
type A blood.

GENOTYPES: IA i
-IAIB (1); IBi (1);
IAi (1); ii (1) IB IAIB IBi
- ratio 1:1:1:1
PHENOTYPES:
-type AB (1); type B (1) i IAi ii
type A (1); type O (1)
- ratio 1:1:1:1
Relative Abundance of Blood Types

A B AB O

40-42% 10-12% 3-5% 43-45%

 Rhesus Factor

The Rhesus factor gets its name

from experiments conducted in
1937 by scientists Karl
Landsteiner and Alexander S.
Weiner.

Involved Rabbits which when

injected with the Rhesus
monkeys red blood cells,
produced an antigen present in
the red blood cells of many
humans
Rhesus Factor (Rh)
If a person has a positive Rh factor, this means that their blood
contains a protein that is also found in Rhesus monkeys.
Most people (about 85%) have a positive Rh factor
Rh is expressed as either positive or negative.
The Rh factor, like other antigens, is found on the surface of the red
blood cells.
 Rhesus Factor

Positive (+) allele is dominant to negative (-)

allele
Rh +: you have the protein Rh-: you dont

Mother Father Child

Rh- Rh+ Rh+

Rh- Rh- Rh-

Rhesus Factor

If a person has either

two (+) genes for Rh or
one (+) and one (-) Rh
gene, they will test
Rh(+).

A person will be
negative only if they
have 2 (-).
 Rhesus Factor
One of the basic difference between ABO and Rh
systems is that the Rh antibodies are not natural i.e.
they are not present at birth but are synthesised in
Rh negative persons in response to the presence of
Rh-antigen.
Rh antigens are transmembrane proteins with loops
exposed at the surface of red blood cells.
They appear to be used for the transport of carbon
dioxide and/or ammonia across the plasma
membrane.
 Rh Blood Group and Rh
Incompatibility
A person with Rh- blood does not have Rh
antibodies naturally in the blood plasma

Blood Alleles
Genotype
Type Produced

RR R
Rh positive
Rr R or r

Rh negative rr r
 A person with Rh- blood develop Rh
antibodies in the blood plasma if he or she
receives blood from a person with Rh+
blood. If such a person is given Rh+ blood,
its anti-Rh antibodies react with the donors
Rh antigens and aggulate the blood.

A person with Rh+ blood can receive blood

from a person with Rh- blood without any
problems.
 Why is an Rh incompatibility so dangerous
when ABO incompatibility is not during
pregnancy?

Incompatibility is seen between Rh- woman and her

foetus. Rh- woman when married to Rh+ man bears
Rh+ foetus. Although the foetal and maternal blood do
not come in direct contact due to placental barrier,
some foetal R.B.Cs manage to enter the maternal
blood stream. The Rh antigen on their surface induces
formation of anti-Rh antibodies. These antibodies then
cross the placenta and enter the foetus blood
circulation and cause a blood disorder known as
erythroblastosis foetalis. The reaction of Rh-woman
against her Rh+offspring becomes progressively more
severe with each subsequent pregnancy.
The Rh Issue Mom = Rh- Baby #1 = Rh+
Relevance of Rh Factor & ABO Typing?

It is very important in terms of babies

Example: An Rh(-) mother has a Rh (+) baby, she will
make antibody against the Rh(+) fetus
 Rh Blood Group and Rh
Incompatibility
P1 : Female Rh- Male Rh+
Baby is Rh+ because father is. Mothers
blood produces antibodies upon birth, (since
blood mixes at birth). First baby is okay.
Second pregnancy- moms antibodies can
now move across the placenta and cause
babys RBCs to clump (agglutinate) if second
baby is also Rh+. This decreases oxygen
delivery in the baby blue baby.
 What can be done?

Mom can be given an injection of a drug that

inhibits antibody production immediately after
delivery.

What happens if this is undetected?

Baby could be given a blood transfusion while
in the womb. Fairly uncommon.
Blood Types & Rhesus Factor Question

R dominant allele (Rh+)

r recessive allele (Rh-)
Example: A woman homozygous for blood type A
and heterozygous for the rhesus allele, Rh+, has a
child with a man with type O blood who is Rh-.
What is the probability that their child will have
blood type A, Rh+?

There will be a 50% chance.

Stats
O+ 1 in 3 persons
O- 1 in 15 persons
A+ 1 in 3 persons
A- 1 in 16 persons
B+ 1 in 12 persons
B- 1 in 67 persons
AB+ 1 in 29 persons
AB- 1 in 167 persons