BLOOD GROUPS

LEARNING OUTCOMES
• Give the physiological basis of classification of blood groups.
• List the agglutinogens and agglutinins of various blood groups.
• Describe the pattern of inheritance of the A, B and Rhesus
antigens.
• State ‘Landsteiner’s law’.
• Explain why O, Rhblood group is a universal donor, and AB, Rh+
blood group is a universal recipient. Cross matching and its
importance.
• Describe the pathogenesis of hemolytic disease of the newborn
(erythroblastosis foetalis). Give the physiologic basis of the
strategy used to prevent hemolytic disease of the newborn.
 Blood Group Systems
• ABO system
• Rh system

• M,N system
• Kell system
• Lewis system
 ABO system
• Depends on the presence or absence of blood
group antigens (agglutinogens ) a and b on the
surface of red cells.
BLOOD ANTIGEN
GROUP
A a antigen
B b antigen
AB both a and b
O none
 AGGLUTININS
• Antibodies against agglutinogens called
agglutinins
• Present in plasma
Agglutinin α acts against antigen a
Agglitinin β acts against antigen b
 LANDSTEINERS LAW
1. If an agglutinogen/s is present on the red cells
of an individual , the corresponding agglutinin/s
must be absent in the plasma
2. If an agglutinogen/s is absent on the red cells,
the corresponding agglutinin/s must be present
in the plasma
Inheritance of Blood Groups
Gene from Blood group Genotype
each parent

A+A or A AA/AO
A+O
B+B or B+O B BB/BO

A+B AB AB

O+O O OO
 Rh SYSTEM OF BLOOD GROUPS
• Red cells of about 90 % humans contain Rh antigen
(Rh positive)

• 10 % do not have Rh antigen(Rh negative )

• Three types of Rh antigens C,D and E commonest is
D antigen
• Rh antibodies not naturally present. (Rh system does
not follow Landsteiner law)
 Genetic transmission of Rh factor
• Rh+ve individual may have DD or Dd genotype
• Rh-ve individual has dd genotype
• If the father is Rh+ve (Dd genotype) and
mother Rh-ve ,only half of the children are
likely to be Rh+ve.
• If father has DD genotype, all the children are
Rh+ve
How do Rh antibodies appear in blood?

• If a Rh-ve individual receives a Rh+ve blood

• Rh-ve mother carries a Rh+ve fetus / gives birth
to a Rh+ve baby (i.e. father is Rh+ve)
 SENSITIZATION
• Rh–ve mother becomes sensitized when Rh+
blood causes her body to synthesize anti Rh
antibodies
Hemolytic Disease of the Newborn
• If father is Rh+ve and mother Rh-ve, carrying Rh+ve fetus

• During first pregnancy specially during delivery , separation of

placenta, some Rh + fetal blood enters maternal circulation. Mother’s
tissues develop Rh antibodies (IgG type).

• During second pregnancy, Rh+ antibodies of a sensitized Rh–ve mother

cross the placenta and attack and destroy the RBCs of an Rh+ baby

• ERYTHROBLASTISIS FETALIS
• Severe anemia and jaundice
• Hydrops fetalis
• Fetal death in utero or
• The baby dies soon after birth or
• Newborn baby has severe anemia and
jaundice
• Fetal peripheral blood shows erythroblasts
• Kernicterus develops
Bilirubin deposited in basal ganglia leading to
permanent brain damage
• Treatment: Exchange blood transfusion with
ABO compatible Rh– blood
Prevention is more important
• After first delivery inject Rh antibodies ( anti D
injections) to the mother. It destroys Rh + fetal
cells before they get implanted in the
maternal immunological competent tissues