[3] CHAPTER II LESSON 1 Flashcards
[?] must be performed on all donors and patients.
• ABO forward and reverse grouping tests
• Most frequently performed test in the blood bank.
• ABO forward and reverse grouping tests
• Most important of all blood groups in transfusion practice.
• ABO forward and reverse grouping tests
• Naturally occurring antibodies
• ABO forward and reverse grouping tests
• Only blood group system in which individuals have antibodies in their serum to antigens that are absent from their RBCs.
• ABO forward and reverse grouping tests
Type A : [?] (surface) - [?] (plasma)
Type B : [?] (surface) - [?] (plasma)
Type AB : [?] (surface) - [?] (plasma)
Type O : [?] (surface) - [?] (plasma)
Type A : A antigen (surface) - Anti-B (plasma)
Type B : B antigen (surface) - Anti-A (plasma)
Type AB : A and B antigen (surface) - none (plasma)
Type O : none (surface) - Anti-A and Anti-B (plasma)
Universal donor:
-Only true for only packed red cells due to what is in the plasma (to prevent adverse reaction)
-There will be a problem in the whole blood due to the presence of Abs
O
Universal acceptor:
AB
INHERITANCE OF THE ABO BLOOD GROUPS
• First described by [?] in 1924
Bernstein
• The inheritance of ABO genes follows the
Mendelian. genetics.
• ABO is [?] in expression
codominant
• One position or locus, on each chromosome [?] is occupied by an [?].
9
A, B, or O gene
• The O gene is considered an [?] (even if present, it is detectable)
amorph
• The group O phenotype is an [?] with the inheritance of 2 0 genes.
autosomal recessive trait
• The designations group [?] refer to phenotypes, whereas [?] denote genotypes.
A and B
AA, BO, and OO
Phenotypes:
Genotypes:
Blood type A, Blood type B
AA, BO, OO
Discovered the first human blood group system ABO
Karl Landsteiner
He was inadvertently the first individual to perform forward and reverse grouping
Karl Landsteiner
In a series of experiments designed to show serologic incompatibilities between humans, he recognized different patterns of agglutination when human blood samples were mixed in random pairings.
Karl Landsteiner
He described the blood groups as A, B, and O.
Karl Landsteiner
Several years later, Landsteiner’s associates, [?], added group AB to the original observations.
von Decastello and Sturli
He noted the presence of agglutinating antibodies in the serum of individuals who lacked the corresponding ABO antigen.
Karl Landsteiner
He observed that group A red cells agglutinated with the serum from group B individuals.
Karl Landsteiner
Most frequent cause of death in FY 2015
- TRALI
- HTR (non-ABO)
- HTR (ABO)
- Contamination (Bacterial)
- TACO
- Allergy or Anaphylaxis
- Hypotensive Reaction
[?]remains a cause of death in hemolytic transfusion reaction fatalities reported to the FDA; however, [?] was the most frequent cause of death in FY 2015.
Transfusion of the wrong ABO group
TRALI
The transfusion of ABOincompatible blood to a recipient can result in [?] and other serious consequences of an [?]
intravascular hemolysis
acute hemolytic transfusion reaction
It has been postulated that [?], and other substances present in nature are chemically similar to A and B antigens.
bacteria, pollen particles
Antibody production in most other blood group systems requires the introduction of foreign RBCs by either [?], although some individuals can occasionally have antibodies present that are not related to the introduction of foreign RBCs.
transfusion or pregnancy
Performance of [?] is, therefore, unique to the ABO blood group system.
serum grouping
The frequency of the ABO blood groups differs among [?]
selected populations and ethnic groups
Phenotype O
Whites
Blacks
Hispanic
Asian
Phenotype A
Whites
Blacks
Hispanic
Asian
Phenotype B
Whites
Blacks
Hispanic
Asian
Phenotype AB
Whites
Blacks
Hispanic
Asian
*Hispanic includes
Mexican, Puerto Rican, Cuban, and other Hispanics.
**Asian includes
Chinese, Filipino, Indian, Japanese, Korean, and Vietnamese
A1A1
A1
A1A2
A1
A1O
A1
A2A2
A2
A2O
A2
A1B
A1B
A2B
A2B
OO
O
BB
B
BO
B
Results from the interaction of genes at three separate loci
(ABO, Hh, and Se)
Produces specific [?] that add sugars to a basic precursor substance.
glycosyltransferases
A, B, H antigens are formed from the same basic precursor material
Paragloboside or glycan-
Specific enzyme transferases elicited by an inherited gene attach sugars to the
paragloboside/glycan.
- precursor structure on which A and B antigens are made
H antigen
Inheritance of the H gene results in the formation of the
H antigen.
The precursor substance on erythrocytes is referred to as
type 2.
A type 1 precursor substance refers to a beta 1-3 linkage between
galactose and Nacetylglucosamine
The substance (?) must be formed for the other sugars to be attached in response to an inherited A and/or B gene.
L-fucose
H (FUT1) Glycosyltransferase
α-2-L-fucosyltransferase
H (FUT1) Immunodominant Sugar
L-fucose
H (FUT1) Antigen
H
A Antigen
A
A Glycosyltransferase
α-3-Nacetylgalactosaminyltransferase
A Immunodominant Sugar
N-acetyl-Dgalactosamine
B Glycosyltransferase
α-3-D-galactosyltransferase
B Immunodominant Sugar
D-galactose
B Antigen
B
AB Glycosyltransferase
α-3-Nacetylgalactosaminyltransferase
α-3-D-galactosyltransferase
AB Immunodominant Sugar
N-acetyl-Dgalactosamine
D-galactose
AB Antigen
AB
can also be found in all body secretions.
ABH-soluble antigens
Their presence is dependent on the ABO genes inherited and on the inheritance of another set of genes called [?] that regulate their formation
Sese (secretor genes)
Secretor gene products of alleles at
ABO and Hh loci
If (?) is present, watery secretions contain water soluble subs.
Se gene
are secretors
SeSe or Sese individuals
are nonsecretors
sese individuals
ABH Antigens on RBCs
• RBC antigens can be
glycolipids, glycoproteins, glycosphingolipids.
ABH Antigens on RBCs
• RBC antigens are synthesized only on
type 2 precursor chains
ABH Antigens on RBCs
• Type 2 chain refers to a
beta 14 linkage.
ABH Antigens on RBCs
• The enzyme produced by the [?] acts primarily on type 2 chains, which are prevalent on the RBC membrane.
H (FUT1) gene
A, B and H Soluble Substances
• Secreted substances are
glycoproteins
A, B and H Soluble Substances
• Secreted substances are primarily synthesized on
type 1 precursor chains
A, B and H Soluble Substances
• Type 1 chains refers to a
beta 1-3 linkage.
A, B and H Soluble Substances
• The enzyme produced by the [?] preferentially acts on type 1 chains in secretory tissues.
Se (FUT 2) gene
Discovery of the first human blood group system
Karl Landsteiner
He was the first individual to perform forward and reverse grouping
Karl Landsteiner
: rule stating that normal, healthy individuals possess ABO antibodies to the ABO blood group antigens absent from their red cells.
Landsteiner’s Laws
The (?) on the RBC determines the blood group
antigen
The (?) is never found in the individuals’ serum
corresponding antibody
The (?) is always found on the individuals’ serum
opposite antibody
“naturally occurring”
ABO ANTIBODIES
Predominantly IgM
ABO ANTIBODIES
Activates complement
ABO ANTIBODIES
Reacts at room temperature or colder
ABO ANTIBODIES
Produce strong direct agglutination reactions during ABO testing
ABO ANTIBODIES
ABO antibody production is initiated at birth, but titers are generally too low for detection until infants are (?) old
3 to 6 months
Therefore, most antibodies found in cord blood serum are of (?).
maternal origin
Results of serum ABO testing before (?) of age cannot be considered valid because some or all of the antibodies present may be IgG maternal antibodies that crossed the placenta.
3 to 6 months
As a result, it is logical to perform only (?) on cord blood from newborn infants.
forward grouping
Antibody production peaks when an individual is between (?) and declines later in life.
5 and 10 years of age
ABO antibodies can cause (?) if the wrong ABO group is transfused, potentially resulting in patient death.
rapid intravascular hemolysis
ABO antigens are widely distributed and are located on (?), (?) (adsorbed from plasma), (?) (adsorbed from plasma), most (?) and (?) cells, and organs such as the (?).
red cells
lymphocytes
platelets
epithelial
endothelial
kidneys
ABO antigens are detectable at (?) in utero. A newborn possesses fewer antigen copies per red cell compared with an adult.
5 to 6 weeks
In (?), ABO antigens have fewer numbers and partially developed antigen structures and may demonstrate weaker ABO phenotyping reactions.
cord blood samples
Antigen development occurs slowly until the full expression of adult levels is reached at about (?).
2 to 4 years of age
(?) is unique to the ABO blood group system.
Serum grouping
Persist (?) unaltered.
throughout life
A and B antigens develop from (?).
precursor H substance
It has been postulated that (?), and other substances present in nature are chemically similar to A and B antigens.
bacteria, pollen particles
(?) is unique to the ABO blood group system.
Serum grouping
: seed extracts that agglutinate human cells with some degree of specificity.
Lectins
Genotype Blood Group O
OO
Genotype Blood Group A
AA, AO
Genotype Blood Group B
BB, BO
Genotype Blood Group AB
AB
Antigen Blood Group O
NONE
Antigen Blood Group A
A
Subgroups of A
Dolichos biflorus
Antigen Blood Group B
B
Subgroups of B
Bandeiraea simplicifolia
Antigen Blood Group AB
A, B,
very little
H
Antibodies Blood Group O
anti-A, anti-B,
anti-AB
Antibodies Blood Group A
anti-B
Antibodies Blood Group B
anti-A
Antibodies Blood Group AB
NONE
A fundamental procedure of immunohematologic testing is the determination of the (?).
ABO phenotype
Testing of the (?) for the presence of ABO antigens (or forward grouping)
red cells
An (?) occurs when red cell testing does not agree with the expected serum testing.
ABO discrepancy
Any discrepancy in ABO testing should be resolved before (?) or labeling of donor units.
transfusion of recipients
(?) is the most frequently performed test in the blood bank.
ABO grouping
Both(?) must be performed on all donors and patients.
ABO forward and reverse grouping tests
Suspension of RBCs in saline solution + solution of known (?)
anti-A antiserum
Suspension of RBCs in saline solution + solution of known (?)
anti-B antiserum
Positive reaction:
Agglutination
Negative reaction:
Absence of agglutination
Front type
Forward grouping
Defined as using known sources of commercial antisera (anti-A, anti-B) to detect antigens on an individuals’ RBCs.
Forward grouping
Back type
Reverse grouping
Defined as detecting ABO antibodies in the patient’s serum by using known reagent RBCs, namely A1 and B cells.
Reverse grouping
Monoclonal antibody Highly specific IgM
Expected 3+ to 4+ reaction
Usually use 1 to 2 drops
Anti-A Reagent
Monoclonal antibody Highly specific IgM
Expected 3+ to 4+ reaction
Usually use 1 to 2 drops
Anti-B Reagent
Human Source 4-5%
Red cell suspension Expected 2+ to 4+ reaction
Usually use 1 drop
Reagent A1 and B cells
Blood group O Anti-A
0
Blood group O Anti-B
0
Blood group O Antigen(s) on RBCs
No A or B Antigen
Blood group O A1 cells
4+
Blood group O B cells
4+
Blood group O Antibody(ies) in serum
A & B
Blood group A Anti-A
4+
Blood group A Anti-B
0
Blood group A Antigen(s) on RBCs
A
Blood group A A1 cells
0
Blood group A B cells
2+
Blood group A Antibody(ies) in serum
B
Blood group B Anti-A
0
Blood group B Anti-B
4+
Blood group B Antigen(s) on RBCs
B
Blood group B A1 cells
3+
Blood group B B cells
0
Blood group B Antibody(ies) in serum
A
Blood group AB Anti-A
3+
Blood group AB Anti-B
3+
Blood group AB Antigen(s) on RBCs
A & B
Blood group AB A1 cells
0
Blood group AB B cells
0
Blood group AB Antibody(ies) in serum
No A & B antibodies
In routine transfusion practices, donor products (?) with identical ABO phenotypes are usually available to the recipient.
RBCs and plasma
This transfusion selection is referred to as providing (?) blood for the intended recipient.
ABOidentical (ABO group–specific)
In situations where blood of identical ABO phenotype is unavailable, (?) blood may be issued to the
recipient.
ABO- compatible (ABO group–compatible)
For RBC transfusions, ABO compatibility between the recipient and the donor is defined as the (?) between the ABO antibodies present in the recipient’s serum and the ABO antigens expressed on the donor’s red cells.
serologic compatibility
When whole blood is transfused, (?) must be provided because both plasma and red cells are present in the product.
ABO-identical donor units
When plasma products are transfused, the selection of an (?) is the ideal situation.
ABO- identical phenotype
When identical ABO phenotypes are unavailable, the rationale for compatible plasma transfusions is the ?.
reverse of RBC transfusions
Persons with group O red cells are called (?) because the RBC product lacks both A and B antigens and could be transfused to any ABO phenotype.
universal donors
(?)can be used in times of urgency for emergency release of donor units.
Group O donor RBCs
? are considered universal recipients because these individuals lack circulating ABO antibodies and can receive RBCs of any ABO phenotype.
Group AB recipients
Universal donor for RBC transfusions is ?
group O
universal donor for plasma transfusions is ?
group AB
Universal recipient for RBC transfusions is ?
group AB
universal recipient for plasma transfusions is ?
group O
Group A Whole Blood
Group A
Group A Red Blood Cells
A, O
Group A Plasma
A, AB
Group B Whole Blood
B
Group B Red Blood Cells
B, O
Group B Plasma
B, AB
Group AB Whole Blood
AB
Group AB Red Blood Cells
AB, A , B , O
Group AB Plasma
AB
Group O Whole Blood
O
Group O Red Blood Cells
O
Group O Plasma
O , A , B , AB
