Department of

Physiology
BRD Medical College,
Gorakhpur

Blood Group and its

clinical
Presented importance
Anshu Pate

Presented by:-
Anshika
Maurya (31)
Anshu Patel
 Introduction

Blood Grouping System

Landsteiner Law
Content Classical ABO Blood
Grouping System

Rhesus Blood Grouping

System
Clinical
Importance
 Introduction
The membrane of human RBCs
contains a variety of blood group
specific antigens, also called
agglutinogens. More than 30 such
antigens are known but a few of them
are of practical significance. These
antigens enable the blood group of
different individuals to be
differentiated.

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3.0

The chief blood groups are:-

I. Classical 'ABO ' blood group.

II. Rhesus (Rh) blood group.
III. M and N blood group.
CLASSICAL 'ABO' BLOOD GROUPS :-

The four main blood types in the ABO system are:-

Type A: Individuals with type A blood have A antigens on the surface of their red blood cells and
anti-B antibodies in their plasma.

Type B: Individuals with type B blood have B antigens on the surface of their red blood cells and
anti-A antibodies in their plasma.

Type AB: Individuals with type AB blood have both A and B antigens on the surface of their red
blood cells and no anti-A or anti-B antibodies in their plasma. AB is considered the universal
recipient because they can receive blood from individuals with A, B, or O blood types.
5
• Type O: Type O is considered the universal donor
because individuals with type O blood can donate
to individuals with any blood type.

• The inheritance of ABO blood types is determined

by the combination of genes received from both
parents. The ABO gene has three main alleles: A,
B, and O. The possible combinations of these
alleles determine an individual's ABO blood type.

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 Landsteiner's Law:

• If an agglutinogen is present in the RBCs of an individual , the corresponding

agglutinin must be absent from the plasma.

• If the agglutinogen is absent in the individual RBCs, the corresponding

agglutinin must be present in the plasma.

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DETERMINATION OF CLASSICAL BLOOD GROUPS:

These can be determined by

mixing a drop of isotonic saline
suspension of subject's RBCs with
a drop of serum A and serum B
separately on a glass slide; and
seeing whether agglutination
occurs or not.
 INHERITANCE OF CLASSICAL 'ABO'
BLOOD GROUPS

• The Agglutinogen A and B are inherited as Mendelian dominant and first appear in the sixth week of
foetal life.

• Their concentration at birth is 1 /5 th the adult level and it progressively rises during puberty and
adolescence.

• Group specific substances A and B are not limited to the RBCs but are also found in many organs like
salivary g lands and pancreas(++); kidney, urine, liver and lungs (+); testes, semen and amniotic
fluid.

• The specific agglutinins are present in the plasma and appear at 10th day, rise to peak at 10 years; and
then decline.

• The 4 classical ABO blood groups depend on 3 genes,named after the corresponding factor A, B and
0. Each person's blood group is determined by the two genes which he receives from each parent.
Fig: Inheritance of blood
groups.
 RHESUS (Rh) BLOOD GROUPING

• Discovered by Landsteiner and Weiner in 1940.

• RBCs of Rhesus monkeys (monkeys with red ischial callosity) when injected into rabbits, the
rabbits respond to the presence of an antigen in these cells by forming an antibody which
agglutinates Rhesus RBC.

• If the immunized rabbit 's serum is tested against human RBCs, agglutination occurs in 85%
of people , these are called Rh '+' (positive) and their serum contains no Rh antibody.No
agglutination occurs in 15%, these are called Rh '-’ (negative) and their se rum also contains
no Rh antibody.
• The Rh blood group system has not been detected in tissues other than RBCs.
• The Rh antigen is called 'D', and its antibody is called anti-
D.

• In Rh system, Rh antibodies are of the IgG type and

antigen-antibody reaction occurs best at the body
temperature. Therefore, the Rh antibodies are called wann
antibodies.

• These antibodies being IgG type can cross the placenta.

• Blood group antigens are the results of the action of genes • If the gametes carry D and d respectively the result is
which are present in the chromosomes. Dd.
• If both gametes carry d the result is dd.
• The gene corresponding to the antigen D is also called D;
when D is absent from a chromosome, its place is occupied • DD (homozygous) and Dd (heterozygous) are both Rh
by the alternate form (Allelomorplt) called 'd’. positive; dd (homozygous) is Rh negative. Of 85% Rh
positive 35% are DD, 48% Dd and 2% have some
• The Rh gene is inherited from both the father and the othergenotype containing D.
mother
• If gene D is carried by both sperm and ovum the resulting
gene composition (genotype) of the offspring is DD.
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• The production of anti-D antibodies in these Rh negative individuals may be evoked
by:-

1. transfusion with Rh positive blood i.e. D-positive RBCs (0.5 mL may be sufficient).

2. entrance of D-positive RBCs from Rh positive foetus in to the maternal circulation

of Rh negative mother.
 HEMOLYTIC DISEASE OF
NEWBORN (ERYTHROBLASTOSIS FETALIS)
• Hemolytic disease is the disease in fetus and newborn, characterized by abnormal hemolysis of
RBCs.
• It is due to Rh incompatibility, i.e. the difference between the Rh blood group of the mother and
baby. Hemolytic disease leads to erythroblastosis fetalis.

• Erythroblastosis fetalis is a disorder in fetus, characterized by the presence of erythroblasts in

blood.

• When a mother is Rh negative and fetus is Rh positive (the Rh factor being inherited from the
father), usually the first child escapes the complications of Rh incompatibility.

• This is because the Rh antigen cannot pass from fetal blood into the mother’s blood through the
placental barrier.
• At the time of parturition (delivery of the child), the Rh antigen from fetal blood may
leak into the mother’s blood because of placental detachment.
• During postpartum period, i.e. within a month after delivery, the mother develops Rh
antibody in her blood
• When the mother conceives for the second time and if the fetus happens to be Rh
positive again, the Rh antibody from mother’s blood crosses placental barrier and enters
the fetal blood. Thus, the Rh antigen cannot cross the placental barrier, whereas Rh
antibody can cross it.
• Rh antibody which enters the fetus causes agglutination of fetal RBCs resulting in
hemolysis.
• Severe hemolysis in the fetus causes jaundice.

• To compensate the hemolysis of more and more number of RBCs, there is rapid
production of RBCs, not only from bone marrow, but also from spleen and liver. Now,
many large and immature cells in proerythroblastic stage are released into circulation.
Because of this, the disease is called erythroblastosis fetalis.
Due to excessive hemolysis severe complications develop:

1. Severe anemia
2. Hydrops fetalis
3. Kernicterus.

1. Severe Anemia
Excessive hemolysis results in anemia and the infant dies when anemia becomes
severe.
2. Hydrops Fetalis
Hydrops fetails is a serious condition in fetus, charact- erized by edema. Severe
hemolysis results in the development of edema, enlargement of liver and spleen and
cardiac failure. When this condition becomes more severe, it may lead to intrauterine
death of fetus.
3. Kernicterus
Kernicterus is the form of brain damage in infants caused by severe jaundice. If the
baby survives anemia in erythroblastosis fetalis (see above), then kernicterusdevelops
because of high bilirubin content.
Treatment :-
Exchange blood transfusion soon after birth i.e.
removing small quantities of infant's blood
successively from IVC (by passing a polyethylene
catheter along the umbilical vein) and replacing
an equal volume of compatible Rh negative
blood. Thus, infant Rh positive RBCs prone to
destruction are removed from the circulation.

Prevention:-
Destruction of Rh positive foetal cell in the
maternal blood can be brought about by
administering a single dose of anti-Rh antibodies
in the form of Rh-immunoglobulin soon after
child birth. This prevents active antibodies
formation by the mother.
M AND N BLOOD GROUPS
M and N factors depend on two minor genes. Each person carries two of the gene of the M and N
group i.e. M + M (= M); N + N (= N) or M + N (= MN). These are antigenic to rabbits.

CLINICAL IMPORTANCE OF BLOOD GROUPING

1. In blood transfusion.
2. In pregnancy (Rh incompatibility).
3. Investigating cases of paternity dispute.
4. Medicolegal value.
5. Blood gro up antigens help in cell recognition.
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Thank you