In 1901, Karl Landsteiner described three main blood groups: A, B, and C (he later renamed C to O after the German Ohne, meaning without, zero, or null).
A year later, Alfred von Decastello and Adriano Sturli, two colleagues of Landsteiner, identified a fourth blood group – A.B.
Introduction:
A variety of genetically determined antigens, known as agglutinogens or isoantigens, are present on the surfaces of red blood corpuscles. These antigens decide a person’s blood group.
The plasma contains antibodies called agglutinins.
Classification:
Human blood is classified based on the presence or absence of inherited antigens on the surface of red blood cells. The International Society of Blood Transfusion (ISBT) reported 41 human blood group systems, out of which the two most common blood groups are the ABO system and the Rh system. Others are M.N. systems: Lutheran, Kell system, and many others.
The well-known systems are the ABO system and the Rh system. In the ABO system, blood is categorized into four main types: A, B, AB, and O.
According to the Rh factor system, blood is either Rh-positive or Rh-negative. These two systems define eight main blood types: A+, A-,B+, B-, AB+,AB-,O+, and O-.
Table to show blood groups
Blood group | Antigen of ABO system | Rh factor |
A+ | A | + |
A- | A | – |
B+ | B | + |
B- | B | – |
AB+ | AB | + |
AB- | AB | – |
O+ | O | + |
O- | O | – |
Agglutinogens, isoantigens, or antigens A, B, and O are group-specific substances present on the membranes of human RBCs. They are found on the surface of other cells like the pancreas, liver, and lungs. Antigens on red blood cells are glycolipids, and those on other tissues and body fluids are soluble glycoproteins.
Chemically A, B, are complex oligosaccharides with the glycoprotein and glycolipids. A and B are water-soluble; therefore, they appear in the body secretions, for example, saliva, semen, tears, urine, etc.
Secretors” and “Non-secretors”:
Agglutinogen A and B are present on the membrane of the RBC and also on other body cells, for example, liver, kidney, and body fluids such as saliva, semen, pancreatic juice, etc.
Secretors have high concentrations of these agglutinogens in their body fluids.
Non-secretors have low concentrations of these agglutinogens in their body fluids.
When does the blood group system appear?
The ABO system first appears in the 6th week of intrauterine life. At birth, its concentration is 1/5th of adult life. The ABO system develops appropriately during the first year of life and rises during puberty in children.
In the ABO system of blood group, agglutinogens are of two types, A and B . Blood groups in the ABO system are of four types: A, B, AB, and O. The O group is the most common 46%, followed by A 42%, B 9%, and A.B. is only 3%.
The ABO system is described along with the Rh- system. Depending on the presence or absence of agglutinogens, humans are grouped into different blood groups: A positive, A negative, B positive, B negative, A.B. positive, A.B. negative, O positive, and O negative. According to the Rh system, blood may be Rh-positive or Rh-negative. 85% population is Rh-positive, but it varies. Blacks in Africa are 100% Rh-positive.
Several Rh antigens and antibodies exist in humans, but D and Anti-D are prevalent. For antigen D, a gene is known as D. When it is present, the person is Rh-positive. On the other hand, when D is absent from the chromosomes, its position is occupied by d, an allelomorph of D, then the person is Rh-negative.
Blood types are inherited from both parents. The blood group is determined by two genes that come from each parent. Antigens are genetically determined. Three genes, A, B, and O, produce the group-specific antigens A.B. and O. The genes A and B are easily demonstrated, but O is hard to establish. Therefore, it is said O does not have a corresponding gene.
Antigen O is recessive, which means if a person receives A from one parent and O from others, his blood group will be A. If he gets O from both, his blood group will be O. It can be like this
If a person receives
gene A+A or A+O B+B or B+O A+ B O+O
His genotype is AA/AO BB/BO AB OO
His blood group is A B, AB, O
If a person’s blood group is A, his genotype may be A.A. (homozygous) or A.O. (heterozygous). Likewise, if a person’s blood group is B, his genotype may be B B (homozygous) or B.O. (heterozygous).
If a person receives from his parents a D.D. Dd dd
His genotype D& D D&d d & d
His Rh status Rh-positive, Rh-positive, Rh-negative
homozygous, heterozygous, homozygous
Usually, antigen D and anti D both are absent in Rh-negative persons. However, anti-D may be formed in some conditions in Rh-negative persons. For example, it is created in an Rh-negative mother if the fetus is Rh-positive and his blood, as little as 0.5ml, gets mixed with her blood, or Rh-positive blood is given to an Rh-negative person. As a result, agglutinins or antibodies are present in the plasma. They are also known as isohaemaglutinins.
Types of agglutinins:
Agglutinin: anti-A or α —This will react with the antigen A,
Agglutinin: anti-B or β –This will react with the antigen B and
Usually, agglutinin,anti-O, is not present. Rarely, anti-O is formed after repeated blood transfusions of blood group O.
Agglutinins present in some newborns are of maternal origin. Their agglutinin appears in 10 days, rises slowly to a peak in 10 years, and then declines.
Distibution of agglutinins
in blood group:
Blood group Agglutinogen or antigen Agglutinins or antibody
A A β
B B α
AB AB —
O —- αβ
Agglutination:
In this process, the agglutinogen of the red blood cells reacts with its specific agglutinin, destroying red blood cells.
Agglutination occurs when agglutinin Anti A is mixed with A, red blood cells. Agglutinogen O, as well as agglutinin O, are not present in the blood. For proper agglutination, the concentration of agglutinogen and agglutinin must be equal. If the difference is significant, agglutination may be doubtful. This is a “zone” phenomenon.
Gradation of agglutination:
1+ Many small aggregates with some free red blood cells.
2+ Medium size agglutinates, no free red blood cells.
3+ Several large agglutinates.
4+ A single large agglutinate.
Mechanism of agglutination
Agglutination is a reaction between agglutinogen and agglutinin. It occurs in two stages: sensitization and agglutination proper.
Sensitization – agglutinin binds with agglutinogen.
Agglutination proper-sensitized red blood cells form clumps, and hemolysis occurs. In addition, the agglutinogen and agglutinin reaction activates the complement system that releases proteolytic enzymes, which aids in hemolysis.
Serum typing:
A person’s Serum is tested against red blood cells containing known antigens.
The Serum is tested with
RBC of blood/ RBC of blood/ RBC of blood/ RBC of blood / Blood group Of/ Antibody in
group A group B group A.B. group O person whose serum
serum is tested
—————————————————————————————————————-
+ + + – O Anti-A,Anti-B
– – – – AB no antibody
+ – + – B Anti-A
– + + – A Anti-B
In leukemias, in which RBC antigens may become very weak, serum typing is performed with blood grouping or blood typing.
In some infections, especially Pseudomonas infection, the RBC may agglutinate by all agglutinins. This agglutination is due to the unmasking of hidden antigens.
Serum typing is also known as “reverse blood typing” or “backward blood typing.”
Landsteiner’s law :
If an agglutinogen is present in RBC, the corresponding agglutinin must be absent from the plasma. Conversely, the corresponding agglutinin must be present if the agglutinogen is missing.
1st part is a logical outcome. The 2nd part is valid only for the classical blood group-ABO system. In some blood group systems, agglutinogen and agglutinin are both absent. For example, Rh agglutinogen and Anti-Rh agglutinin are both absent.
Why is blood grouping done?
1. For blood transfusion.
2. To detect Rh-compatibility.
3. For medicolegal purposes.