ABO Blood grouping system and Rhesus blood group system : Physiology

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ABO AND RH BLOOD GROUPS
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• ABO and Rh groups are of particular clinical significance because they are most prevalent and most likely to be involved
• in detrimental transfusion reactions.

ABO Blood Groups
• Comprises A and B antigens, which are oligosaccharide molecules produced on the surfaces of red blood cells (aka,
• erythrocytes).
• These antigens are genetically determined by the alleles A, B, and O.
• A and B are codominant, and O is recessive; so, from 6 possible genotypes, we get 4 phenotypic blood types.

Antibodies
• A unique feature of the ABO blood group is that individuals produce antibodies against antigens absent in their blood.
• These antibodies attack the red blood cells displaying the corresponding antigens, causing agglutination and hemolysis.

Type A blood
• Blood type A is characterized by red blood cells with the A antigen on their surfaces
• Anti-B antibodies, aka, agglutinins, circulate in the plasma
• Addition of Type B blood/B antigens will cause agglutination.

Type B blood
• Blood type B is characterized by B antigens on the surfaces of red blood cells
• Anti-A antibodies circulate in the plasma
• Addition of Type A blood/A antigens will cause agglutination.

Type AB blood
• Type AB blood cells have both A and B antigens on their surfaces
• Neither anti-A nor anti-B antibodies circulate in the plasma, which makes sense: Anti -A or Anti-B
antibodies would attack a person's own red blood cells.
• Addition of A or B antigens does not cause agglutination.

Type O blood
• Type O has neither A nor B antigens on its red blood cells
• Both anti-A and anti-B antibodies circulate in the plasma.
• Addition of A or B antigens causes agglutination.

Rh Blood Group
• There are several Rh antigens, but the D antigen is most prevalent and most cross-reactive; thus, it is most clinically
• relevant.
• D antigen is either present on the surface of red blood cells or not
• It is coded for by two alleles: D and d.
• Unlike the ABO blood types, antibodies against the D antigen are not pre-produced in Rh-negative individuals.
• Rh-negative individuals produce anti-Rh antibodies in response to exposure to D antigens.
• Thus, if Rh+ blood is added to Rh- blood that happens to have anti-Rh+ antibodies, agglutination will occur.

Clinical Correlations:
• Blood transfusion recipients and donors must be matched to avoid agglutination.
• When an Rh-negative woman gives birth to an Rh-positive infant; invariably, there will be some mixture of maternal and fetal blood. Consequently, the mother's body will produce anti-Rh antibodies, which will have negligible, if any, immediate effects. But, the circulating anti-Rh antibodies will attack the red blood cells of any subsequent Rh-positive fetus. Preventative assessment of maternal Rh status and immunization protects against this reaction.


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