IMMUNOHAEMATOLOGY

P R E PA R E D B Y
D I V YA T K
DEPT OF MICROBIOLOGY
E D U C A R E D E N TA L C O L L E G E
 IMMUNOHAEMATOLOGY

 Immunohaematology is one of the specialized branches of

medical science which deals with the concepts and clinical
techniques related to modern transfusion therapy.

 Among the 33 recognized blood group systems, the ABO system

is the oldest system to be discovered (Landsteiner, 1900).

 The other blood group systems include Rh, MN, P, Lutheran,

Lewis, Kell, Duffy, Kidd, Diego, Yt, Kg, Dombrock and Colton.
 ABO BLOOD GROUP SYSTEM

 In the 1900, a German Scientist Karl Landsteiner established

the existence of the first known blood group system, the ABO
system.

 Classification of the blood group was based on his observation of

the agglutination reaction between an antigen on
erythrocytes and antibodies present in the serum of
individuals directed against these antigens.

 Where no agglutination had occurred, either the antigen or the

antibody was missing from the mixture.
Landsteiner recognized the presence of two separate
antigens, the A & B antigens.

The antibody that reacted with the A antigens was

known as anti A, and the antibody that reacted with the
B antigen was known as anti B.

Based on the antigen present on the red cells, he

proposed three separate groups A, B & O.
Shortly hereafter, von Decastello and Sturli identified a
fourth blood group AB, by demonstrating agglutination
of individuals red cells with both anti-A and anti B.
 depends on the antigen present
on the red cells

 Individuals who express the  Individuals who lack both the

A antigen on their red cell i.e. A and B antigen on their red

cells that is their red cell show
their red cells agglutinate
no agglutination either with
with anti - A belong to
anti- A or anti- B belong to
group A. – group O.

 Individuals who express the  Individuals who express both

B antigen on their red cells A and B antigens on their red
i.e. their red cells agglutinate cells that is their red cells
with anti-B belong to group show agglutination with
B. - both anti- A and anti –B
belong to group AB.
Natural Isoantibodies
Anti-A and anti-B isoantibodies are called natural
antibodies because they are seen to arise without any
apparent antigenic stimulation.
They are IgM in nature (pentameric), produced by the
age of 6 months and persist thereafter.
ABO SYSTEM IN OTHER ANIMALS
 ABO blood types are also present in some other
animals, for example rodents and apes, such as
chimpanzees, and gorillas.

DISTRIBUTION OF BLOOD GROUPS IN INDIA

A recent study done in North India had shown that
group B is the commonest (35%), follow by group O
(30%), A (21%) and AB (14%).
Previous south Indian studies had shown blood group
O to be the most common.
OTHER BLOOD GROUPS
 RH BLOOD GROUP SYSTEM

Rh blood group is the most important blood group system

in humans after ABO system.
 It was so named because the antibody against this Rh
blood group antigen was first prepared in Rhesus
monkey by Landsteiner and Wiener.
Rh blood group system consists of 50 defined blood-
group antigens, among which the five antigens D, C, c,
E, and e are the most important.
The commonly used terms Rh factor, refer to the D
antigen only.
Rh positive and Rh negative denote presence or absence
of Rh antigen on the surface of RBCs.
Unlike ABO system, there are no natural Rh antibodies in
our blood.
In India, about 95% of individuals have Rh positive
blood group; the remainder (5%) are Rh negative.
Rh blood group system has two important clinical
applications-
(1) its role in blood transfusion,
(2) its role in causing hemolytic disease of the newborn
(or Erythroblastosis fetalis).
 Erythroblastosis Fetalis

 When the mother is Rh-negative and the father is Rh positive, the

fetus can inherit the Rh factor from the father. This makes the
fetus Rh-positive.
 During delivery, the Rh positive blood may be passed into
maternal circulation.
 The mother being Rh-negative, may develop antibodies to an Rh-
positive fetal RBCs.
 However, as anti-Rh antibodies are produced only after exposure
to Rh antigen (from Rh-positive fetus to Rh-negative mother or
mismatched transfusion) and take some time to generate anti-Rh
IgG which can cross the placenta; hence, maternal Rh antibodies
fail to lyse fetal RBCs during the first Rh-incompatible
pregnancy.
 During the subsequent pregnancies with a Rh positive fetus, the
Rh antibodies being IgG in nature, can cross the placenta from
mother to fetus and can destroy the fetal RBCs.
 This condition is called hemolytic disease of newborn(HDN) It
can become severe enough to cause serious illness, brain damage,
or even death of the fetus or newborn.
 SAFE BLOOD TRANSFUSION PRACTICES

Safe blood transfusion practices require that the following

conditions are satisfied in choosing a donor:
 The recipient's plasma should not contain any antibodies that will
damage the donor's RBCs.
 The donor plasma should not have any antibodies that will
damage the recipient's RBCs.
 The donor red cells should not have any antigen that is lacking in
the recipient RBCs. If the transfused cells possess a 'foreign
antigen' it will stimulate an immune response in the recipient.
Selection of Blood Group for Blood Transfusion

 Ideally, the donor and recipient should belong to the same

ABO group.
 However in emergency situations. 0 blood group can be used for
transfusion for any other ABO group and individuals with AB
blood group can receive blood unit with any blood group.
 Universal donor: Individuals with 'O' blood group are called as
universal donors because they do not possess either A or B
antigen; hence, they are generally safe
 Universal recipients: Individuals with AB blood group do not
have both A and B antibodies in serum; therefore, they can
receive any other blood group. Hence, they are called as
universal recipients.
 DETECTION OF Rh ANTIBODIES
Most Rh antibodies are IgG in nature and are
incomplete antibodies ; that do not agglutinate Rh
positive cells in saline.

IgG Anti-D antibodies are detected by

1. Using a colloid medium such as 20% bovine serum
albumin.
2. Using red cells treated with enzymes such as trypsin,
pepsin or bromelin .
3. By indirect Coomb’s test.
 ABO HEMOLYTIC DISEASE

Maternofetal incompatibility is very common.

In persons with A or B, natural isoantibodies are IgM in

nature, so they dot cross placenta to harm the fetus.

In persons with O, isoantibodies are IgG in nature.

Hence ABO hemolytic disease is present in O group

mothers bearing A or B group fetuses.
 BLOOD GROUP AND DISEASES
 Red cell suspension are contaminated with certain bacteria,
such as Pseudomonas aeruginosa , become agglutinable by all
blood group sera and even by normal human sera.

 This phenomenon is termed as Thomsen- Freidenreich

Phenomenon,is due to the unmasking of hidden antigens
normally present on all human RBCs called as T-antigens.

 Anti-T agglutinins are normally present in human sera.